Citation Nr: 21022650 Decision Date: 04/16/21 Archive Date: 04/16/21 DOCKET NO. 16-21 403 DATE: April 16, 2021 REMANDED Entitlement to service connection for degenerative disc disease of the lumbar spine, as due to service-connected left ankle disability, is remanded. Entitlement to service connection for degenerative joint disease (DJD) of the right ankle, as due to service-connected left ankle disability, is remanded. Entitlement to service connection for DJD of the left knee, as due to service-connected left ankle disability, is remanded. Entitlement to service connection for DJD of the right knee, as due to service-connected left ankle disability, is remanded. Entitlement to service connection for DJD of the right foot, as due to service-connected left ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1985 to September 1989. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a February 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The claims were previously before the Board in August 2020, at which time the Board remanded the matters to the agency of original jurisdiction (AOJ) in order to obtain, and associate with the Veteran’s claims file, relevant outstanding private treatment records. The matters have now been returned to the Board for further appellate consideration. For the reasons discussed below, the Board finds that another remand is warranted. After a review of the Veteran’s claims file, the Board notes that the record contains two nexus opinions for each of the claimed disabilities. In January 2013, the Veteran underwent VA examinations to determine the nature and etiology of his lumbar spine, right ankle, right foot, and bilateral knee disabilities. For each respective disorder identified, the examiner opined that the disabilities were less likely than not “secondary to his service[–]connected residuals, fracture of left ankle with traumatic arthritis.” However, the opinions are inadequate for adjudicative purposes because they are not supported by a rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) (for a medical opinion to be adequate for decision-making purposes, it must be supported by a rationale or explanation for the conclusion reached). The Veteran was also afforded VA examinations for the disabilities on appeal in July 2019. For each of the disabilities for which the Veteran seeks service connection, the clinician opined that the respective disorder was less likely than not caused by or aggravated by the Veteran’s service-connected left ankle disability. See VA examinations dated July 29, 2019. In rendering these opinions, the clinician reasoned that, because the Veteran reported he did not walk with a chronically altered gait due to his left ankle disability until approximately 2000, the period of roughly 15 years between the time he sustained the left ankle disability and the time at which the disability caused an altered gait precludes the possibility that the disabilities were caused or aggravated by his left ankle disorder. The examiner further relayed that a chronically altered gait is “the only mechanism by which his left ankle condition could have caused [the current disabilities].” Although this reasoning seems to contemplate the theory of causation, it does not provide a rationale for the conclusion that the left ankle disability less likely than not aggravated the Veteran’s claimed disabilities beyond their natural progression. As such, the July 2019 nexus opinions are inadequate for decision-making purposes. A remand is warranted in order to procure new medical opinions, supported by an adequate rationale, addressing the secondary service connection elements of both causation and aggravation. Accordingly, the matters are REMANDED for the following action: 1. Send the Veteran’s claims file to an appropriate clinician for review and for the opinions sought regarding the Veteran’s claims for service connection for the disabilities on appeal. ONLY IF another examination is deemed necessary to answer the questions below, should one be scheduled. The clinician is asked to address the following: (a.) Is it at least as likely as not (50 percent probability or greater) that each of the Veteran’s claimed disabilities (degenerative disc disease of the lumbar spine, degenerative joint disease of the right ankle, degenerative joint disease of the left knee, degenerative joint disease of the right knee, and degenerative joint disease of the right foot) is causally related to his military service. In providing responses to the above, the clinician is asked to furnish an independent opinion for each of the Veteran’s claimed disabilities. (b.) Is it at least as likely as not (50 percent probability or greater) that each of the Veteran’s claimed disabilities (degenerative disc disease of the lumbar spine, degenerative joint disease of the right ankle, degenerative joint disease of the left knee, degenerative joint disease of the right knee, and degenerative joint disease of the right foot) was caused by his service-connected left ankle disability? In providing responses to the above, the clinician is asked to furnish an independent opinion for each of the Veteran’s claimed disabilities. (c.) Is it at least as likely as not (50 percent probability or greater) that each of the Veteran’s claimed disabilities (degenerative disc disease of the lumbar spine, degenerative joint disease of the right ankle, degenerative joint disease of the left knee, degenerative joint disease of the right knee, and degenerative joint disease of the right foot) was aggravated beyond its natural progression by his service-connected left ankle disability? In providing responses to the above, the clinician is asked to furnish an independent opinion for each of the Veteran’s claimed disabilities. It should be noted that the Veteran is competent to attest to observable symptomatology. The clinician should note that the phrase “as 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 conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it. Aggravation is defined as any increase in the severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The clinician is further advised that a finding that any of the claimed disabilities was aggravated beyond its natural progression by the Veteran’s service-connected left ankle disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from the left ankle disability. A clear rationale for all opinions expressed would be helpful; and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Tolbert, Associate 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.