Citation Nr: 21041988 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-01 304 DATE: July 10, 2021 REMANDED 1. Entitlement to service connection for a right knee disability, to include as secondary to service-connected bilateral heel calcaneal stress fracture. is remanded. 2. Entitlement to service connection for a left knee disability, to include as secondary to service-connected bilateral heel calcaneal stress fracture. is remanded. 3. Entitlement to service connection for a right ankle disability, to include as secondary to service-connected bilateral heel calcaneal stress fracture, is remanded. REASONS FOR REMAND The appellant is a Veteran who had active service from November 1965 to November 1968. These matters are before the Board of Veterans' Appeals (Board) on appeal from an April 2014 Department of Veterans Affairs (VA) rating decision. In May 2019 the Board remanded these matters for further development. 1., 2., 3. Entitlement to service connection for right and left knee disabilities and for a right ankle disability, all to include as secondary to service-connected bilateral heel calcaneal stress fracture. In Stegall v. West, 11 Vet. App. 268, 271 (1998), the United States Court of Appeals for Veterans Claims (CAVC) held that a remand by the Board confers upon the Veteran, as a matter of law, the right to compliance with the Board's remand order. The CAVC held that the Board itself errs when it fails to ensure compliance with the terms of its remand. Id. The Board finds that the AOJ did not substantially comply with the prior Board's remand directives. While the additional delay inherent with another remand is regrettable, the Board finds that another remand is required to fairly decide these appeals, and that remand for corrective action is necessary. The Veteran claims he has left and right knee, and right ankle disabilities, each of which is secondary to his service-connected bilateral calcaneal heel stress fractures. On April 2014 VA ankle and knee examinations an ankle disability diagnosis was not found. During the knee examination, the Veteran reported gradual onset of bilateral knee pain, right greater than left, about 10 years prior. The examiner opined that the claimed bilateral knee condition was less likely than not proximately due to or the result of the Veteran's service connected bilateral heel disabilities because the 10 year prior to the examination onset of the knee disability was decades after the bilateral calcaneal stress fractures occurred; furthermore, there was insufficient medical evidence to establish a baseline level of severity of knee condition. On January 2020 VA knee and ankle examinations (conducted in response to the Board's remand), bilateral chronic knee strain and chronic ankle strain were diagnosed. The examiner found (without including any rationale) that each disability was not proximately caused by the service-connected calcaneal stress fractures of the heels. It noted that the Veteran's gait was normal and [therefore] unlikely that any injury to the knees would have occurred in absence of a significantly altered gait and also (without explanation of rationale) that the Veteran's knee conditions appeared to be age related. The opinions offered are conclusory statements, without adequate explanation if rationale or adequate citation to supporting factual data in the record or medical principles. Moreover, the examiner failed to consider/address the Veteran's lay statements. Therefore, the January 2020 medical opinions are inadequate for rating purposes. Accordingly, the matters are REMANDED for the following action: Arrange for the Veteran's claims file to be forwarded to an appropriate clinician (in orthopedics) for review and an advisory medical opinion identifying the likely etiology of his diagnosed right and left chronic knee strain and right ankle strain disabilities, and specifically whether they were incurred in service or are secondary to (were caused or aggravated [aggravation must be addressed] by) his service-connected bilateral heel calcaneal stress fractures. Upon review of the claims file, specifically including this remand, the consulting clinician should provide responses to the following: (a) Was the diagnosed chronic right ankle strain at least as likely as not (a 50 percent or better probability) incurred in service, to include as due to the same trauma that resulted in his bilateral heel calcaneal stress fractures? (b) If not, was the right ankle strain at least as likely as not either caused or aggravated by his service-connected bilateral heel calcaneal stress fractures? (c) Were the Veteran's diagnosed chronic right and left knee strain, each, at least as likely as not incurred in service, to include as due to the trauma therein that resulted in his bilateral heel calcaneal stress fractures? (d) If not, were the right and left knee strain, each, at least as likely as not caused or aggravated by his service-connected bilateral heel calcaneal stress fractures? (e) If chronic right ankle strain, right knee strain, and/or left knee strain is determined to not have been incurred in service, but found to have been aggravated by the service-connected bilateral heel calcaneal stress fracture, to the extent possible (if not possible explain why that is so) identify the baseline level of severity of the disability (e.g., symptoms and impairment) shown before the aggravation occurred and the level of severity of the disability when the aggravation was completed. (f) If the diagnosed chronic right ankle strain, and chronic right and/or left chronic knee strain are determined to not have been incurred in service or caused or aggravated by the service-connected bilateral heel stress fractures, identify the etiology for each of those disabilities that is considered to be more likely, as shown or suggested by the record, and explain why that is so. All opinions must include a clear explanation of rationale, with citation to supporting clinical/factual data in the record and to medical principles. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Camille NeSmith, 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.