Citation Nr: 21065654 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 11-03 634 DATE: October 27, 2021 REMANDED Entitlement to service connection for a left knee disability, to include arthritis, is remanded. Entitlement to service connection for a left ankle disability, to include arthritis, is remanded. REASONS FOR REMAND The Veteran had active service from June 1974 to October 1974 and from November 1974 to August 1979. 1. Entitlement to service connection for a left knee disability, to include arthritis, is remanded. VA clinical documentation dated in October 2017 states that the Veteran underwent a left total knee replacement in 2009. The report of a June 2021 knee examination conducted for VA indicates that the Veteran exhibited a "normal physical exam to left knee." The examining nurse practitioner commented that he was "unable to confirm a current chronic diagnosis with current available records and/or today's exam" and "therefore, no nexus or plausible secondary relationship is established." As the examiner did not note that the Veteran has a left total knee replacement, the Board of Veterans' Appeals (Board) finds that the examination report is of essential no probative value. When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Therefore, further VA knee examination is needed. Clinical documentation dated after July 2021 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to service connection for a left ankle disability, to include arthritis, is remanded. VA clinical documentation dated in April 2017 states that the Veteran underwent a left total ankle replacement in 2017. The report of a June 2021 ankle examination conducted for VA indicates that the Veteran exhibited a "physical exam normal" and "there is no chronic ankle condition." The examining nurse practitioner commented that he was "unable to confirm a current chronic diagnosis with current available records and/or today's exam" and "therefore, no nexus or plausible secondary relationship is established." As the examiner did not note that the Veteran has a left total ankle replacement, the Board finds that the examination report is of essential no probative value. Therefore, further VA ankle examination is needed. Accordingly, these matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated any left knee and left ankle disabilities. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain any VA treatment records not of record, to include those pertaining to treatment after July 2021. 3. Schedule the Veteran for a VA knee examination conducted by a medical doctor to assist in determining the nature and etiology of any identified left knee disabilities and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all left knee disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified left knee disability had its onset during active service or is causally related to any incident of service, including the documented left knee injury. (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified left knee disability is due to or caused by the right total knee arthroplasty residuals and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any identified left knee disability has been aggravated (increased in severity beyond the natural progress of the disorder) by the right total knee arthroplasty residuals and the other service-connected disabilities. 4. Schedule the Veteran for a VA ankle examination conducted by a medical doctor to assist in determining the nature and etiology of any identified left ankle disabilities and any relationship to active service. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all left ankle disabilities found. (b) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified left ankle disability had its onset during active service or is causally related to any incident of service. (Continued on the next page) (c) Opine whether it is at least as likely as not (50 percent probability or greater) that any identified left ankle disability is due to or caused by the right total knee arthroplasty residuals and the other service-connected disabilities. (d) Opine whether it at least as likely as not (50 percent probability or greater) that any identified left knee disability has been aggravated (increased in severity beyond the natural progress of the disorder) by the right total knee arthroplasty residuals and the other service-connected disabilities. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Marsdale 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.