Citation Nr: 21066809 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 16-01 263 DATE: November 2, 2021 REMANDED Entitlement to service connection for a left knee disability, as secondary to service-connected left ankle disability, is remanded REASONS FOR REMAND The Veteran served on active duty from July 1982 to February 1992, followed by periods of service in the Army National Guard. This matter is before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) that, inter alia, denied entitlement to service connection for left knee and right knee disabilities. In December 2018, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. In April 2019, the claims were remanded by the Board to the agency of original jurisdiction (AOJ) for further development. After accomplishing the above, the AOJ continued to deny the Veteran's claims (as reflected in a January 2021 supplemental statement of the case (SSOC)). In April 2021, the claims were remanded by the Board to the AOJ for further development. After accomplishing the above, the AOJ granted service connection for the Veteran's right knee disability (as reflected in a July 2021 rating decision), but denied service connection for his left knee disability (as reflected in a July 2021 SSOC). As the RO's grant of service connection for his right knee disability represents a full grant of that benefit sought on appeal, that issue is no longer before the Board. Unfortunately, the Veteran's claim must be remanded again. In the April 2021 remand, the AOJ was directed to obtain VA medical opinion regarding whether the Veteran's left knee disability was caused or aggravated by his service-connected left ankle disability. Pursuant to the Board remand, the Veteran underwent a VA knee examination in July 2021. The examiner opined that the Veteran's left knee disability was neither caused nor aggravated by his service-connected left ankle disability. As rationale for causation, she stated that the available medical literature did not clearly evidence that "an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless injury to 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 individuals gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait." As rationale for aggravation, the examiner stated that there is no evidence to support a finding that the left knee disability occurred after his left ankle disability. However, the Board finds that the examiner's opinion is flawed as she neglected to discuss the specific facts relevant to the Veteran's claims and relied only on the absence of medical literature showing a positive connection. Notably, in its remand, the Board instructed the examiner to consider the Veteran's testimony at the December 2018 Board hearing indicating a relationship between his left knee and left ankle disabilities. As a result, this opinion is inadequate. Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018) (reliance on the absence of medical literature supporting nexus without discussing the specific facts of the case renders an opinion inadequate). Thus, the Board finds that VA addendum opinion should be obtained with complete rationale as to whether the Veteran's left knee disability was caused or aggravated by his service-connected left ankle disability. The matter is REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate medical professional to obtain addendum opinion regarding the etiology of his left knee disability, on a secondary basis. The Veteran's entire electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. Following the review of the claims file, the medical opinion provider is then requested to respond to the following: (a) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left knee disability is proximately due to or caused by his service-connected left ankle disability? (b) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left knee disability has been aggravated (made worse beyond its natural progression) by his service-connected left ankle disability? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. In formulating his or her opinion, the examiner must consider the Veteran's December 2018 Board hearing testimony. The Veteran testified that his service-connected left ankle disability causes him gait issues, thereby causing and/or aggravating his current left knee condition. If the requested opinions cannot be provided without a new examination, one should be scheduled. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.