Citation Nr: 21003302 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 15-35 112A DATE: January 21, 2021 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1980 to May 1982. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office. In September 2017, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. In August 2018, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) for development. In August 2020, it was remanded for an addendum opinion. The AOJ obtained a November 2020 examination and opinion, but the Board finds remand is necessary as the opinions expressed by the examiner do not adequately address the concerns identified by the Board and the Veteran. Pursuant to the remand, the November 2020 examiner reviewed the Veteran’s claims file and medical records, and conducted an in-person examination, determining his chronic right knee strain manifested in 2019. As requested, the examiner explained that the July 2012 VA examination reference to right knee chondromalacia was erroneous, as it was based on imaging performed for the left knee with no correlating right knee images in the Veteran’s record. The November 2020 examiner considered the Veteran’s contention that in-service overuse and sports activities caused the right knee disability, but noted that there was nothing to back up the claim as right knee symptoms were not noted until 30 years after service. Notably, the Veteran’s service-connected right ankle disability resulted from a well documented 1981 football injury and illustrates activity in sports during service. The examiner did not provide medical rationale for the nature and etiology of the right knee disability but instead summarily relied absence of evidentiary records for a knee disability. Thus, the examiner did not adequately address the Board’s concerns nor discuss the Veteran's reports as to his history. The November 2020 examiner also provided an opinion on whether the right knee disability was proximately due to or caused by the Veteran’s right ankle disability. According to the examiner, there was not a way to determine with at least 50 percent probability that the Veteran's right knee condition did not develop simply as a manifestation of his age. Of note, the November 2020 examiner acknowledged the Veteran was recently service connected for a left knee disability, reporting that the right ankle disability led to antalgic gait and regular use of a cane because stress was placed on the left joint. However, aside from the general age-related statement, the examiner did not consider whether gait issues resulted from the comorbid left knee disability, which is, arguably, now raised by the record. A claim for a disability includes any disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and other information of record. See Clemons v. Shinseki, 23 Vet. App. 1, 5-6 (2009). The March 2020 rating decision reflects that the Veteran was service-connected for the left hip, ankle, radiculopathy and back, secondary to his right ankle disability, and the impact of these service-connected musculoskeletal conditions should be considered upon remand. In light of the above, the Board cannot make a fully-informed decision on the issue of entitlement to service connection for a right knee disability because the record does not contain an adequate opinion on whether the Veteran's currently diagnosed right knee strain is etiologically related to his active duty service. The matters are REMANDED for the following action: 1. The AOJ should obtain an addendum opinion from the November 2020 examiner. If the same examiner is not available, the claims file should be forwarded to another examiner. The claims file, including a copy of this REMAND order, should be reviewed and noted as performed in the medical opinion. If, and only if, determined necessary by the examiner, the Veteran should be scheduled for another examination and/or any additional tests the examiner deems necessary. The examiner must set forth a complete rationale for all opinions expressed and conclusions reached. If it is not possible to provide an opinion without resorting to speculation, the examiner must state if the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. Also, if the examiner cannot provide an opinion, the examiner must affirm that all procurable and assembled data was fully considered, and a detailed rationale must be provided for why an opinion cannot be rendered. The examiner is asked to: (a.) Provide an opinion as to whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's diagnosed right knee disability is etiologically related to his active duty service, to include specific consideration of the Veteran’s assertion that the condition is due to overuse and playing sports during service. See e.g. October 2015 VA Form 9. (b.) Provide an opinion as to whether it is at least as likely as not (at least a 50 percent probability) that the right knee disability was proximately due to or caused by the Veteran’s service-connected bilateral ankle, left knee, left hip, back and/or radiculopathy disabilities, giving specific consideration to the Veteran’s assertion that knee pain developed over the years because his right ankle caused gait issues. See e.g. VA Examinations, dated May 20, 2019 and November 4, 2020, and Audie Murphy VA Medical Center treatment record, dated April 22, 2013. (c.) Provide an opinion as to whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's diagnosed right knee disability was aggravated by his service-connected bilateral ankle, left knee, left hip, back and/or radiculopathy disabilities, giving specific consideration to the Veteran’s assertion that his right ankle disability caused an uneven gait, leading to knee pain. See e.g. San Antonio VA Clinic medical treatment record, dated June 15, 2010, and Audie Murphy VA Medical Center treatment record, dated April 22, 2013. Aggravation is a permanent increase in the severity of the disability that is beyond natural progression. If aggravation is found, the examiner must address: (1) the baseline manifestations of the disability prior to aggravation; and (2) the increased manifestations that are proximately due to the service-connected 2. After completion of the above and any additional development deemed necessary, the issues on appeal must be readjudicated. If the claims remain denied, the Veteran and his representative must be provided a Supplemental Statement of the Case and afforded the opportunity to respond. Thereafter, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Gipson, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.