Citation Nr: 18140594 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 10-16 138 DATE: October 3, 2018 REMANDED 1. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is remanded. 2. Entitlement to service connection for a low back disability, to include as secondary to a service-connected right knee disability, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1979 to May 1984. These matters are before the Board on appeal from June 2008 and September 2010 rating decisions. In July 2016, the Board remanded the matters for additional development. 1. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is remanded. In the previous [July 2016] remand, the Board instructed that the Veteran be afforded a new VA examination which fully addresses the issue on appeal. The examiner was to provide opinions regarding whether the Veteran’s current left knee disability had its onset in service, is otherwise etiologically related to an injury or incident in service to include his March 1981 motorcycle accident, or was caused or aggravated by his service-connected right knee disability (and if aggravated, to identify pre- and post-aggravation levels of severity). On September 2016 VA examination, the examiner opined that the [left knee disability] was less likely than not incurred in or caused by the injury in service [in a motorcycle accident]. The examiner did not address the secondary service connection theory of entitlement. The opinion is therefore inadequate and a remand for corrective action is necessary. 2. Entitlement to service connection for a low back disability, to include as secondary to a service-connected right knee disability, is remanded. The Board’s July 2016 remand instructed that the Veteran be afforded a VA examination; the examiner was to provide opinions regarding whether the Veteran’s current low back disability had onset during service, is otherwise etiologically related to any incident during service (to include the September 1981 report of a low back strain and June 1983 report of ongoing low back pain with inability to bend), or was caused or aggravated by a service-connected right knee disability (and if aggravated identify the pre- and post-aggravation levels of severity of the disability). On September 2016 VA examination, the examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, and less likely than not proximately due to, or secondary to, his right knee disability. The examiner did not opine whether the Veteran’s low back disability was aggravated by his service-connected right knee disability. As the examiner did not address aggravation the opinion is inadequate for rating purposes. The July 2016 remand instructions were not adequately fulfilled. Corrective action is necessary. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following action: 1. Arrange for an orthopedic examination of the Veteran to ascertain the likely etiology of his left knee and low back disabilities, and in particular whether or not each is related to (was caused or aggravated by) his service-connected right knee disability. The Veteran’s VA record must be reviewed by the examiner in conjunction with the examination. On examination/interview of the Veteran and review of his record, the examiner should respond to the following: (a.) Identify (by diagnosis) each left knee and low back disability entity found, and regarding each left knee and low back disability found/diagnosed, opine whether it at least as likely as not (a 50% or greater probability) was incurred in, or is otherwise etiologically related to an injury or incident during, the Veteran’s active duty service. Regarding low back disability, the examiner should specifically note, the September 1981 report of a low back strain and the June 1983 report of ongoing low back pain with inability to bend; regarding left knee disability, note the March 1981 motorcycle accident. (b.) If a left knee or low back disability found is determined to not be etiologically related to service/injury or incident therein, opine further whether it is at least as likely as not that the disability was caused or aggravated by (increased in severity due to) the Veteran’s service-connected right knee disability. [The opinion must address aggravation.] Any finding of aggravation of a left knee or low back disability by a service-connected disability must include identification of the pre- and post-aggravation levels of severity of the claimed disability. (c.) If any left knee or low back disability found is determined to not have been incurred in service or caused or aggravated by a service-connected [right knee] disability, identify the etiology for the disability considered to be more likely, and explain why that is so. The examiner must include rationale with all opinions. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Schechner, Counsel