Citation Nr: 21076820 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 20-10 935 DATE: December 27, 2021 REMANDED 1. Entitlement to service connection for a kidney condition, to include as secondary to medication prescribed for the service-connected right ankle disability, is remanded. 2. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected right ankle disability, is remanded. 3. Entitlement to a rating in excess of 10 percent for the service-connected residuals of right ankle fracture, with traumatic arthritis, (right ankle disability) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1965 to May 1969. These matters come before the Board of Veterans' Appeals (BVA or Board) on appeal from a January 2019 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for a kidney condition, to include as secondary to medication prescribed for the service-connected right ankle disability, is remanded. The Veteran seeks service connection for a kidney condition as secondary to medication prescribed for his service-connected right ankle disability. The record confirms a diagnosis of chronic renal disease. The Board notes that the January 2019 VA examiner did not clearly address whether the claimed disability is secondary to the medication prescribed for the Veteran's service-connected right ankle disability. Indeed, it does not appear that the examiner reviewed the Veteran's prescribed medications in rendering the opinion, or explain why it follows that the presence of ischemic nephropathy rules out a connection with medication. As such, the Board finds that an addendum opinion is warranted to address the etiology of the Veteran's kidney condition. 2. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected right ankle disability, is remanded. The Veteran seeks service connection for a right knee disability as secondary to his currently service-connected right ankle disability. The record confirms a diagnosis of degenerative arthritis of the right knee. Additionally, at the August 2021 Board hearing, the Veteran testified that his right knee was injured at the same time as his right ankle during service, and that the ankle disability continued to cause problems with his right knee. The Board notes that the January 2019 VA examiner only addressed direct service connection and failed to provide an opinion as to whether the right knee disability is secondary to the service-connected right ankle disability. Given the Veteran's testimony regarding the in-service injury and current symptomatology, it is reasonable to seek an opinion addressing secondary service connection. Thus, the Board finds that an addendum opinion is warranted to determine the etiology of the Veteran's right knee disability. 3. Entitlement to a rating in excess of 10 percent for the service-connected right ankle disability is remanded. At the August 2021 Board hearing, the Veteran testified that his right ankle disability had worsened in severity since his previous VA examination. Specifically, he noted that the stiffness of his right ankle continued to become more severe. Based on the Veteran's testimony at the August 2021 Board hearing, the medical evidence of record, and the fact that his last VA examination related to this condition took place in January 2019, nearly three years ago, the Board finds that he should be afforded a new VA examination to determine the current severity of his service-connected right ankle disability. The matters are REMANDED for the following action: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to his claims. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained. 2. Forward the claims file to an appropriate examiner to obtain an addendum opinion regarding the Veteran's claimed kidney condition. If a new examination is deemed necessary, one should be scheduled. The claims file, and a list of the Veteran's prescribed medications, should be made available to and be reviewed by the examiner. Following a review of the claims file, the examiner should provide the following opinions: a) Whether it is at least as likely as not that the kidney condition was caused by medication prescribed for the service-connected right ankle disability. b) Whether it is at least as likely as not that the kidney condition is aggravated by medication prescribed for the service-connected right ankle disability. If the examiner finds that the Veteran's kidney condition has been aggravated by medication prescribed for the right ankle disability, the examiner should state the baseline level of severity of the kidney condition, established by the earliest available medical evidence, and describe the extent to which the condition was permanently worsened by the Veteran's prescribed medication. The examiner should specifically indicate the reasons and bases for the conclusions expressed. If the examiner is unable to offer the requested opinion, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Forward the claims file to an appropriate examiner to obtain an addendum opinion regarding the Veteran's claimed right knee disability. If a new examination is deemed necessary, one should be scheduled. The claims file should be made available to and be reviewed by the examiner. Following a review of the claims file, the examiner should provide the following opinions: a) Whether it is at least as likely as not that the right knee disability was caused by the service-connected right ankle disability. b) Whether it is at least as likely as not that the right knee disability is aggravated by the service-connected right ankle disability. If the examiner finds that the Veteran's right knee disability has been aggravated by the right ankle disability, the examiner should state the baseline level of severity of the right knee disability, established by the earliest available medical evidence, and describe the extent to which the condition was permanently worsened by the Veteran's right ankle. The examiner should specifically indicate the reasons and bases for the conclusions expressed. If the examiner is unable to offer the requested opinion, that person should offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Schedule the Veteran for a VA examination by a qualified clinician to determine the severity and extent of his service-connected right ankle disability. All indicated tests and studies should be accomplished and all clinical findings should be reported in detail. A complete rationale for all opinions expressed should be provided. The examiner is specifically asked to address the functional and occupational effect of the Veteran's right ankle disability. MICHAEL KILCOYNE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Erin J. Trojanowski, 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.