Citation Nr: 18139822 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 13-18 867 DATE: October 1, 2018 REMANDED Entitlement to service connection for a right knee disorder, to include as secondary to service-connected diabetes mellitus, is remanded. Entitlement to special monthly compensation based on aid and attendance or housebound status (SMC) is remanded. REASONS FOR REMAND The Veteran had active military service from January 1969 to January 1970. In October 2016, the Veteran appeared and provided testimony at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. This case was previously before the Board in August 2017. At that time, the Board remanded the Veteran’s claims for further development. The Veteran was afforded a VA examination in August 2017 for his right knee pursuant to the Board remand. However, the examiner did not clearly provide the requested nexus opinions, particularly regarding aggravation of the condition by the Veteran’s service-connected diabetes mellitus, and did not use the “at least as likely as not” legal standard in the remarks he did provide. The Veteran had been afforded a previous VA examination in this matter in September 2013, but that VA examiner also failed to provide all nexus opinions the Board needs to decide the Veteran’s claim. A new VA knee examination with nexus opinions should be obtained. The Veteran is also seeking SMC based on aid and attendance or housebound status. As a determination on the issue of service connection for the Veteran’s right knee disorder could impact the outcome of the issue of entitlement to SMC, the Board finds that the issues are inextricably intertwined and entitlement to SMC must be remanded, as well. The matters are REMANDED for the following action: 1. Provide the Veteran with a VA examination of his right knee. The examiner should diagnose any right knee disability that the Veteran has or has had at any time during the appeal period, to include residuals of sepsis or septic arthritis which was treated in July 2008. For each disability diagnosed, the examiner should provide the following opinions: (a.) Is it at least as likely as not (50 percent or greater) that the right knee disability either began during or was otherwise caused by the Veteran’s military service? Why or why not? (b.) Is it at least as likely as not (50 percent or greater) that the right knee disability was caused by his service-connected diabetes mellitus? Why or why not? (c.) Is it at least as likely as not (50 percent or greater) that the right knee disability was aggravated (made worse) by his service-connected diabetes mellitus? Why or why not? In rendering this opinion, the examiner should also address the June 15, 2012 opinion from VA physician Dr. Bronchitis suggesting that the Veteran’s right knee osteoarthritis progression was aggravated by the 2008 right knee infection, which has been medically linked to the Veteran’s service-connected diabetes mellitus by the September 2013 VA examiner. If aggravation is found, the examiner should identify a baseline level of severity of the right knee disability by medical evidence created before the onset of aggravation or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity of the right knee disability. If such cannot be done, it should be explained why. (Continued on the next page)   (d.) If a diagnosis of right knee arthritis is made, the examiner should also discuss whether it is at least as likely as not (i.e., a likelihood of 50 percent or greater) that arthritis of the Veteran’s right knee was manifested to a compensable degree within one year of separation from active service? Why or why not? MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Davidoski, Associate Counsel