Citation Nr: 21003471 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 10-47 682 DATE: January 21, 2021 REMANDED Entitlement to service connection for a right knee/leg disability is remanded. INTRODUCTION The Veteran served on active duty from April 1953 to February 1958. He died in March 2016; the Appellant is his surviving spouse and has been substituted as the claimant in these matters. In June 2018, the Appellant testified at a hearing before the undersigned Veterans Law Judge. A transcript of this hearing has been associated with the claims file. When this case was before the Board in August 2018 and May 2019, the above-noted claim was remanded for additional development. The case has since been returned for additional appellate review. REASONS FOR REMAND While further delay of this appeal is quite regrettable, the Board finds additional development is yet again required before the Veteran’s remaining claim is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). To be considered adequate, medical examination reports must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Additionally, an opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Further, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Following the above-noted May 2019 remand, the RO obtained a VA medical opinion addressing the Veteran’s right knee/leg disability in November 2020. In sum, the examiner found the Veteran’s right knee osteoarthritis was neither incurred in service, caused by his service-connected bilateral foot disability, or aggravated by his service-connected bilateral foot disability. In support of these conclusions, the examiner indicated he found no notation of a knee condition during the Veteran’s period of active duty. However, the Veteran’s service treatment records do indeed show a right leg injury occurred in service, with resulting severe bruise in April 1954. Further, the Appellant provided testimony in June 2018 indicating the Veteran reported his leg injury occurred while he was loading the back of a truck. The Veteran stated he slipped on ice and got hung up on the steps by his leg. The Veteran notified the Appellant that he had experienced ongoing knee pain since that time. The November 2020 VA examiner wholly failed to acknowledge or discuss these pertinent facts. The November 2020 VA examiner also found no objective evidence to suggest the Veteran developed right knee osteoarthritis as a result of his service-connected bilateral foot disability. The examiner failed to explain how or why he came to this conclusion. Further, the examiner appears to have ignored the Appellant’s reports of increased knee pain following prolonged periods of standing. Additionally, the November 2020 examiner explained the evidence failed to establish a “permanent worsening” of the Veteran’s osteoarthritis as a result of his bilateral foot disability. Unfortunately, the examiner employed the incorrect legal standard. In Ward v. Wilkie, the United States Court of Appeals for Veterans Claims held that, for secondary service connection, “aggravation” need not be permanent in nature. 31 Vet. App. 233, 241-42 (2019). Based on the foregoing insufficiencies, the Board finds a remand is again required in order to obtain an adequate medical opinion, which substantially complies with the May 2019 remand instructions. Accordingly, these matters are REMANDED for the following actions: Obtain an addendum medical opinion from an Orthopedic specialist with sufficient experience and expertise, who has not previously provided an opinion in this matter, to address the etiology of the Veteran’s claimed right knee/leg disability. All pertinent evidence of record must be made available to and reviewed by the examiner. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether any diagnosed right knee/leg disability at least as likely as not (a 50 percent probability or greater): a) originated during the Veteran’s period of active service or is otherwise etiologically related to his active service. b) was caused by his service-connected bilateral foot pes planus; or c) was worsened to any degree by his service-connected bilateral foot pes planus. The examiner must provide a complete rationale for all proffered opinions. In this respect, the examiner must consider and expressly discuss the Veteran and Appellant’s competent lay statements, as well as the service treatment records indicating a traumatic injury of the right leg occurred in April 1954. The examiner is asked to specifically consider the Veteran’s reports of an injury to his right knee/leg in service, as well as his reports of ongoing pain thereafter. Additionally, the examiner is asked to specifically consider and discuss the Veteran’s reports of increased knee pain after prolonged standing on his pes planus afflicted feet. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Fraser, 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.