Citation Nr: 21015163 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 10-43 132 DATE: March 16, 2021 ORDER Entitlement to service connection for a right knee disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, is granted. Entitlement to service connection for a right hip disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, is granted. Entitlement to service connection for a lumbar spine disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, is granted. FINDINGS OF FACT 1. The Veteran’s current right knee disability has been shown to be aggravated by his service-connected chronic right ankle sprain with arthritis and bilateral pes planus. 2. The Veteran’s service right hip disability has been shown to be aggravated by his service-connected chronic right ankle sprain with arthritis and bilateral pes planus. 3. The Veteran’s lumbar spine disability has been shown to be aggravated by his service-connected chronic right ankle sprain with arthritis and bilateral pes planus. CONCLUSIONS OF LAW 1. The criteria for entitlement to service connection for a right knee disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2020). 2. The criteria for entitlement to service connection for a right hip disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2020). 3. The criteria for entitlement to service connection for a lumbar spine disability, secondary to antalgic gait resulting from service-connected chronic right ankle sprain with arthritis and bilateral pes planus, have been met. 38 U.S.C. §§ 1131, 5107 (2012); 38 C.F.R. § 3.310 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Air Force from March 1978 to March 1982. This matter was previously before the Board of Veterans’ Appeals (Board) in July 2019, whereupon the Board denied the claims listed above. The Veteran appealed that decision to the United States Court of Appeals for Veterans Claims (Court). In June 2020, while the case was pending at the Court, the parties signed a Joint Motion for Remand (JMR) requesting that the Court vacate the July 2019 Board decision. In a subsequent order, the Court granted the JMR. The claims have now been returned to the Board for further consideration. Service Connection Claims The Veteran seeks entitlement to service connection for right knee, right hip, and lumbar spine disabilities. He argues that these disabilities were caused or aggravated by his service-connected chronic right ankle sprain with arthritis and bilateral pes planus, to include as a result of gait abnormalities. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). Alternatively, any disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. See 38 C.F.R. § 3.310. As an initial matter, multiple VA examination reports of record demonstrate that the Veteran has been diagnosed with degenerative arthritis of the right knee, right hip, and lumbar spine during the pendency of his appeal. As such, the “current disability” element has been met for each of these claims. The Board now turns to whether these disabilities were caused or aggravated by his service-connected right ankle and bilateral foot disabilities. In this regard, the Veteran has submitted positive evidence in the form of opinions from multiple physicians indicating that the Veteran has experienced altered gait as a symptom of his service-connected right ankle and bilateral foot disabilities; these opinions reflect that antalgic gait could, in general, cause or contribute to knee, hip, and back problems. More specifically, a March 2020 letter from a foot and ankle specialist indicated that, in the specialist’s opinion, “due to the instability in [the Veteran’s] foot and ankle it has caused him hip, knee and lower back problems,” which would likely “remain a progressive problem for him in the future.” (Continued on the next page)   The Board acknowledges the presence of negative evidence of record, including opinions authored by VA examiners, most recently in January 2018. However, as explained in the JMR, the parties have agreed that these opinions are flawed with respect to the question of aggravation, and therefore cannot be considered probative evidence on that point. Specifically regarding the claimed right knee and right hip disabilities, the JMR noted that the January 2018 VA medical opinion incorrectly relied on the premise that aggravation, for purposes of secondary service connection under 38 C.F.R. § 3.310, is defined as a permanent worsening beyond the natural progression of the disease. See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019) (holding that “compensation is warranted for any incremental increase in disability . . . in non-service-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase—regardless of its permanence”). As for the claimed lumbar spine disability, the parties agreed that a January 2018 VA medical opinion relied on an incorrect assumption that there was “no objective evidence” of an “altered gait.” The Board has considered remanding the claims for yet another nexus opinion, particularly in light of the instructions noted in the JMR. The Board further acknowledges that the positive opinions of record could stand to include more in the way of supporting rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (medical opinions are regarded as more probative when they include clear conclusions and supporting data with a reasoned analysis connecting the data and the conclusions). Nevertheless, the Board finds under the facts of this case that the lay and medical evidence of record regarding the etiology of the Veteran’s disabilities—and specifically regarding the question of whether gait abnormalities caused by service-connected disabilities have aggravated his claimed right knee, right hip, and lumbar spine disabilities—is sufficient to support a finding of nexus. The benefit of the doubt will be conferred in the Veteran’s favor. The claims will be granted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Minot, 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.