Citation Nr: 21042697 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 17-18 347 DATE: July 13, 2021 ORDER Entitlement to service connection for residuals of a meniscal tear of the left knee as secondary to service-connected lateral ligament instability of the left ankle is granted. FINDING OF FACT The Veteran's residuals of a meniscal tear of the left knee is proximately due to his service-connected lateral ligament instability of the left ankle. CONCLUSION OF LAW The criteria for service connection for residuals of a meniscal tear of the left knee as secondary to lateral ligament instability of the left ankle are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served honorably in the United States Army from March 1991 to July 1997. In January 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript is of record. In April 2020 and March 2021, the Board remanded the case for further development. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to service connection for left knee condition secondary to service-connected lateral ligament instability of the left ankle The Veteran contends he is entitled to service connection for left knee condition secondary to his service-connected left ankle condition as he has increased knee pain and swelling due to his ankle pain. In January 2020, the Veteran testified before the Board that a couple years into military service his knee started getting sore due to parachute jumps. He stated that since discharge he has experienced pain, which tremendously increased since his left ankle surgery in 2013. The Veteran explained that his ankle injury causes a limp on the left side and he incurred permanent nerve damage from his left ankle surgery, which causes instability. The Veteran's testimony as to the presence of his observable symptoms is competent and credible. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board notes that evidence of record contains several VA medical opinions regarding the nature and etiology of the Veteran's left knee condition. In April 2020 the Board remanded the claim as the July 2015 medical opinion was deemed inadequate for failure to consider the Veteran's symptoms of pain and functional loss. Another medical opinion was obtained August 2020. The VA examiner provided a negative nexus opinion stating that after reviewing the history, physical examination, treatment records and medical textbook, the Veteran was treated and resolved for overused left knee pain. He then noted that there was no evidence of serious injury or chronic condition of low back during service or in the civilian record. In October 2020, the Veteran provided a positive private medical opinion linking the Veteran's knee condition to his service-connected ankle condition, but the clinician, Dr. P.S. did not provide a supporting rationale. The doctor noted that the Veteran's left ankle disability caused a meniscal tear in the left knee. Consequently, in March 2021 the Board again remanded the case for a medical opinion as the August 2020 medical opinion failed to substantially comply with the previous remand directives and relied on a factually inaccurate premise as the Veteran is not claiming injury secondary to his low back. See Stegall v. West, 11 Vet. App. 268 (1998). Additionally, the October 2020 private opinion was inadequate for failure to provide a rationale as a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In March 2021, the same VA examiner again provided a negative nexus opinion stating that he reviewed the opinion of Dr. P.S., but his opinion remained the same. Again, in complete disregard for the remand directives, the examiner repeated the same incompetent rationale citing to no evidence of a back condition, which is not at issue, and failing to consider the lay evidence of record; thereby, providing yet another inadequate opinion. As such, the Board concludes that the VA medical opinions of record carry no weight. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that a medical opinion based on an inaccurate factual premise has no probative value). Conversely, the clinician, Dr. P.S. who provided the October 2020 medical opinion provided an addendum opinion in May 2021. Dr. P.S. reported that he is a Board-Certified Orthopedic Surgeon who provides care to the Veteran for left ankle and knee condition. He opined after review of the Veteran's current and military records and full examination, to include x-rays of the ankle and knee that the pain, frequent locking, swelling and meniscus tears of the left knee are due to the service-connected left ankle injury. Dr. P.S. explained that the Veteran's left ankle condition causes poor ankle alignment, which causes poor knee alignment. The poor knee alignment results in injury to the left knee meniscus. The Board finds the opinion of Dr. P.S. to be persuasive and affords it probative weight as it was provided by a competent, qualified health care professional, who reviewed the record, conducted a physical examination, and provided an adequate rationale. Accordingly, the competent and credible testimony provided by the Veteran and the medical opinion provided by Dr. P.S. establish that the left knee residuals of a meniscal tear is proximately due to his service-connected lateral ligament instability of the left ankle. Entitlement to service connection is granted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102." G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.