Citation Nr: 22017362 Decision Date: 03/24/22 Archive Date: 03/24/22 DOCKET NO. 17-57 217 DATE: March 24, 2022 REMANDED Service connection for a right ankle disorder is remanded. Service connection for a left ankle disorder is remanded. REASONS FOR REMAND The Veteran, who is the Appellant, served on active duty from May 1979 to July 1979, and from February 1986 to March 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2016 rating decision from the Regional Office (RO), which, in pertinent part, denied service connection for right and left ankle conditions. This case was previously before the Board in April 2019, where the issues on appeal were remanded. A remand by the Board confers on the claimant, as a matter of law, the right to compliance with the remand orders. Failure of the Board to ensure compliance with remand instructions constitutes error and warrants the vacating of a subsequent Board decision. Stegall v. West, 11 Vet. App. 268, 271 (1998). VA must afford a veteran a medical examination and/or obtain a medical opinion when it is necessary to decide a claim. 38 U.S.C. § 5103A (d) (2012); 38 C.F.R. § 3.159(c)(4) (2017). To that end, when VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In the April 2019 Board Remand, the Board indicated that the examiner should reconcile all prior diagnoses with the current findings and, if a diagnosis could not be reconciled with the current findings, the examiner should explain why. Prior diagnoses in the record included bilateral degenerative joint disease (DJD) of the ankle, equinus contracture of the ankle and foot, tenosynovitis of the ankle and foot, bilateral posterior tibial tendon dysfunction, and Charcot-Marie-Tooth. See May 2012, April 2014, September 2015, August 2019 private treatment records; see also May 2017, April 2019 VA treatment records. The Veteran was provided a VA ankle examination in December 2019. The VA examiner diagnosed indicated ankle range of motion in dorsiflexion, bilateral, and ankle pain secondary to diagnosed Charcot Marie Tooth (CMT). The VA examiner opined that the CMT disease is a neurologic condition, which is unrelated to the musculoskeletal complaints (bilateral ankle sprain) that were treated in service. The VA examiner also noted that x-rays in December 2019 do not evidence degenerative joint disease in the ankles. The VA examiner did not reconcile additional diagnoses of equinus contracture of the ankle, tenosynovitis of the ankle, and posterior tibial tendon dysfunction, which are also diagnosed in the record. The VA examiner has not indicated whether these diagnoses are also neurological conditions that are apart from the CMT disease or separate ankle disorders. As such, an addendum opinion may help reconcile the additional diagnoses of bilateral equinus contracture and tenosynovitis of the ankle, and bilateral posterior tibial tendon dysfunction with the neurologic diagnosis of CMT disease. In a December 2019 statement, the Veteran asserted that he began to walk unevenly due to pain associated with the service-connected left proximal tibia with residuals chronic left knee strain and right knee strain, which caused him to develop problems with both ankles over time. This assertion raises a theory of secondary service connection. See 38 C.F.R. § 3.310. The RO should also request a medical opinion as to whether the right and left ankle disorders were caused or aggravated (worsened in severity beyond a normal progression) by the service-connected left proximal tibia with residuals chronic left knee strain and right knee strain. Service connection for right and left ankle disorders are REMANDED for the following action: 1. Return the VA medical opinion report to the VA examiner who provided the medical opinion in December 2019. If the original VA examiner is unavailable, a new examiner may be assigned to address the requested opinion. The relevant documents in the record should be reviewed by the examiner, and a detailed history of relevant symptoms should be obtained from the record. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The examiner should offer opinions: a) Are the ankle diagnoses of bilateral equinus contracture of the ankle, tenosynovitis of the ankle, and posterior tibial tendon dysfunction a part of the (neurologic) CMT disease? Or are they separate and unrelated ankle disorders? b) If they are separate ankle disorders, is it at least as likely as not (50 percent or greater probability) that the current right and/or left ankle conditions (to include equinus contracture of the ankle, tenosynovitis of the ankle, and posterior tibial tendon dysfunction) were caused by or etiologically related to bilateral ankle strain during service? c) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed right and/or left ankle disorder (to include CMT, equinus contracture of the ankle, tenosynovitis of the ankle, and posterior tibial tendon dysfunction) was caused by the service-connected left proximal tibia with residuals chronic left knee strain and right knee strain? If so, please explain how bilateral knee strains could cause bilateral ankle disabilities. b) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed right and/or left ankle condition (to include CMT, equinus contracture of the ankle, tenosynovitis of the ankle, and posterior tibial tendon dysfunction) was aggravated by (worsened beyond its natural progression by) the service-connected left proximal tibia with residuals chronic left knee strain and right knee strain? If so, please explain how bilateral knee strains might act on both ankles to worsen any ankle disability. J. PARKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Moore, S. 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.