Citation Nr: 21071875 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 18-12 716 DATE: December 1, 2021 REMANDED Entitlement to service connection for a lumbar spine disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1987 to September 2007. On appeal is a June 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) that, as relevant here, denied service connection for a lumbar disability, left knee disability, right knee disability, left ankle disability, and right ankle disability. This matter was previously before the Board of Veterans' Appeals (Board) in May 2020 and July 2021, when the Board remanded for further development. The matter has now returned to the Board for appellate review. 1. Entitlement to service connection for a lumbar spine disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. 4. Entitlement to service connection for a left ankle disability is remanded. 5. Entitlement to service connection for a right ankle disability is remanded. The Board regrets any further delay in this matter, but finds additional development is required. When VA undertakes to obtain an examination/opinion, it must ensure that the examination/opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion/examination is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, the Veteran's case has been remanded twice (in May 2020 and July 2021) for medical opinions to assess the nature and etiology of his claimed lumbar spine, bilateral knee, and bilateral ankle disabilities. In the May 2020 Remand, the Board noted the December 2020 VA examinations were inadequate because: (1) the absence of evidence in the service treatment records is an insufficient basis, by itself, for a negative opinion; and (2) the mere passage of time before treatment is an insufficient basis for a negative opinion. In the July 2021 Remand (the most recent), the Board conceded an in-service incurrence due to the nature and time span (20 years) of the Veteran's active duty service and his testimony at a Board hearing in this matter that his in-service duties included going up and down several different decks, working on sonar equipment, carrying heavy tools and physically strenuous duties generally, and his aches and pains began during the latter half of his 20-year active Navy service and have continued to the present day. The Board also gave specific remand directives, stating the examiner must specifically discuss each of the following: (1) the Veteran's conceded in-service duties, including going up and down several different decks, working on sonar equipment, carrying heavy tools and physically strenuous duties generally; (2) private medical records in April 2015 documenting reports of longstanding symptomatology of the knees, ankles and low back, including pain and swelling; (3) the VA knee treatment note of February 2013 indicating a knee pain history spanning at least five years; and (4) the Veteran's competent and credible March 2020 testimony specifically describing how his knee, ankle, and back pain began during his service and how those same symptoms have persisted from his time in service to the present. New medical opinions were obtained in August 2021. However, none of the medical opinions addressed the conceded in-service incurrence; the private treatment records documenting reports of longstanding symptomatology of the knees, ankles and low back; or the Veteran's testimony regarding pain and continuity of symptomatology since service. Instead, the examiner appeared to focus on the Veteran's post-service employment, reasoning essentially that his back, knee, and ankle disorders stem not from his many years in service but instead from the physical demands of his work as an electrician and his post-service exercise routine and participation on a softball league. A remand by the Board confers on the claimant a legal right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268, 271 (1998). A failure by the Board to ensure that its remand orders are complied with constitutes legal error. Id. On remand, new medical opinions that address all of the Board's remand directives must be obtained. The matters are REMANDED for the following action: Obtain an addendum opinion from a qualified examiner other than the examiner who provided the August 2021 opinions regarding the etiology of the Veteran's bilateral knee, bilateral ankle, and lumbar spine disorders. If the examiner determines the Veteran should be given another examination (including via telehealth if an in-person examination is not possible) to answer the below questions, one should be scheduled. The examiner is asked to provide a thorough, well-reasoned opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's lumbar spine, bilateral knee, and bilateral ankle disorders: had onset in service, within one year of service separation, or are otherwise related to active service. In rendering this decision, the examiner must specifically discuss each of the following: (a) The Veteran's conceded in-service duties during his 20 years of active duty, including going up and down several different decks, working on sonar equipment, carrying heavy tools, and physically strenuous duties generally. (b) The private medical records in April 2015 documenting reports of longstanding symptomatology of the knees, ankles and low back, including pain and swelling. (c) The VA knee treatment note of February 2013 indicating a knee pain history spanning at least five years. (d) The Veteran's competent and credible March 2020 testimony specifically describing how his knee, ankle, and back pain began during his service and how those same symptoms have persisted from his time in service to the present. A complete rationale for all opinions must be provided. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Jiggetts, Tenisha 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.