Citation Nr: 18147427 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 14-32 276 DATE: November 5, 2018 REMANDED Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected right and left knee disabilities, is remanded. Entitlement to service connection for a right hip disability, to include as secondary to service-connected right and left knee disabilities, is remanded. Entitlement to service connection for a left hip disability, to include as secondary to service-connected right and left knee disabilities, is remanded. Entitlement to a compensable rating for chronic right knee dislocation is remanded. Entitlement to an increased rating for right knee degenerative joint disease (DJD) with torn ACL, status post right total knee replacement, currently rated as 20 percent disabling prior to December 6, 2011, and 30 percent disabling since February 1, 2013 is remanded. Entitlement to a rating in excess of 10 percent for left knee chondromalacia (left knee disability) is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from June 1978 to January 1980. These matters are before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In December 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Video Conference hearing. A transcript of her testimony is of record. Regarding the Veteran’s right knee and TDIU claims, she was in receipt of a temporary total rating (TTR) from December 6, 2011, to January 31, 2012. As this is the maximum rating assignable, an increased rating or TDIU for that period is not for consideration. 1. Entitlement to service connection for a lumbar spine disability, to include as secondary to service-connected right and left knee disabilities is remanded. 2. Entitlement to service connection for a right hip disability, to include as secondary to service-connected right and left knee disabilities is remanded. 3. Entitlement to service connection for a left hip disability, to include as secondary to service-connected right and left knee disabilities is remanded. 4. Entitlement to a compensable rating for chronic right knee dislocation is remanded. 5. Entitlement to an increased rating for right knee DJD with torn ACL, status post right total knee replacement, currently rated as 20 percent disabling prior to December 6, 2011 and 30 percent disabling since February 1, 2013 is remanded. 6. Entitlement to a rating in excess of 10 percent for left knee chondromalacia is remanded. 7. Entitlement to a TDIU is remanded. The record indicates that there are outstanding private treatment records. VA and private treatment records indicate that the Veteran received private treatment from outside primary care providers, to include Carolina Primary Care and Dr.Bhat. To date, these records have not been requested or otherwise obtained. On remand, reasonable efforts should be made to obtain them. Regarding the Veteran’s right and left knee claims, the Veteran asserts that her knee disabilities have increased in severity since she was last examined by VA in August 2011. Specifically, she noted that she underwent a total right knee arthroplasty on December 6, 2011. In light of the Veteran’s assertions and her right knee arthroplasty, she should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of her right and left knee disabilities. Regarding the Veteran’s lumbar spine, right hip, and left hip claims, the Board cannot make a fully-informed decision on the issues because no VA examiner has opined whether the Veteran’s current lumbar spine and hip disabilities are related to her service-connected right and left knee disabilities, to include addressing her assertions regarding her having an altered gait and injuring her back and hips in falls after her right knee gave out. While the Board acknowledges the December 2010 VA examiner’s opinions, those opinions are insufficient to adjudicate the claims because the opinions did not address the Veteran’s assertions regarding her altered gait and falls. Accordingly, addendum opinions are warranted. In July 2013, the Veteran submitted a VA Form 21-8940. To date, information from the identified prior employers has not been requested. As such information is relevant to the Veteran’s TDIU claim, that information must be requested. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated her for her claimed disabilities, to include Dr. Bhat and Carolina Primary Care. After securing any necessary releases, the AOJ should request any relevant records identified. In addition, obtain updated VA treatment records. If any requested records are unavailable, the Veteran should be notified of such. 2. Request employment information from the employer identified on the July 2013VA Form 21-8940 and any other employer identified by the Veteran. If additional information is needed from the Veteran to permit the request to be undertaken, the Veteran should be asked to provide such. 3. After records development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected right and left knee disabilities. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s right and left knee disabilities alone and discuss the effect of the Veteran’s right and left knee disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A complete rationale should be provided for all opinions and conclusions expressed. 4. Forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's lumbar spine disability. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any lumbar spine disability, including but not limited to lumbar strain, DJD, and degenerative disc disease DDD, was caused by the Veteran’s service-connected right and left knee disabilities? (b.) If not caused by the service-connected right and left knee disabilities, is it at least as likely as not that the Veteran's lumbar spine disability, including but not limited to lumbar strain, DJD, and DDD, is worsened beyond natural progression (aggravated) by her service-connected right and left knee disabilities? In rendering the above requested opinions, the clinician should address the Veteran’s assertions that her lumbar spine disability is related to an altered gait secondary to her service-connected knee disabilities and / or falls from her right knee giving out. A complete rationale should be provided for all opinions and conclusions expressed. 5. Forward the claims file to a VA clinician to obtain an addendum opinion regarding the Veteran's right and left hip disability claims. If an examination is deemed necessary to respond to the questions presented, one should be scheduled. Following review of the claims file, the clinician should opine: (a.) Whether it is at least as likely as not (50 percent probability or greater) that any right or left hip disability, including but not limited to DJD, was caused by the Veteran’s service-connected right and left knee disabilities? 6. If not caused by the service-connected right and left knee disabilities, is it at least as likely as not that any right or left hip disability, including but not limited to DJD, is worsened beyond natural progression (aggravated) by her service-connected right and left knee disabilities? In rendering the above requested opinions, the clinician should address the Veteran’s assertions that her right and left hip disabilities are related to an altered gait secondary to her service-connected knee disabilities and / or falls from her right knee giving out. (Continued on the next page)   A complete rationale should be provided for all opinions and conclusions expressed. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Anderson