Citation Nr: 21026802 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 15-20 108 DATE: May 4, 2021 ORDER Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right foot disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from May 2006 to June 2009. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in June 2018. A transcript of that hearing has been associated with the claims file. These issues, along with the issue of entitlement to service connection for a right elbow disorder, were remanded by the Board in August 2018 and May 2020 decision for further development. As a result of the development, the agency of original jurisdiction (AOJ) granted entitlement to service connection for a right elbow disorder in a September 2020 rating decision. As the benefit sought is granted for the right elbow disorder, the issue is no longer on appeal. The remaining issues are returned to the Board for appellate review. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issues. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Remand is necessary to obtain an addendum VA opinion, or a new VA examination if necessary. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate "where it is based on consideration of the veteran's prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board's evaluation of the claimed disability will be a fully informed one." Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). 1. Entitlement to service connection for a right knee disorder is remanded. The August 2018 Board decision stated that the February 2014 VA examiner found the Veteran to not have a diagnosis of the right knee. However, an October 2016 VA medical provider observed the Veteran's bilateral knees to have an audible crepitus. In a June 2016 VA treatment record the medical provider observed the Veteran to have instability in the bilateral knees. The Board directed the agency of original jurisdiction (AOJ) to obtain a new VA examination to determine if there is any diagnosed disability of the bilateral knees. The Board specifically directed the AOJ to address VA treatment records findings of audible crepitus and instability. The May 2020 Board decision directed the AOJ to obtain an addendum VA opinion, or new examination if necessary, to determine whether it is at least as likely as not that any currently diagnosed right knee disorder, to include knee pain, is related to service, to include a May 2006 in-service fall. The Board specifically directed the examiner to address the May 2006 in-service fall, post-service complaints of bilateral knee pain in VA treatment records, and the Veteran's statements of continued symptoms since service. VA treatment records show the Veteran undergoing physical therapy treatment for the right knee. Here, the September 2020 VA examiner found the Veteran to have no right knee disorder, but did not address the Veteran's reported symptoms of pain, instability, or crepitus or the Veteran's statements of continued symptoms since service. Therefore, a remand is required to obtain an additional addendum VA opinion, or VA examination if necessary. 2. Entitlement to service connection for a right ankle disorder is remanded. 3. Entitlement to service connection for a left ankle disorder is remanded. The August 2018 Board decision stated that the May 2017 VA examination did not address the Veteran's left ankle x-ray showing mild joint changes or the right ankle pain the Veteran states he has experienced since service. The Board directed the AOJ to provide the Veteran with a new VA examination. The Board specifically directed the AOJ to address the Veteran's complains of right ankle pain. The May 2020 Board decision directed the AOJ to provide the Veteran with an addendum VA opinion to determine the nature and etiology of the Veteran's bilateral ankle disorder. The Board specifically directed the VA examiner to determine whether it is at least as likely as not that any currently diagnosed bilateral ankle disorder, to include bilateral ankle pain, is etiologically related to service. The Board stated that the examiner must specifically address the 2006 in-service fall, March 2007 left ankle injury, VA treatment of bilateral ankle pain in 2010, May 2017 VA findings of left ankle joint changes, and must consider and discuss the Veteran's statements related to continued symptoms. A March 2007 service treatment record (STR) shows that the Veteran was treated for a left ankle injury during service. VA treatment records show in April 2010 the Veteran complained of left ankle pain that had its onset years prior. In June 2010 the medical provider recommended that the Veteran be treated by physical therapy for right ankle. Here, the September 2020 VA examiner opined that the Veteran's right ankle disorder is less likely than not caused by service. The examiner noted that in May 2007 the Veteran was diagnosed with a left ankle sprain in-service, and not the right. The examiner also found no complaints of right ankle pain at the time. Also, in May 2006, the Veteran reported a fall to his right side. Here, the examiner found there were no complaints in-service for the right ankle. Further, the separation examination did not indicate any complaints for the right side. Therefore, the right ankle disorder is not caused by service. The examiner stated they were unable to find 2010 VA treatment for bilateral ankle pain. Here, the September 2020 VA examiner opined that the Veteran's left ankle disorder is less likely than not caused by service. The examiner reasoned that the separation examination did not indicate any complaints and there were no complaints in service for the left ankle. Also, the first complaint of the ankle was in 2015. However, the VA examiner provided contradictory opinions. The examiner stated in the right ankle opinion that the Veteran was diagnosed with a left ankle sprain in service, but in the left ankle opinion stated that the Veteran had no in-service complaints of the left ankle. Also, the examiner did not address the May 2017 VA treatment record showing left joint changes or the Veteran's statements of continued symptoms since service. Unfortunately, the examiner did not address the August 2018 or May 2020 directives from the Board and the September 2020 VA opinion is inadequate. Therefore, a remand is required to obtain an additional addendum VA opinion, or VA examination if necessary. 4. Entitlement to service connection for a right foot disorder is remanded. The August 2018 Board decision stated that a December 2014 VA treatment record, the Veteran complained of foot pain and the medical provider assessed the Veteran to have bursitis of the right foot. The Board directed the agency of original jurisdiction (AOJ) to obtain a VA examination and opinion to determine whether the Veteran's right foot disorder was caused by service. The Board specifically directed the new examiner to address the Veteran's December 2014 VA diagnosis of bursitis of the right foot. Here, the October 2018 VA examiner indicated that the Veteran does not have a diagnosis of the right foot. However, VA treatment records show the Veteran to have a history of tendinitis of the foot. Further, the examiner noted that the Veteran reported functional loss of the right foot due to flare-ups, specifically in the form of aching when he has been on his feet all day. The May 2020 Board decision directed the AOJ to obtain an addendum VA opinion to determine whether it is at least as likely as not that any diagnosed right foot disorder, to include foot pain, is etiologically related to service, to include a May 2006 in-service fall. The Board specifically directed the examiner to discuss the May 2006 in-service fall; a December 2014 diagnosis of right foot bursitis; and consider the Veteran's statement of continued symptoms. Here, the September 2020 VA examiner found the Veteran to not have a diagnosis of the right foot. However, the examiner did not address the VA treatment records diagnosis of bursitis in the right foot, or the history of tendinitis, or offer an opinion regarding the etiology of the Veteran's right foot bursitis and tendinitis and their relation to service. The examiner also did not address the Veteran's statements related to continued symptoms. As a result, the September 2020 VA examination is inadequate as it did not address diagnoses noted in VA treatment records. Therefore, a remand is required to obtain an additional addendum VA opinion, or VA examination if necessary. The matters are REMANDED for the following action: 1. Obtain an addendum VA opinion by an appropriate clinician to determine the nature and etiology of any right knee disorder, to include the symptoms of pain, crepitus, and instability as documented by June 2016 and October 2016 VA treatment providers and described by the Veteran. For each such diagnosed disorder and/or symptoms (if there is no diagnosis), the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. The examiner must address the VA treatment records findings of audible minimal crepitus and instability and VA physical therapy treatment and must reconcile those findings with any conclusion that there is no right knee disability present at any point during the appeal period. The examiner must also discuss the Veteran's report of ongoing symptoms since service in the context of any negative opinion. 2. Obtain an addendum VA opinion by an appropriate clinician to determine the nature and etiology of any bilateral ankle disorder. For each diagnosed disorder, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include the documented May 2006 in-service fall. The examiner must address the Veteran's mild joint changes and pain of the ankle as documented by VA treatment providers in May 2017 and described by the Veteran and the March 2007 documented in-service left ankle injury. The examiner must also discuss the Veteran's report of ongoing symptoms since service in the context of any negative opinion. 3. Obtain an addendum VA opinion by an appropriate clinician to determine the nature and etiology of any right foot disorder, to include bursitis and tendinitis. The examiner must opine whether any diagnosed right foot disorder is at least as likely as not related to an in-service injury, event, or disease, including the documented May 2006 in-service fall. The examiner must address the Veteran's December 2014 diagnosis of bursitis of the right foot and history of tendinitis. The examiner must also discuss the Veteran's report of ongoing symptoms since service in the context of any negative opinion. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thompson, 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.