Citation Nr: 21008098 Decision Date: 02/11/21 Archive Date: 02/11/21 DOCKET NO. 16-21 469 DATE: February 11, 2021 REMANDED The claim of entitlement to service connection for residuals of a right leg amputation is remanded. The claim of entitlement to service connection for a left leg disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1978 until April 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a rating decision by a U.S. Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified in a hearing before the Board. A transcript of the hearing has been included in the electronic claims file and has been reviewed. The Board remanded this matter for additional development in October 2019 and October 2020. The case is again before the Board for appellate review. Another remand is warranted for a new VA compensation examination. Pursuant to October 2019 remand, the Veteran underwent VA examination into his claims in January 2020. The January 2020 report and opinion are inadequate because they do not address evidence noted in the service treatment records (STRs) documenting that the Veteran injured each leg during service. In the October 2020 remand, the Board requested an addendum opinion. In response, three addendum opinions have been issued. These are inadequate as well. The first addendum opinion, dated in November 2020, states inaccurately that the STRs are silent regarding injuries to the lower extremities during service. The second addendum opinion, also dated in November 2020, acknowledges the STRs and the evidence of in-service injuries but does not address the Veteran’s lay assertions that he has experienced a continuity of symptomatology since service. And the third addendum opinion (dated in December 2020) as with the first two, does not address whether it is “at least as likely as not” that the current disorders relate to service. Rather, the examiner merely states with regard to the claims, “I cannot favorably opinion.” 38 C.F.R. § 3.102. As such, a new VA compensation examination should be provided to the Veteran with a new VA examiner. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: Schedule an examination to determine the nature and etiology of any lower extremity disorder. After reviewing the claims folder, interviewing the Veteran, and examining him, the examiner should answer the following question: Is it at least as likely as not (i.e., probability of 50 percent or more) that a right or left lower extremity disorder had its onset during service, or is related to a disease, event, or injury during service? All medical and lay evidence of record must be considered in answering this question. In particular, the examiner should review the description of the in-service injuries detailed in the March 2019 testimony, which the Board found credible. Further, the Board seeks commentary regarding the medical opinions of record dated in 1989-90, in which a physician states that evidence dated at that time indicates that problems in the right lower extremity may relate to an earlier right lower extremity injury. An opinion analyzing the 1989-90 comments regarding “Austro condo” and talus disorders would be especially useful. Does this evidence along with the evidence in the STRs indicate that the right leg amputation in the early 2000s is rooted in the right ankle injury during service – i.e., that the injuries in service led to right ankle problems in the late 1980s/early 1990s which then led to surgery and the infection that resulted in amputation? Note that the November 2020 VA opinion of record sufficiently establishes that the left leg problems are secondary to disability associated with the right leg amputation. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. In rendering the requested opinion, the examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should indicate this in the examination report and provide a rationale for that determination. Please explain in detail any opinion provided and the supporting rationale. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Christopher McEntee, 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.