Citation Nr: 21004650 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 16-34 197 DATE: January 27, 2021 REMANDED Entitlement to service connection for a right knee disability, to include rheumatoid arthritis with degenerative joint disease, is remanded. Entitlement to service connection for a left ankle condition is remanded. Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a right ankle condition is remanded. Entitlement to service connection for a left foot condition is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a right knee disability, to include rheumatoid arthritis with degenerative joint disease, is remanded. 2. Entitlement to service connection for a left ankle condition is remanded. 3. Entitlement to service connection for a left knee condition is remanded. 4. Entitlement to service connection for a right ankle condition is remanded. 5. Entitlement to service connection for a left foot condition is remanded. The Board previously remanded these claims in February 2020 for medical examinations to be conducted by VA, and medical opinions to be provided regarding the Veteran’s several claims for service connection. The examiner was directed to provide opinions regarding both direct and secondary theories of service connection. A review of the evidence of record shows that medical examinations were conducted. However, the opinions provided by the examiner are inadequate, and further remand is necessary. Specifically, the Board instructed that the VA examiner should consider the Veteran’s in-service complaints of ankle, foot, knee and thigh pain in August 1983, September 1983, January 1984, June 1984, October 1985, November 1990, and March 1991. The examiner’s several reports stated that the medical record did not show any complaints or treatment for the Veteran’s ankles, feet, and knees during service. The Board disagrees, and it again observes the Veteran’s in-service complaints of pain listed above. Because the examiner’s conclusions are based on deficient understanding of the Veteran’s medical records, the Board finds the resulting opinions are inadequate. Additionally, the Board directed that the examiner should assess the Veteran’s right knee rheumatoid arthritis. However, the examiner’s reports did not address rheumatoid arthritis except to briefly observe that the Veteran’s rheumatoid arthritis condition arose “since discharge.” The examiner’s use of the phrase “since discharge” without further explanation has unfortunately created confusion regarding the etiology of Veteran’s condition. In context, the examiner’s use of this phrase seems intended to mean that the Veteran’s condition arose after service. This is shown by the remainder of the opinion, which concluded that the Veteran’s arthritis was not likely due to her service because it arose “since discharge.” However, taken on its face, the plain meaning of the examiner’s statement is unclear, since it potentially implies that the Veteran has had such a rheumatoid condition during her military service, or at the time of her discharge from service. The See July 2020 C&P Examination. For this additional reason, as well as because the opinion did not consider the Veteran’s in-service complaints as discussed above, the examiner’s opinion regarding right knee rheumatoid arthritis is inadequate. Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 2 Vet. App. 303, 311-12 (2007). Accordingly, further examination is necessary before the Board may render a decision. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination (or a telehealth interview, a review of the record, or other appropriate substitute for an in-person examination, if deemed sufficient in the event that an in-person examination is not feasible) to determine the nature and etiology of any right knee, left knee, right ankle, and left foot conditions. The examiner should opine whether each disability is at least as likely as not (50 percent or greater probability) (a) incurred in, caused by, or otherwise related to active service, to include a November 1990 incident where a cabinet fell on top of the Veteran’s foot; (b) proximately caused by service-connected fracture of the distal fibular sesamoid of the right foot; and /or (c) aggravated by service-connected fracture of the distal fibular sesamoid of the right foot. The examiner is instructed that it is insufficient to opine that the Veteran’s service treatment records do not show complaints or treatment for lower limb injuries. The Board directs the examiner’s attention to the November 1990 incident in which a cabinet fell on the Veteran’s right foot. The examiner’s attention is also invited to records of injuries and follow-up in August 1983, September 1983, January 1984, June 1984, October 1985, and March 1991. The examiner should directly address the Veteran’s rheumatoid arthritis condition, including a discussion of whether the Veteran’s rheumatoid arthritis of any claimed joint has been caused or aggravated by her service-connected foot disability. The examiner’s opinion should address the Veteran’s contentions that she has experienced numerous falls due to her service-connected fracture of the right foot, and has broken her ankle after service as a result of the instability of her foot and her resulting altered gait. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Hermsdorfer, 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.