Citation Nr: 21032611 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 13-25 958 DATE: May 27, 2021 REMANDED Entitlement to service connection for a left lower extremity disability (diagnosed as degenerative joint disease of the left knee), to include as secondary to service-connected pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1952 to September 1954, and from October 1954 to September 1957. Unfortunately, the Veteran died in May 2015. The Veteran's surviving spouse has been substituted as the appellant for purposes of processing the claim to completion. See 38 U.S.C. § 5121A. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2016, the Board remanded the claim to the agency of original jurisdiction (AOJ) for additional development. In a June 2019 decision, the Board, in pertinent part, denied the issue on appeal. The appellant appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In April 2020, the Court granted a Joint Motion for Remand (JMR) filed by the parties to the appeal (the appellant, through an attorney, and representatives from VA General Counsel), thereby vacating the Board's June 2019 decision as to the denial of the claim or issue on appeal and remanding the matter for readjudication. In October 2020, the Board remanded the issue currently on appeal to the AOJ for additional development. After taking further action, the AOJ confirmed and continued the prior denial and returned the case to the Board. See February 2021 supplemental statement of the case. Entitlement to service connection for a left lower extremity disability, to include as secondary to service-connected pes planus, is remanded. Although the Board sincerely regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the appellant's claim and to afford her every possible consideration. The Veteran claimed that his left leg/knee issue is related to his service-connected pes planus. He also advanced additional theories of service-connection. In a statement from March 2004, the Veteran indicated that artillery shells turned over a truck and caused an injury on his left side. In a March 2010 statement, the Veteran reported being involved in a motor vehicle accident while in service in which he struck his left leg on the dashboard. He reported not going to the hospital following this incident and there are no records of this accident in his file. With respect to direct service connection, a December 2018 VA examiner could not determine what effect a left leg injury would have on the Veteran's degenerative changes of the left knee, and indicate that he would have would have to resort to speculation what the injury was. The October 2020 Board remand requested that the AOJ obtain an addendum opinion addressing whether the left knee/leg disability was aggravated by service-connected pes planus. A February 2021 VA examiner opined that the Veteran's left knee/leg disability was not at least as likely as not aggravated beyond its natural progression by the service-connected pes planus. The rationale was that there is no evidence in the Veteran's file documenting that pes planus directly or indirectly caused the Veteran's left knee/left leg condition. The examiner further explained that there is no possible pathophysiologic mechanism discussed in the medical literature and know medical principles that would explain such a caused relationship between these conditions. While the February 2021 VA examiner provided a negative opinion with respect to whether the Veteran's left knee/leg disability was aggravated by service-connected pes planus, the rationale focused on the absence of causation. Accordingly, the Board finds that the February 2021 VA opinion is inadequate because it is not supported by an adequate rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (a medical opinion that is unsupported by a coherent rationale is of no probative value); see also Jones v. Shinseki, 23 Vet. App. 382 (2010). Based on the foregoing, the Board finds that there has not been substantial compliance with the October 2020 Board remand directives, and that a remand for an addendum VA opinion is, therefore, warranted. See Stegall v. West, 11 Vet. App. 268 (1998); Barr v. Nicholson, 21 Vet. App. 303 (2007) (finding that VA must provide an examination that is adequate for rating purposes). The matter is REMANDED for the following action: 1. Arrange for the claims file to be reviewed by a VA examiner with appropriate expertise for the purpose of preparing an addendum opinion with respect to the etiology of the Veteran's left lower extremity disability. After reviewing the record, the examiner is requested to provide an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the Veteran's left lower extremity disability (diagnosed as degenerative arthritis of the left knee) had its onset in, or was otherwise attributable to, service. In providing the above-referenced, the examiner should address the Veteran's March 2004 statement that artillery shells turned over a truck and caused an injury to his left side, as well as the March 2010 statement that he was involved in a motor vehicle accident while in service in which he struck his left leg on the dashboard. In this regard, the examiner should consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, did the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or were the Veteran's reports generally inconsistent with medical knowledge or implausible? If it is the examiner's opinion that it is unlikely that the Veteran's left lower extremity disability was incurred in service or is otherwise related to service, the examiner should render a further opinion as to whether it is at least as likely as not (i.e., is it 50 percent or more probable) that the Veteran's left lower extremity disability was (a) caused or (b) aggravated (i.e., worsened beyond normal progression) by his service-connected pes planus. A complete medical rationale for all opinions expressed must be provided. If an opinion cannot be provided without resorting to speculation, the examiner is requested to provide complete explanations of why this is so. In so doing, the examiner should explain whether any inability to provide a more definitive opinion is the result of a need for additional information, or whether the limits of current medical knowledge have been exhausted in providing an answer to that particular question. 2. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraph, the issue on appeal should be readjudicated based on the entirety of the evidence. If the benefit sought remains denied, the appellant and her representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. J. Ragheb Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.