Citation Nr: 21004505 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 13-29 434 DATE: January 27, 2021 REMANDED The claim for entitlement to service connection for a left hip subtrochanteric bursitis is remanded. The claim for entitlement to service connection for a left knee disability is remanded. The claim for entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1978 to November 1984. The Veteran appeals the denial of service connection for a left hip, left knee and right hip disability. The Veteran is service-connected for a left ankle and lumbar spine disability. The Veteran contends her current left hip and bilateral knee conditions are related to her service-connected disability. She contends these conditions are related to an altered gait resulting from her left ankle disability. In relation to this claim, the Veteran was last afforded a VA examination in October 2020. The VA examiner opined that the claimed conditions were less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service-connected condition. In doing so, the examiner reasoned in part that the conditions were not related in any way and there is no medical or claims file documentation to support a causal connection. With regard to the right knee, the VA examiner specifically addressed the Veteran’s argument that her conditions are related to an altered gait resulting from her left ankle disability. The examiner, however, did not address the Veteran’s argument when discussing the left hip and/or left knee. The Board notes, however, that a January 2018 outpatient treatment evaluation shows that the Veteran presented with gait deviations that included “increased pain and difficulty maintaining B knee extension with heel walking and toe walking.” Also, in the article submitted by the Veteran titled the Long Term Effects of Ankle Sprains, it was noted that in the long run ankle sprains can cause chronic stiffness and that the loss of range in the ankle can have a domino effect such that normal walking can be compromised, and muscles higher in the leg and pelvis lose efficiency and strength. It was further noted that it can lead to other problems such as lower back pain and hip bursitis. The Board is still is unclear as to whether the Veteran’s left knee and/or left hip conditions are related to an altered gait resulting from her service-connected left ankle disability. As a well-reasoned opinion on this matter still has not been obtained, another remand is warranted. Furthermore, with regard to aggravation, the VA examiner noted that “there is no medical literature to even begin to causally connect these conditions and, as such, there is insufficient medical evidence to comment on the non-existent aggravation.” The Board notes that the VA examiner ultimately did not render an opinion on aggravation as he found that there was no causal connection but the Veteran has submitted some medical literature speaking to ankle problems which may compromise other musculoskeletal problems. The Board is still is unclear as to whether the Veteran’s left knee and left hip conditions are related to an altered gait resulting from her service-connected left ankle disability. The Board also notes that a well-reasoned opinion has not been obtained regarding whether the Veteran’s left hip, left knee and/or right knee conditions were aggravated beyond its normal progression by the service-connected left ankle and/or low back disabilities. A Court or Board remand confers upon the Appellant the right to compliance with that order. Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, the Board finds that an addendum opinion is needed on this matter. The matters are REMANDED for the following action: 1. Obtain a VA addendum opinion to determine the nature and etiology of the Veteran’s left hip, left knee and right knee disability. If, after review of the electronic file, the examiner determines that another VA examination is necessary, such must be scheduled and the Veteran must be notified. After examination and review of the record the examiner must opine as to whether it is at least as likely as not (50 percent or greater possibility) that any diagnosed left hip, left knee and/or right knee condition was caused or aggravated (a medically discernible increase in symptoms even if temporary) by the service-connected left ankle and/or low back disabilities. The examiner must specifically address the Veteran’s claim that her conditions are related to an altered gait resulting from her service-connected left ankle disability. In providing any opinions, the examiner should also consider: • a March 2005 private medical record which included the examiner’s impression of being at a loss to explain hip discomfort with examination reflecting painful motion and x-ray examination interpreted as showing evidence of some spur formation; • the significance of the June 2011 VA examination report reflecting findings of tenderness and abnormal motion of the left hip, left knee and right knee; • x-ray examination interpreted as showing chronic trochanteric bursitis of the left hip and early degenerative joint disease, mild osteoarthritic changes of the right and left patellofemoral joints; and diagnoses of trochanteric bursitis of the left hip and degenerative joint disease of the knees; • the September 2016 private orthopedic evaluation report; • the Veteran’s testimony at the August 2016 Board hearing; • A January 2018 outpatient treatment evaluation showing that the Veteran presented with gait deviations that included “increased pain and difficulty maintaining B knee extension with heel walking and toe walking;” and • the article, Long Term Effects of Ankle Sprains, which notes that in the long run ankle sprains can cause chronic stiffness and that the loss of range in the ankle can have a domino effect such that normal walking can be compromised, and muscles higher in the leg and pelvis lose efficiency and strength The VA examiner should provide a complete rationale for any opinions provided. The examiner must reconcile any opinion with the service treatment and personnel records, any post-service diagnoses, lay statements and testimony of the Veteran. 2. Thereafter, readjudicate the remanded issues. If any benefit sought on appeal remains denied, the Veteran and her representative should be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T.S. Willie 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.