Citation Nr: 18149993 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 09-20 993 DATE: November 14, 2018 REMANDED The issue of service connection for degenerative joint disease (DJD) of the left knee, claimed secondary to the service-connected right knee disability and left great toe disability is remanded. The issue of a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1972 to July 1974. These matters came before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision issued by the RO. The Veteran testified at a Board hearing held at the RO in April 2011 before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been made a part of the record. The Board remanded the appeal in January 2014 and September 2016 for further development of the record. In an August 2017 decision, the Board denied the claims for entitlement to service connection for DJD of the left knee and entitlement to a TDIU rating. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In May 2018, the Court granted the parties’ Amended Joint Motion for Partial Remand (Joint Motion), vacated the August 2017 decision and remanded the issue to the Board for additional development of the record. The remand directives are as stated below. This appeal was processed using the Veterans Benefits Management System (VBMS) paperless claims processing system. 1. Entitlement to service connection for DJD of the left knee, claimed secondary to the service-connected right knee disability and left great toe disability is remanded. Remand is required to afford the Veteran VA examination to determine the nature and etiology of the claimed left knee DJD. An addendum opinion as to whether the left knee DJD was aggravated by the service-connected residuals of right knee strain with DJD is necessary. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Additionally, remand is necessary to determine if his left knee DJD was caused or aggravated by his service-connected left great toe disability. 2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. The claim for a TDIU rating is inextricably intertwined with the claim of entitlement to service connection for left knee DJD and the Board will defer the issue until the requested development below has been completed. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and likely etiology of the claimed left knee DJD. The VBMS file must be reviewed by the examiner. All indicated tests and studies should be performed and the clinical findings should be reported in detail. A comprehensive clinical history should be obtained, to include a discussion of the Veteran’s documented medical history and assertions – he asserts that his left knee DJD was caused or aggravated by his service-connected right knee or left great toe disabilities. After reviewing the entire record, the examiner should provide an opinion with supporting explanations as to the following: (A) Was the Veteran’s current left knee DJD AGGRAVATED by service-connected right knee strain with DJD? (B) Was the Veteran’s current left knee DJD CAUSED OR AGGRAVATED by service-connected fracture of the left great toe? If aggravation of current left knee DJD by service-connected right knee or left great toe disabilities is shown, the examiner should objectively quantify, to the extent possible, the degree of aggravation beyond the level of impairment had no aggravation occurred. As indicated above, the examiner must review the record in conjunction with rendering the requested opinion; however, his/her attention is drawn to the following: *March 2008 report of X-ray that documents a diagnosis of mild DJD of the left knee. *March 2011 VA orthopedic clinic consult that documents the Veteran had a 3-month history of left knee pain (and left wrist pain) following a motor vehicle accident (MVA) in which the motorcycle he was riding on struck a truck. *The October 2011 report of VA examination that reflects the physician’s opinion, based on the Veteran’s history and the physician’s clinical experience and expertise, that the Veteran’s left knee disability was less likely than not related to his service connected right knee disability. *November 2011 VA treatment record documents the Veteran’s report that his left knee disability onset after a motorcycle accident in 2009. *During the April 2011 Board hearing, the Veteran testified that his left knee disorder resulted from his overcompensation for the service-connected right knee disability. (Continued on the next page)   *The December 2016 VA examination addendum that reflects the Veteran’s mild left knee DJD is consistent with normal aging process for a person who has had body mass index (BMI) in the range of 36 to 40 between 1998 and 2008. The physician explained that the Veteran’s claim that his left knee DJD is a result of overcompensation for his service-connected right knee disability is not supported by scientific literature and opined that the claimed left knee DJD was less likely than not proximately due to or the result of the service-connected right knee disability. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Jackson, Counsel