Citation Nr: 18149498 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 15-11 453 DATE: November 9, 2018 REMANDED Entitlement to service connection for arthritis of the low back, to include as secondary to service-connected left knee disability, is remanded. Entitlement to service connection for arthritis of the right knee, to include as secondary to service-connected left knee disability, is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1984 to April 1991. 1. Entitlement to service connection for arthritis of the low back is remanded. In a March 2015 written statement, the Veteran reported that her back pain began in service. A February 1991 entry in the service treatment record noted pain in the left back and shoulder with lifting. It was noted that the Veteran reported pain in the scapular area. A diagnosis of costochondritis (ribs) was noted. In an October 2018 brief, the Veteran’s representative that the Veteran’s low back disability is related to her service-connected left knee disability. The Veteran had a VA examination in October 2018. The examiner noted degenerative disc disease and facet arthrosis of the spine, a condition associated with the wear and tear of aging. The examiner opined that the current back condition is less likely than not due to the left knee condition. The opinion did not address whether the claimed back condition is directly related to service and did not include an opinion about aggravation due to the service-connected left knee disability. The claim is being remanded for a new VA examination and medical opinion. 2. Entitlement to service connection for arthritis of the right knee is remanded. In a November 2011 statement in support of her claim, the Veteran stated that her right knee problems were caused by marching drills which required a lot of stomping with the right leg. A September 1984 entry reflects that the Veteran reported “knee problems” and was diagnosed with possible muscle strain. A November 1988 entry in the service treatment record shows a report of sharp pain in the right leg quad muscles. The Veteran was diagnosed with a quad pull. The January 1991 separation examination reflects that the Veteran reported a history of leg cramps. The Veteran also contends that her right knee disability is related to service-connected left knee patellofemoral arthritis. In an October 2018 brief, the Veteran’s representative presented the contention that the right knee disability is caused or aggravated by an altered gait from her left knee disability. The Veteran’s representative cited to medical research from the American College of Rheumatology, regarding the effect of an altered gait. The Veteran has not been afforded a VA examination to determine whether her right knee disability is related to service or a service-connected left knee disability. The claim is being remanded for a VA examination and medical opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the complaint of back and shoulder pain reported in February 1991. The examiner must opine whether a current low back disability is at least as likely as not (1) proximately due to service-connected left knee disability, or (2) aggravated beyond its natural progression by the service-connected left knee disability. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right knee disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease in service. The examiner should address the following: a) marching exercises during service; b) a right quad strain diagnosed in November 1988; c) the complaint of leg cramps in November 1991; and d) the complaint of knee problems in September 1984. The examiner must opine whether a current right knee disability is at least as likely as not (1) proximately due to service-connected left knee disability, or (2) aggravated beyond its natural progression by the service-connected left knee disability. The examiner should address the argument in the October 2018 brief that the Veteran’s right knee disability is related to overcompensation and gait changes secondary to the service-connected left knee. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Catherine Cykowski