Citation Nr: 22015497 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 16-39 934 DATE: March 17, 2022 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2012 to May 2012. This matter was remanded by the Board of Veterans' Appeals (Board) in May 2020 for further development. Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a left knee disability is remanded. After carefully considering this matter, and for reasons expressed immediately below, the Board finds that this case must again be remanded for further development. A May 2020 Board decision remanded this matter for medical opinions to ascertain the nature and etiology of the Veteran's claimed left ankle and left knee disabilities. Pursuant to the remand, medical opinions regarding these issues were obtained in December 2020. Unfortunately, the Board finds these opinions to be inadequate. Specifically, the December 2020 examiner opined that it was less likely than not that the Veteran's left knee disability was caused by active service. The examiner explained that the Veteran had no knee complaints while in service and did not complain of bilateral knee pain until an August 2012 Disability Benefits Questionnaire (DBQ), which showed no objective findings or diagnosis. Regarding secondary service connection, the examiner opined that it was less likely than not that the Veteran's left knee disability was proximately due to or caused by the service-connected left hip disability. The examiner explained that a condition of the hip would not cause a condition of the knee. It was stated that antalgic gait/gait accommodation does not cause a condition of another joint, with rare exceptions. The December 2020 VA examiner also opined that it was less likely than not that the Veteran's left ankle disability was caused by active service. The examiner stated that there is no evidence of a chronic left ankle condition during the Veteran's service. The examiner noted that a February 2012 bone scan revealed bilateral ankle stress reaction however, a 2013 follow-up bone scan showed resolution of the previously seen hotspots on the knees and ankles to which, the examiner implied resolution of the mild stress reaction. While the examiner noted the Veteran's current achilles tendinitis diagnosis, the examiner explained that this is an anatomical area completely separate from the medial malleolar stress reaction seen on the original bone scan. The examiner stated that regardless of its onset, the Veteran's current achilles tendinitis is not consistent with the findings on the prior bone scan. Regarding secondary service connection, the examiner opined that it was less likely than not that the Veteran's left ankle disability was proximately due to or caused by the service-connected left hip disability. The examiner explained that achilles tendinitis would not be caused by an antalgic gait/date accommodation or pelvic ramus fracture/hip condition because such condition is an overuse injury or can occur acutely. Further, a condition of one joint does not cause a condition of the other, especially in the case of a pelvic ramus fracture and achilles tendinitis. In this regard, the Board finds the December 2020 VA examiner's opinion failed to adequately address aggravation regarding secondary service connection. Specifically, the examiner did not address the possibility that the Veteran's left knee and/or left ankle have been aggravated by her service-connected left hip condition. The Board also finds that the December 2020 VA examiner did not adequately address the Veteran's lay statements. The Veteran has consistently reported left knee and left ankle pain since active service; however, these reports were not discussed by the examiner. As such, the Board finds that the December 2020 examiner's opinions are inadequate for adjudicative purposes and new medical opinions that adequately addresses the nature and etiology of the Veteran's left ankle and left knee disabilities must be obtained. Accordingly, this matter is REMANDED for the following action: 1. Undertake appropriate efforts to obtain medical opinions regarding the nature and etiology of any current left knee and left ankle disabilities. The entire claims file must be provided to the examiner for review. The examiner should opine as to the following: (a.) Is it at least as likely as not (a 50 percent or greater probability) that any current left knee disability was incurred in, or was otherwise caused by, the Veteran's period of active service? (b.) Is at least as likely as not (a 50 percent or greater probability) that any current left knee disability was (1) caused by the Veteran's service-connected left pubic ramus stress fracture or, (2) aggravated by the Veteran's service-connected left pubic ramus stress fracture? (c.) Is it at least as likely as not (a 50 percent or greater probability) that any current left ankle disability was incurred in, or was otherwise caused by, the Veteran's period of active service? (d.) Is at least as likely as not (a 50 percent or greater probability) that any current left ankle disability was (1) caused by the Veteran's service-connected left pubic ramus stress fracture or, (2) aggravated by the Veteran's service-connected left pubic ramus stress fracture? A complete rationale for all opinions must be provided. In providing the requested opinions, the examiner must address the Veteran's lay assertions. Lay statements of record cannot be disregarded solely due to lack of contemporaneous medical evidence. The examiner is asked to address the Veteran's reports of symptoms of left knee and ankle symptoms since her period of service in August 2012, January 2015, July 2016, and May 2019. The examiner is also asked to address the records from the Moncrief Army Hospital from the Veteran's period of active service (February 24, 2012) reporting an antalgic gait on the left. Patrick M. Johnson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. R. Bobb, 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.