Citation Nr: 22014133 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 15-27 825 DATE: March 11, 2022 REMANDED Entitlement to service connection for a low back disability, to include as secondary to a service-connected left ankle disability, is remanded. Entitlement to service connection for a right hip disability, to include as secondary to a service-connected left ankle disability, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to a service-connected left ankle disability, is remanded. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected left ankle disability, is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected left ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from February 1980 to February 1984. This matter comes before the Board of Veterans Appeals (Board) on appeal from an April 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran unfortunately died in December 2018, during the pendency of this appeal. The appellant is his surviving spouse, who has since been substituted to process these claims for accrued benefits to completion. This matter was most recently before the Board in June 2021 when it was remanded to the Agency of Original Jurisdiction (AOJ) for additional development. 1. Entitlement to service connection for a low back disability, to include as secondary to a service-connected left ankle disability is remanded. 2. Entitlement to service connection for a right hip disability, to include as secondary to a service-connected left ankle disability is remanded. 3. Entitlement to service connection for a left hip disability, to include as secondary to a service-connected left ankle disability is remanded. 4. Entitlement to service connection for a right knee disability, to include as secondary to a service-connected left ankle disability is remanded. 5. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected left ankle disability is remanded. The Board finds that additional development is needed prior to adjudication to the issues on appeal. Pursuant to the June 2021 Board remand, a VA opinion was obtained to address secondary service connection. The examiner provided negative opinions as to whether the Veteran's service-connected left ankle disability caused his other disabilities in her July 2021 opinion, which included a rationale. An additional opinion was obtained in October 2021. The examiner provided negative opinions as to whether the Veteran's disabilities were aggravated by his service-connected left ankle disability. However, she did not provide an adequate rationale as to her aggravation opinions; rather, she reiterated her causation rationale. This rationale was inadequate because, in pertinent part, the VA examiner appears to have mixed consideration of the questions of causation and aggravation, which must be addressed separately as they are distinct theories of service connection. Atencio v. O'Rourke, 30 Vet. App. 74, 91 (2018); El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Accordingly, the Board finds that a remand is warranted for a supplemental opinion. The matters are REMANDED for the following action: Obtain an addendum opinion from a new VA examiner to determine the nature and etiology of the Veteran's low back, right hip, left hip, right knee, and left knee disabilities. The examiner is requested to review all pertinent records associated with the claims file, including a copy of this remand, the Veteran's service treatment records, post-service medical records, and statements. It should be noted that the Veteran was competent to attest to factual matters of which he had first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. After considering the Veteran's pertinent medical history and lay statements regarding his reported symptoms, the examiner should opine as to: (a) Whether it is at least as likely as not (a 50 percent probability or greater) that his low back, right hip, left hip, right knee, and left knee disabilities were incurred in, aggravated by, or etiologically related to his military service. (b) Whether it is at least as likely as not (a 50 percent probability or greater) that his low back, right hip, left hip, right knee, and left knee disabilities were caused by his service-connected left ankle disability, such as from overcompensating for that service-connected disability. (c) Whether it is at least as likely as not (a 50 percent probability or greater) that his low back, right hip, left hip, right knee, and left knee disabilities were aggravated by his service-connected left ankle disability, such as from overcompensating for that service-connected disability. The examiner must address the Veteran's June 2012 lay statements and medical evidence showing he used a cane to walk and had an altered gait. Aggravation is defined as any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease or injury, and not due to the natural progress of the nonservice-connected disease. The examiner is advised that a finding that a disability was aggravated beyond the normal progression due to a service-connected disability does not require evidence of permanent worsening and may encompass any additional impairment in earning capacity resulting from an already service-connected condition. A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The examiner is notified that mere reference to prior opinions will not be accepted as a sufficient rationale for the requested opinions; a thorough explanation for each opinion requested must be provided. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Javed, 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.