Citation Nr: 21020813 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 16-09 481 DATE: April 8, 2021 REMANDED Service connection for a right knee disability is remanded. Service connection for a right ankle disability is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from May 5, 1991 to May 19, 1991. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). This appeal is being adjudicated under the legacy appellate framework. The Veteran testified at a personal hearing before the Board in January 2019, and a transcript of the hearing. These matters were previously before the Board, and, in April 2019 and in August 2020, the Board remanded these matters for further development. Further development in substantial compliance with the Board’s previous remand instructions has been completed.   1. Service connection for a right knee disability is remanded. 2. Service connection for a right ankle disability is remanded. At issue is whether the Veteran is entitled to service connection for a right knee disability and a right ankle disability. Unfortunately, this matter must be remanded again for a VA examination. The Veteran testified at a personal hearing before the Board in January 2019 that her right knee and right ankle disabilities first began to manifest approximately one month after her right foot injury, and that she believed they were due to an altered gait caused by previously service-connected right foot disability. See Transcript. The Veteran was provided VA examinations in February 2016 and in November 2019 which taken together indicate that the Veteran’s right knee and right ankle disabilities were not proximately due to or aggravated by the Veteran’s previously service-connected disabilities, because the Veteran’s right knee and right ankle disability could not possibly have been caused by a right foot disability. Nevertheless, a VA examination in June 2008 indicated that the Veteran’s left knee disability was proximately due to an altered gait; which in turn was due to the Veteran’s right foot disability. Based on this examination, the VA granted service connection for a left knee disability in August 2008. Once VA undertakes the effort to provide the Veteran with a VA examination, VA must provide the Veteran with an adequate one, and an adequate examination is sufficiently adequate to ensure that VA’s evaluation of the Veteran’s claim is fully formed. Barr v. Nicholson, 21 Vet. App. 303 (2007). The rationales for the February 2016 and November 2019 examinations unfortunately do not discuss how the Veteran’s right foot disability could of have (and in fact did) cause the Veteran’s left knee disability, but the Veteran’s right knee and right ankle disability could not possibly have been caused by a right foot disability. Therefore, this matter must be remanded for a new VA medical opinion in order to discuss this.   The matters are REMANDED for the following action: Arrange to provide the Veteran with a VA examination in order to discuss the following: (a.) Is it at least as likely as not (50 percent or more) that the Veteran’s right ankle disability was proximately due to or aggravated by the Veteran’s previously service-connected disability? Why or why not? (b.) Is it at least as likely as not (50 percent or more) that the Veteran’s right knee disability was proximately due to or aggravated by the Veteran’s previously service-connected disability? Why or why not? (c.) If the answer to either of the previous questions is no, then please discuss how an altered gait caused by the Veteran’s right foot disability could cause the Veteran’s left knee disability; but not result in a right knee or right ankle disability. (d.) What is the medical significance, if any, of the June 2008 VA examination which indicated that the Veteran’s left knee disability was the result of   an altered gait caused by the Veteran’s right foot disability? Why? DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Seaton 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.