Citation Nr: 21009399 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 14-32 377A DATE: February 22, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to a right knee disability, is remanded. Entitlement to service connection for a low back disability, to include as secondary to a right knee disability, is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a low back disability is remanded. The Veteran contends that he is entitled to service connection for a back and left knee disability because the claimed disabilities were caused by service-connected right knee and right femur disabilities. In a January 2013 VA examination, the examiner opined that the back disability and left knee disability were not caused or aggravated by a service-connected disability. The rationale provided was that there was no objective medical evidence to establish a temporal connection between the low back disability and the left knee disability to the service-connected right femur disability and the evidence also did not show aggravation by the right femur disability. When VA obtains an examination or opinion, the examination or opinion must be adequate.  Barr v. Nicholson, 21 Vet. App. 303 (2007). The examiner’s rationale did not consider the Veteran’s reports of continuity of symptomatology since the right femur injury. In April 2013, the Veteran stated that following the shortening of the right leg, he became more reliant on the left leg, which caused the development of the left knee and low back disability. The examiner stated that there was no objective medical evidence to establish a temporal connection, but did not address the Veteran’s reports of observing pain from the claimed disabilities following the service-connected right femur and right knee disability. The Veteran is competent to report symptoms observable to a layperson and the continuance of those symptoms in the years since service. It is also unclear if the examiner opined that there was no medical evidence of record to establish a temporal connection or that there was no medical evidence in general to support that conclusion. As a result, further VA examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a medical doctor to determine the nature and etiology of any low back disability. The examiner must review the claims file and should note that review in the report. A thorough rationale should be provided for all opinions. The examiner should opine whether any diagnosed low back disability is at least as likely as not (50 percent or greater probability) (1) proximately due to or the result of any service-connected disability, to include right femur fracture residuals and a right knee disability, or (2) aggravated (increased beyond the natural progress) by any service-connected disability, to include right femur fracture residuals and a right knee disability. The examiner is advised that the Veteran is competent to report symptoms and history, and those statements by the Veteran must be specifically acknowledged and considered in formulating any opinions. The examiner should specifically address the Veteran’s contention that a shortening of the right leg resulted in altered gait that caused or aggravated a low back disability. 2. Schedule the Veteran for a VA examination with a medical doctor to determine the nature and etiology of a left knee disability. The examiner must review the claims file and should note that review in the report. A thorough rationale should be provided for all opinions. The examiner should opine whether any diagnosed left knee disability is at least as likely as not (50 percent or greater probability) (1) proximately due to or the result of any service-connected disability, to include right femur fracture residuals and a right knee disability, or (2) aggravated (increased beyond the natural progress) by any service-connected disability, to include right femur fracture residuals and a right knee disability. The examiner is advised that the Veteran is competent to report symptoms and history, and those statements by the Veteran must be specifically acknowledged and considered in formulating any opinions. The examiner should specifically address the Veteran’s contention that a shortening of the right leg resulted in altered gait that caused or aggravated a left knee disability. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cross, 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.