Citation Nr: 21063346 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-50 406A DATE: October 14, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to September 1978. The Veteran attended a hearing before the undersigned Veterans Law Judge in July 2021. A transcript of the hearing is of record. 1. Entitlement to service connection for a left knee disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. 2. Entitlement to service connection for a left hip disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. 3. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected degenerative disc disease of the lumbar spine, is remanded. The Veteran contends that his left knee, left hip, and left ankle conditions were caused or aggravated by his service-connected disabilities, including his lumbar spine disability. The Veteran had examinations for his claimed left knee, left hip, and left ankle disabilities in August 2015. The examiner opined that the Veteran's claimed left knee, left hip, and left ankle disabilities were more likely due to a direct overuse rather than a result of his back condition. The Board finds the August 2015 opinion to be inadequate. The examiner did not address whether the Veteran's service-connected disabilities aggravated his claimed left knee, left hip, and left ankle disabilities. An opinion that something "is not related to" or "is not due to" does not answer the question of aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Accordingly, remand is appropriate to obtain an additional VA medical examination regarding the etiology of the Veteran's claimed left knee, left hip, and left ankle disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination from a qualified VA medical professional to determine the nature and etiology of any current left knee disability. Any necessary diagnostic tests should be conducted, and a full history of all left knee disability symptoms should be obtained. The examination should include a full neurological work up of the lower extremities. Following a review of the entire record, the examiner should address the following: a) Notwithstanding the above, is it at least as likely as not (i.e., a 50 percent or greater probability) that a left knee disability was caused by the Veteran's service-connected disabilities, to include his service-connected low back disability? b) Notwithstanding the above, is it at least as likely as not (50 percent or greater probability) that a left knee disability is aggravated by the Veteran's service-connected disabilities, to include his service-connected low back disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 2. Schedule the Veteran for a VA examination from a qualified VA medical professional to determine the nature and etiology of any current left hip disability. Any necessary diagnostic tests should be conducted, and a full history of all left hip disability symptoms should be obtained. The examination should include a full neurological work up of the lower extremities. Following a review of the entire record, the examiner should address the following: a) Is it at least as likely as not (i.e., a 50 percent or greater probability) that a left hip disability was caused by the Veteran's service-connected disabilities, to include his service-connected low back disability? b) Notwithstanding the above, is it at least as likely as not (50 percent or greater probability) that a left hip disability is aggravated by the Veteran's service-connected disabilities, to include his service-connected low back disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 3. Schedule the Veteran for a VA examination from a qualified VA medical professional to determine the nature and etiology of any current left ankle disability. Any necessary diagnostic tests should be conducted, and a full history of all left ankle disability symptoms should be obtained. The examination should include a full neurological work up of the lower extremities. Following a review of the entire record, the examiner should address the following: a) Is it at least as likely as not (i.e., a 50 percent or greater probability) that a left ankle disability was caused by the Veteran's service-connected disabilities, to include his service-connected low back disability? b) Notwithstanding the above, is it at least as likely as not (50 percent or greater probability) that a left ankle disability is aggravated by the Veteran's service-connected disabilities, to include his service-connected low back disability? Note that aggravation means any incremental increase in disability in non-service-connected disabilities (i.e., any additional impairment of earning capacity) resulting from service-connected conditions. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board David M. Sebstead, 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.