Citation Nr: A21016851 Decision Date: 10/18/21 Archive Date: 10/18/21 DOCKET NO. 210511-159442 DATE: October 18, 2021 REMANDED Entitlement to service connection for left ankle arthritis, to include as secondary to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 1971 to June 1971. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2021 Appeals Modernization Act (AMA) rating decision that considered the evidence of record on that date. The Veteran timely appealed this decision to the Board by requesting the AMA direct review lane for a reevaluation of the evidence considered by the Agency of Original Jurisdiction (AOJ). As this is a direct review appeal under the AMA, the record closed on the date of the Veteran's March 2021 rating decision. Entitlement to service connection for left ankle arthritis, to include as secondary to service-connected disabilities is remanded. Under the AMA, the Board is responsible for identifying duty to assist errors that were made by the AOJ, prior to the rating decision on appeal. 38 C.F.R. § 3.159(c). Once identified, the Board must remand to the AOJ to correct pre-decisional duty to assist errors. 38 C.F.R. § 20.802(a). The Board finds that the March 2021 VA opinion is inadequate. The Veteran has claimed that a gait imbalance caused by service-connected disability has caused or aggravated a left ankle disability. The 2021 examiner opined that it is less likely than not that the Veteran's left ankle disability is proximately due to his service-connected disabilities. The examiner reasoned that "there was no medical literature that supports degenerative arthritis of one joint causing degenerative arthritis of another joint." The examiner's rationale was conclusory and provided no further explanation. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, reliance solely on medical literature without discussing the Veteran specific facts renders an opinion inadequate. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018). Lastly, the examiner also failed to provide a secondary service connection opinion as to aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013) (an opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation). The Board finds that the inadequacy of the March 2021 examination, which was obtained prior to the AOJ decision on appeal, constitutes a pre-decisional duty to assist error. 38 C.F.R. § 20.802(a). Accordingly, remand for a new examination and etiological opinion is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his left ankle disability. The examiner should review the claims folder, and then opine whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's left ankle disability is 1) caused by the service-connected disabilities, or 3) aggravated by the service-connected disabilities (e.g., a worsening of left ankle symptoms beyond those expected by the baseline level of disability, even if temporary). The Board notes that the term "aggravation" requires that a service-connected disability condition cause a "functional increase in the severity" of the nonservice-connected disability. Garner v. Tran, 33 Vet. App. 241 (2021). The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinion. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Adeleke, T. 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.