Citation Nr: 21024952 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 15-13 569 DATE: April 27, 2021 REMANDED Service connection for a left knee disability, to include osteoarthritis, to include as secondary to service-connected right medial meniscus tear, is remanded. Service connection for a low back condition, to include degenerative arthritis, to include as secondary to service-connected right medial meniscus tear, is remanded. Service connection for a right ankle condition, to include as secondary to service-connected right medial meniscus tear, is remanded. Service connection for a right hip condition, to include as secondary to service-connected right medial meniscus tear, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1968 to September 1972. These matters return to the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by the Department of Veterans’ Affairs (VA) Regional Office (RO) in St. Paul, Minnesota. In a December 2018 decision, the Board remanded these claims for additional development. Unfortunately, another remand is necessary to ensure substantial compliance with the Board’s December 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Service connection for a left knee disability, to include osteoarthritis, to include as secondary to service-connected right medial meniscus tear, is remanded. 2. Service connection for a low back condition, to include degenerative arthritis, to include as secondary to service-connected right medial meniscus tear, is remanded. The Veteran contends his left knee disability and low back condition were either caused by or incurred during service, or are secondary to his service-connected right knee disability. The Veteran was afforded a VA examination in November 2019 wherein the examiner opined that the Veteran’s left knee osteoarthritis and degenerative arthritis of the spine were less likely than not aggravated by his service-connected right knee disability. The examiner explained that the Veteran was on his feet following separation for 47 years which when considered with age and body habitus is the basis for the Veteran’s lower extremity joint pain. However, the examiner did not provide a rationale in support of the aggravation opinion specifically addressing whether the Veteran’s left knee osteoarthritis was aggravated (any worsening beyond the natural progression) by his service-connected right knee disability. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Additionally, the examiner failed to address the Veteran’s lay statements of increased left knee and low back symptoms in relation to his right knee disability. See Miller v. Wilkie, 32 Vet. App. 249 (2020). The Veteran’s representative has also submitted medical articles discussing a potential relationship between knee pain and lower back pain due to changes in gait which remains unaddressed by a VA examiner. Thus, remand is necessary to obtain an addendum opinion adequately addressing aggravation and the Veteran’s lay statements in relation to his service connection claims for the left knee and low back. 3. Service connection for a right ankle condition, to include as secondary to service-connected right medial meniscus tear, is remanded. 4. Service connection for a right hip condition, to include as secondary to service-connected right medial meniscus tear, is remanded. The Veteran contends his right ankle condition and right hip condition were caused by or incurred during service, or in the alternative, are secondary to his service-connected right knee disability. The Veteran was afforded a VA examination in November 2019 wherein the examiner opined that the Veteran did not have a right ankle or right hip diagnosis, and therefore, there was no nexus to service or secondary causation/aggravation to the service-connected right knee disability. As part of the Board’s December 2018 decision, the Board found the April 2013 VA examination inadequate for failing to address the Veteran’s reports of ankle and hip pain and whether said pain causes functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The November 2019 VA examiner, however, failed to address the Veteran’s complaints of ankle and hip pain and whether the pain causes functional impairment. Additionally, the Veteran’s representative has submitted medical articles discussing a potential relationship between knee pain and ankle pain as well as knee joints and hip pain. On remand, the examiner should address the relevance, if any, of these medical articles. Thus, remand is again necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from the November 2019 VA examiner, or a suitable substitute, as to the nature and etiology of the Veteran’s left knee, low back, right ankle, and right hip conditions. A new examination is only required if deemed necessary by the examiner. The entire claims file and a copy of this Remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. After review of the record, the examiner should provide the following opinions: (a.) Whether the Veteran’s left knee disability, to include osteoarthritis, and the Veteran’s low back condition, to include degenerative arthritis, is at least as likely as not (i.e., 50 percent or greater probability) aggravated by his service-connected right medial meniscus tear. **The examiner must address the following evidence: (i) The Veteran’s lay statements of left knee and low back symptoms presenting in relation to his right knee disability. (ii) The medical articles referenced within the Veteran’s representative’s March 2021 Brief, discussing a potential relationship between knee pain and lower back pain due to changes in gait. (b.) Whether the Veteran’s relevant right ankle symptomatology and right hip symptomatology at least as likely as not (i.e., 50 percent or greater probability) cause functional impairment of earning capacity. **The examiner must address the Veteran’s lay statements regarding his right hip and right ankle symptomatology, including reports of pain. i. If and only if the Veteran’s reported right ankle symptoms and/or right hip symptoms cause functional impairment, whether such symptoms are at least as likely as not (i.e., 50 percent or greater probability) related to or caused by service; ii. If and only if the Veteran’s reported right ankle symptoms and/or right hip symptoms cause functional impairment, whether such symptoms are at least as likely as not (i.e., 50 percent or greater probability) caused by his service-connected right knee disability; and iii. If and only if the Veteran’s reported right ankle symptoms and/or right hip symptoms cause functional impairment, whether such symptoms are at least as likely as not (i.e., 50 percent or greater probability) aggravated by his service-connected right knee disability; ***In providing these opinions, the examiner must address the medical articles referenced within the Veteran’s representative’s March 2021 Brief, discussing a potential relationship between knee problems and ankle pain as well as knee joints and hip pain. The VA examiner is cautioned that the term “aggravated,” as used in 38 C.F.R. § 3.310(b), does not require that there be “permanent worsening” of the nonservice-connected disability. Instead, secondary service connection is warranted for “any incremental increase in disability and any additional impairment of earning capacity in nonservice-connected disabilities resulting from service-connected conditions, above the degree of disability existing before the increase regardless of its permanence.” See Ward v. Wilkie, 31 Vet. App. 233, 239 (2019). A detailed rationale should be provided for the opinions rendered. If any opinion cannot be expressed without resort to speculation, ensure that the examiner so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. Then, readjudicate the claims on appeal. Megan R. Thomas Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.C. Allen, 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.