Citation Nr: 21007543 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 18-00 602 DATE: February 9, 2021 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a left ankle fracture, is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a left ankle fracture and/or secondary to a right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1987 to November 1991. This case comes before the Board of Veterans’ Appeals (Board) on appeal of a November 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in March 2020. His representative waived RO review of new evidence during the hearing. This case was remanded in April 2020 for a VA knee examination. The examiner was requested to identify all left and right knee conditions and to opine on direct and secondary service connection. Also, part of the remand directive was that if necessary, an examination may be conducted. No in person examination took place for the Veteran’s knees. However, a VA opinion was completed in June 2020. The examiner noted that the Veteran did not have any evidence on current examination or documented history of a significantly altered gait. The examiner went on to report that the altered gait would be the only likely means by which his right or left knee conditions would have been caused by or related to his service-connected left ankle condition. The examiner ultimately opined that it would be less likely than not that this Veteran's current right or left knee condition is related to his service-connected left ankle condition. Remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board’s remand order. Stegall v. West, 11 Vet. App. 268, 270- 71 (1998). The June 2020 examiner wrote how “evidence on current examination or documented history” did not show altered gait. However, there was no in-person examination. The record reveals examinations in 2020 for other disabilities, but not for his knees. This renders the opinion confusing and unreliable. Additionally, even if there was no need for an in-person examination, the opinion submitted in June 2020 is inadequate. The examiner failed to provide an adequate rationale when he gave the negative nexus opinion for secondary service connection for the Veteran’s right and left knees. Thus, the inadequate rationale would also warrant a remand on its own. The matters are REMANDED for the following action: After completing any needed preliminary development, forward the Veteran’s claims file to a qualified medical professional for a VA examination to determine the nature and etiology of the Veteran’s bilateral knee disabilities. The Veteran’s entire record (including this remand) must be reviewed by the examiner. The examiner must provide opinions, with a full rationale, that respond to the following: a.) Identify all right and left knee disabilities demonstrated during the appeal period or in proximity to the claim, even if currently resolved; b.) For any diagnosed right knee disability, provide an opinion as to 1.) whether it is at least as likely as not (a 50 percent or greater probability) that such diagnosis was caused by or incurred in active service, or 2.) was caused or aggravated by the Veteran’s left ankle fracture; and c.) For any diagnosed left knee disability, provide an opinion as to 1.) whether it is at least as likely as not that such diagnosis was caused by or incurred in active service, or 2.) was caused or aggravated by the Veteran’s left ankle fracture, or 3.) was caused or aggravated by the right knee disability. All opinions offered must be accompanied by a clear rationale consistent with the evidence of record. The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hetman 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.