Citation Nr: 21068769 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 17-53 415 DATE: November 12, 2021 REMANDED Entitlement to service connection for a lumbosacral or cervical spine disorder, to include as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a right shoulder disorder, to include as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a right wrist disorder, to include as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a right ankle disorder, to include as secondary to service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran serviced on active duty in the United States Army from January 1988 to December 1989. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision by an agency of original jurisdiction (AOJ) of the United States Department of Veterans Affairs (VA). In an April 2019 decision, the Board reopened previously denied claims of service connection for a cervical spine disorder, a right wrist disorder, and a right ankle disorder due to new and material evidence. The Board denied the Veteran's claims for entitlement to secondary service-connection for a cervical spine disorder, a right shoulder disorder, a right wrist disorder, and a right ankle disorder. The Veteran appealed the case to the Court of Appeals for Veterans Claims (Court). In a September 2020, the parties agreed to a joint motion for partial remand (JMPR). The Court vacated the portion of the Board's decision denying these claims and remanded the matters to the Board for action consistent with the JMPR. The matters were remanded because the parties agreed that June 2017 VA medical opinions were inadequate for rating purposes because they were not supported by adequate rationales. In January 2021, the Board remanded the matters for additional development, including to obtain missing medical records and additional VA exams. In April 2021, the Veteran was afforded VA medical exams. In July 2021, the Board again remanded the matters because the April 2021 medical opinions did not provide an explanation to support the conclusions that the Veteran's disorders were not secondary to a service-connected right knee disability. In August 2021, the Veteran was afforded additional VA medical exams. Unfortunately, further remand of the issues is warranted as the August 2021 opinions are inadequate for adjudication purposes; the examiner does not adequately address whether the Veteran's disabilities were caused by his service-connected right knee disorder and because the opinion did not comply with the Board's prior remand instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998). In its July 2021 remand, the Board asked the examiner to comment on "(i) the January 2019 MRI of the right knee which showed changes of Osgood-Schlatter disease, mild patellar chondrosis, and no evidence for an anterior cruciate ligament tear, and ligaments intact on all planes; (ii) the discussion of the MRI by the Veteran's physician who noted that the ligaments were intact but that chondromalacia of the patella and lateral facet of the trochlea were noted and discussed wearing the brace to decrease episodes of instability and continue to strengthen muscles surrounding the knee; and (iii) the April 2012 medical opinion which noted that the origins of the Veteran's cervical spine, right shoulder, right wrist, and right ankle issues could be described adequately and completely as being mostly attributable to age, wear and tear, clumsiness, or sheer accident, without adding any knee issues and that that the right knee weakness which would necessarily be present to induce all of the precipitating events was simply not supported by the most recent MRI evidence." In August 2021, the Veteran was afforded additional VA examinations for his cervical spine disorder, a right shoulder disorder, a right wrist disorder, and a right ankle disorder. The examiner reported that a right knee x-ray taken in 1998 showed the Veteran's was "normal" and that other factors could have contributed to the Veteran's falls. The examiner also opined that degenerative disc disease is age related. The examiner failed to address the Veteran's MRI from January 2019, as directed by the Board. The Board finds the August 2021 examinations for cervical spine disorder, right shoulder disorder, right wrist disorder, and right ankle disorder are inadequate for adjudication purposes because the examiner did not sufficiently address whether the Veterans conditions were caused by instability of his right knee. The Veteran is service connected for instability of the right knee and falls due to such are to be presumed. As such, a new opinion by a new examiner must opine as to whether it is at least as likely as not that such falls caused, contributed to, or aggravated any current disability of the cervical spine, right shoulder, right wrist, and right ankle. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a new examiner. The entire claims file and a copy of this remand must be reviewed in conjunction with the opinion. The need for a new physical examination is at the discretion of the reviewer. The VA examiner must opine as to whether it is at least as likely as not that falls due to Veteran's right knee instability caused, contributed to, or aggravated any current disability of the cervical spine, right shoulder, right wrist, and right ankle. A full and complete rationale for all opinions expressed is required. 2. Then, readjudicate the remanded issue. If any benefit sought remains denied, issue a supplemental statement of the case. After appropriate time for a response, the case should then be returned to the Board for appellate review if otherwise in order. WILLIAM H. DONNELLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lauren Barletta 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.