Citation Nr: 21006215 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 14-20 600A DATE: February 3, 2021 REMANDED Entitlement to service connection for right foot drop is remanded. Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a low back condition is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to November 1974. This matter again comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Newington, Connecticut. The Board previously remanded this matter in March 2018 and February 2020. 1. Entitlement to service connection for right foot drop is remanded. 2. Entitlement to service connection for a left knee condition is remanded. 3. Entitlement to service connection for a right knee condition is remanded. 4. Entitlement to service connection for a low back condition is remanded. In compliance with the Board’s February 2020 decision, an addendum opinion has been obtained regarding the etiology of the Veteran’s current low back disability. However, the clinician who authored this opinion did not provide a rationale behind the conclusion that the Veteran’s low back condition was less likely than not due to living and working in tight spaces, with bending, twisting, and rotating activities while submerged in deep waters, all during his active duty service. Medical opinions must contain clear conclusions with supporting data and a reasoned explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, the Board notes that, although the Veteran claims that his bilateral knee conditions and right foot drop are due to his back condition, his service treatment records and competent lay statements reflect that the Veteran caught himself by the foot on a ladder and that he complained of right knee troubles in April 1974, while on active duty. See April 1974 and June 1974 Service Treatment Records; August 2012 VA Form 21-526; January 2013 VA C&P Examinations; August 2013 VA Primary Care Consult; May 2014 DRO Hearing Transcript. Hence, the Board finds that even though the Veteran asserts that his knee conditions and foot condition are secondary to his low back disability, there is a question as to whether his lower extremity disabilities are etiologically related directly to his active service. Therefore, the Board finds that, on remand, addendum opinions regarding the natures and etiologies of the Veteran’s low back, right knee, left knee, and right foot conditions must be obtained. The matters are REMANDED for the following action: 1. Return the claims file to the clinician who authored the February 2020 opinion for an addendum opinion ascertaining the nature and etiology of the Veteran’s low back disability. If the February 2020 clinician is not available, forward the claims file to another clinician with the appropriate expertise. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. The clinician should identify any and all low back conditions attributable to the Veteran throughout the appellate period. For each condition so identified, the clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s condition manifested during, or is the result of, his active service, to include a June 1974 back injury and the rigors of service, to include living and working in tight quarters with bending, twisting, and rotating motions while submerged. In formulating his or her opinion, the clinician should consider and address the competent medical and lay evidence of record, including, but not limited to: (a) The Veteran’s service treatment records; (b) The Veteran’s post-service VA medical records; (c) The Veteran’s post-service private medical records; and (d) The Veteran’s and Veteran’s wife’s competent lay statements of record reflecting the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s low back condition(s) is/are less likely than not due to his active service, the clinician should discuss what other factor(s) caused the disorder(s). A complete rationale must be provided for all opinions and conclusions reached. 2. Forward the claims file to an appropriate clinician to ascertain the natures and etiologies of any and all bilateral knee disabilities attributable to the Veteran. The entire claims file, including a copy of this remand, must be made available to the clinician, who must note its review. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. The clinician should identify any and all bilateral knee conditions attributable to the Veteran throughout the appellate period. For each condition so identified, the clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s condition manifested during, or is the result of, his active service, to include April 1974 in-service complaints of right knee pain, a June 1974 back injury, and the rigors of service, to include living and working in tight quarters with bending, twisting, and rotating motions while submerged. For each condition so identified, the clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s condition was either (i) caused or (ii) aggravated by his low back condition(s). NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require “permanent worsening” of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of disability prior to such aggravation. In formulating his or her opinions, the clinician should consider and address all competent medical and lay evidence of record, including, but not limited to: (a) The Veteran’s service treatment records; (b) The Veteran’s post-service VA medical records; (c) The Veteran’s post-service private medical records; and (d) The Veteran’s, and the Veteran’s wife’s, competent lay statements regarding the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s bilateral knee condition(s) is/are less likely than not due to his active service, and/or that it/they is/are less likely than not caused and/or aggravated by his low back condition(s), the clinician should discuss what other factor(s) caused the disorder(s). A complete rationale must be provided for all opinions and conclusions reached. 3. Forward the claims file to an appropriate clinician to determine the nature and etiology of the Veteran’s right foot drop. The entire claims file, including a copy of this remand, must be made available to the clinician, who must note its review. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be provided. The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right foot drop manifested during, or is the result of, his active service, to include a June 1974 incident in which the Veteran caught his right foot on the rung of a ladder, and the rigors of service, to include living and working in tight quarters with bending, twisting, and rotating motions while submerged. The clinician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right foot drop was either (i) caused or (ii) aggravated by his low back condition(s). NOTE: With respect to the question concerning aggravation, the clinician is advised that aggravation under 38 C.F.R. § 3.310(b) does not require “permanent worsening” of the nonservice-connected disability. If aggravation is found, the clinician should attempt to identify the baseline level of disability prior to such aggravation. In formulating his or her opinions, the clinician should consider and address the competent medical and lay evidence of record, including but not limited to: (a) The Veteran’s service treatment records; (b) The Veteran’s post-service VA medical records; (c) The Veteran’s post-service private medical records; and (d) The Veteran’s and the Veteran’s wife’s competent lay statements of record relating to the onset and continuity of his symptomatology. If the clinician determines that the Veteran’s right foot drop is less likely than not due to service and/or caused and/or aggravated by his low back condition(s), the clinician should discuss what other factor(s) caused the disorder. A complete rationale must be provided for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Seserman 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.