Citation Nr: 18145631 Decision Date: 10/30/18 Archive Date: 10/29/18 DOCKET NO. 12-02 110 DATE: October 30, 2018 REMANDED ISSUES Entitlement to service connection for a low back disability, to include as secondary to a bilateral knee disability, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to a bilateral knee disability, is remanded. Whether a reduction from 20 to 10 percent for a right knee disability was proper, is remanded. Entitlement to a disability rating in excess of 10 percent for a right knee disability, is remanded. Entitlement to special monthly pension based on the need of aid and attendance, is remanded. Entitlement to a total disability rating based on individual unemployability, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from February 1990 to April 1993. Entitlement to service connection for a low back disability, to include as secondary to a bilateral knee disability, is remanded. Concerning the Veteran’s service connection claim for a low back disability, in its December 2015 remand the Board determined that a new VA back examination was necessary in light of evidence suggesting the Veteran’s back disability may be due to an altered gait caused by his service-connected knee disability. The Board observes the Veteran has a long history of an abnormal gait, as due to his service-connected left knee disability. See July 1999, January 2000, July 2001, March 2003, July 2005, December 2008, and August 2010 VA medical examination. In February 2016, the Veteran was afforded a VA examination for his service connection claim for a low back disability, but the medical opinion addressing secondary service connection did not include discussion of the effect of the Veteran’s abnormal gait, if any. Following remand, the Veteran was afforded another VA examination in August 2017, and the examiner opined the Veteran’s low back disability was medically unrelated to his service-connected knee disabilities. By way of rationale, the examiner stated that the back disorder is a separate entity entirely from the service-connected knee, and the medical literature does not support a medical relationship. Again, the examiner did not specifically discuss the Veteran’s history of an abnormal gait, and whether despite the fact the back and knee are two separate entities, such gait problems could cause or aggravate the back condition. Notably, in a January 2017 Appellate Brief, the Veteran submitted a medical discussion paper indicating that limping or altered gait may accelerate disc degeneration in the lumbar spine. See January 2017 Appellate Brief. On remand, an addendum opinion should be obtained specifically addressing the effect, if any, of the Veteran’s altered gait on his back disability. The issues of (1) entitlement to service connection for a left hip disability; (2) whether a reduction from 20 to 10 percent for a right knee disability was proper; (3) entitlement to a disability rating in excess of 10 percent for a right knee disability; (4) entitlement to special monthly pension based on the need of aid and attendance; and (5) entitlement to a total disability rating based on individual unemployability (TDIU), are remanded. In an August 2015 decision, the Board remanded the issues of (1) entitlement to service connection for a left hip disability; (2) whether a reduction from 20 to 10 percent for a right knee disability was proper; (3) entitlement to a disability rating in excess of 10 percent for a right knee disability; (4) entitlement to special monthly pension based on the need of aid and attendance; and (5) entitlement to a total disability rating based on individual unemployability (TDIU) for additional evidentiary development and readjudication. It is evident, upon review of the file, that the AOJ has taken no action on the Board’s August 2015 remand instructions. Upon further inquiry, it appears that these remanded issues were erroneously closed in VA’s appeals tracking system. The error has been corrected, and the Board will remand these issues again at this time to ensure compliance with its prior instructions. The matter is REMANDED for the following action: 1. With any necessary authorization from the Veteran, obtain all of his outstanding treatment records. 2. Obtain an addendum medical opinion addressing the etiology of the Veteran’s back disability. A new examination is only required if deemed necessary by the examiner. The record and a copy of this remand must be made available to the examiner for review. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran’s back disability was caused or aggravated beyond its natural progression by his service-connected bilateral knee disabilities, to specifically include any altered gait and/or body mechanics resulting from such. In so opining, the examiner must consider and discuss the Veteran’s lay statements, and the medical discussion paper concerning limping and back pain submitted with the Veteran’s January 2017 Appellate Brief. Any opinion expressed should be supplemented with a supporting medical explanation. 3. Arrange for the Veteran to undergo an appropriate VA examination to determine the nature and etiology of any left hip disability. The claims folder must be thoroughly reviewed by the examiner in connection with the examination, and a complete history should be elicited from the Veteran. Any tests and studies deemed necessary by the examiner should be conducted. All findings should be reported in detail. 4. The examiner should identify any pertinent pathology found and should diagnose any current left hip disability. As to any pertinent disability identified on examination, the VA examiner should express an opinion as to whether it is at least as likely as not (a 50 percent probability or more) that any such disability was incurred or aggravated as a complication of his service-connected bilateral knee disabilities, to specifically include an altered gait, or alternatively, as a result of his active service. Any opinion expressed must be accompanied by a complete rationale. 5. Schedule the Veteran for a VA Aid and Attendance examination. The entire claims file must be provided to and reviewed by the examiner. Any indicated tests must be obtained prior to the final examination report. 6. Issue a Statement of the Case to the Veteran and his representative, addressing the issue of whether the rating reduction from 20 percent to 10 percent for a right knee disability was proper. The Veteran and his representative must be advised of the time limit in which he may file a Substantive Appeal. Then, only if the appeal is timely perfected, should the issue of whether the rating reduction from 20 percent to 10 percent for a right knee disability was proper be returned to the Board for further appellate consideration, if otherwise in order. 7. Then, readjudicate the issues remaining on appeal. If any benefit sought remains denied, issue the Veteran and his representative a Supplemental Statement of the Case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Mask, Associate Counsel