Citation Nr: 21064214 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-33 446 DATE: October 19, 2021 REMANDED Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a right ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from May 1979 to May 1983 and from October 1986 to October 1989. In May 2020, the Board remanded the above issues for additional development. The case has since returned to the Board for appellate review. 1. Entitlement to service connection for a right ankle disability is remanded. The Veteran contends he is entitled to service connection for his right ankle condition. The Veteran asserts that he injured his ankle in service, and it has gotten progressively worse, he has continuously sought treatment at the VA Medical Center (VAMC) Houston, and he does not feel that all of his records from VAMC Houston were reviewed. The Veteran was seen twice for his ankle injury during his first period of active duty. Notably, an October 1982 service treatment record reflects that the Veteran was seen for follow up treatment four days after his "right ankle traumatic injury" and was given a profile for no running or jumping. As to a diagnosis, in May 2020, the Board remanded the Veteran's service connection claim for a right ankle disability in part to identify any disabilities to the right ankle that the Veteran has had at any time since January 2015 to include any degenerative joint disease or other functional impairment of earning capacity. In December 2020, the VA examiner noted that the Veteran's service treatment records (STRs) are positive for a right ankle sprain in 1982. The examiner noted that there was no evidence that the Veteran continued to suffer from an ankle condition throughout the rest of his active duty service or for the first 30 years post separation, as the Veteran did not report problems with his right ankle until 2013. The examiner further noted that there is no evidence in the record of right ankle degenerative joint disease or functional impairment from 2015 until the present time. The Board finds the December 2020 opinion as to a diagnosis inadequate. The Board notes that a March 2015 VAMC Houston treatment record reflects a notation of moderate degenerative joint disease of the left knee and right ankle. In addition, the Board notes that the Veteran's VA treatment records contain ongoing complaints of ankle pains. See, e.g., April 2020 VA primary care telephone liaison note. As to a nexus, in December 2020, the December 2020 VA examiner concluded that the Veteran's right ankle condition was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness. The VA examiner noted that the Veteran's service treatment records note a right ankle sprain in 1982. According to the examiner, most ankle sprains heal within six weeks with just conservative measures, which seems to be the case with this Veteran. There was no evidence that the Veteran continued to suffer from an ankle condition throughout the rest of his active duty service or for the first 30 years following separation, as the Veteran did not report ankle problems until 2013.The examiner also noted that there is no evidence of right ankle degenerative joint disease or function impairment from 2015 until the present time. The Board finds the December 2020 VA opinion inadequate. In determining that the Veteran's right ankle condition was less likely than not (less than 50 percent probability) incurred in or caused by an in-service injury, event, or illness, the examiner, in part, relied on the claim that there was no evidence of right ankle degenerative joint disease or function impairment from 2015 until the present time. However, as noted above, that a March 2015 VAMC Houston treatment record reflects a notation of moderate degenerative joint disease of the left knee and right ankle. Given the above, a remand is necessary to obtain another VA examination and opinion to determine the nature and etiology of the Veteran's right ankle condition. 2. Entitlement to service connection for a left knee disability, to include as secondary to a right ankle disability, is remanded. At the outset, the Board notes that the Veteran has a diagnosis of degenerative arthritis in the bilateral knees. See October 2019 VA examination. As the Veteran contends his left knee condition is secondary to his right ankle condition, the Veteran's left knee claim must be remanded as well. Stegall, 11 Vet. App. at 271. Moreover, the Board notes that, in terms of a nexus as to whether the Veteran's left knee condition is secondary to his right ankle sprain, the December 2020 VA examiner noted that the Veteran's left knee condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner reasoned that there is no clear evidence from a review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb (including aggravation) unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis, or shortening of the injured limb resulting in length discrepancy of more than 5cm so that the individual's gait pattern has been altered to the extent that, clinically, there is an obvious Trendelenburg gait. This level of severity is not supported based on record review, history or exam. The examiner noted that it is not unusual for two joints to share properties in the same person, but one joint's disease does not "spread" to another or cause damage to it. Therefore the left knee condition has not been aggravated by right ankle condition. The Board finds the December 2020 opinion inadequate, as the examiner did not discuss whether the Veteran's left knee disability was at least as likely as not proximately due to or aggravated, i.e., worsened beyond its natural progression, by his right ankle condition. Therefore, on remand, another opinion is needed to determine the etiology of the Veteran's left knee condition. The matters are REMANDED for the following action: 1. Contact the Veteran and ask him to identify any outstanding treatment records for his right ankle or left knee. Obtain any outstanding VA treatment records. If the Veteran identifies any private treatment records, provide him with an authorization form for the release of private records and obtain any records for which he provides authorization. 2. RIGHT ANKLE: Schedule the Veteran for a VA examination for his right ankle condition. The examiner must review the claims file. The examiner should identify any disabilities of the right ankle that the Veteran has had at any time since January 2015, to include any degenerative joint disease or other functional impairment of earning capacity, that is identified. The examiner is requested to discuss the March 2015 VAMC Houston treatment record that reflects a notation of moderate degenerative joint disease of the left knee and right ankle. Additionally, if a diagnosis cannot be provided the examiner should determine whether the Veteran's ankle condition manifests in symptoms that cause functional impairment, and the examiner should consider that a "disability" for the purpose of providing the requested opinion(s) below. For each identified right ankle condition since January 2015, the examiner is asked to provide a response to the following: a. Is the right ankle condition at least as likely as not related to service, including his right ankle injury noted in his STRs in October 1982, Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. 2. LEFT KNEE: Obtain a VA opinion for his left knee condition. The examiner must review the claims file. The examiner should identify all left knee conditions present. If a diagnosis cannot be provided but the Veteran's left knee condition manifests in symptoms that cause functional impairment, the examiner should consider that "disability" for the purpose of providing the requested opinion(s) below. For each diagnosed left knee condition, to include degenerative arthritis, the examiner is asked to provide a response to the following: b. Is the left knee condition at least as likely as not proximately due to the Veteran's right ankle condition. c. Is the left knee condition at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the Veteran's right ankle condition. Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. 3. Then, readjudicate the claims. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. E. Grossman, 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.