Citation Nr: 18153673 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 16-03 826 DATE: November 28, 2018 REMANDED Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served active duty from April 1960 to May 1972, including service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision issued by a Regional Office (RO) of the United States Department of Veterans Affairs (VA). Although the Board sincerely regrets additional delay in the adjudication of this claim, a remand is necessary for further development to ensure that there is a complete record upon which to decide the Veteran’s appeal. This matter was last before the Board in October 2017, at which time it was remanded for further evidentiary development, to include, in pertinent part, a VA examination. In addition to requesting a VA medical nexus opinion, the Board directed the examiner to “address the Veteran’s contention that he fell during service and that he hurt his right knee while in Korea or Vietnam with continued symptoms since then.” Veterans, as a matter of law, are entitled to substantial compliance with Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board observes that the February 2018 VA examiner did not discuss the Veteran’s competent reports of an in-service fall and injury to the right knee, as well as continued symptoms since service. To the contrary, the examiner stated, “there was no evidence or report of any injuries to the Veteran’s right knee occurring while service on active duty.” As the examiner failed to comply with the Board’s October 2017 remand directive, another remand is warranted for corrective action. Due the Veteran’s allegation that his current right knee disability is the result of a November 2012 fall caused by difficulty seeing due to his service-connected bilateral cataracts, the RO undertook efforts to get a VA medical opinion addressing whether the Veteran’s current right knee disability was secondary to his service-connected bilateral cataracts under 38 C.F.R.§ 3.310. However, while the examiner addressed the issue of proximate cause, the RO failed to ensure that the VA examiner addressed the issue of aggravation. See Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). Once VA undertakes efforts to obtain a VA examination or medical opinion, it must ensure it is complete. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, the Board finds a remand is warranted to get a medical nexus opinion addressing whether the Veteran’s current right knee disability has been aggravated by his service-connected bilateral cataracts. [Continued on Next Page]   The matter is REMANDED for the following action: 1. Forward the Veteran’s electronic claims file to an appropriate VA examiner for an addendum medical opinion. Following review of the electronic claims file, the examiner should answer the following question: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current right knee disability occurred in or is otherwise etiologically related to the Veteran’s active duty service? In rendering an opinion, the examiner MUST address the Veteran’s contention that he fell during service and that he hurt his right knee while in Korea or Vietnam with continued symptoms since discharge from service. (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s current right knee disability is proximately due to, the result of, or aggravated by, the Veteran’s service-connected bilateral contacts? The term “aggravated” means a lasting increase in severity of the underlying disability that is not due to the natural progress of the disease. The examiner MUST address the Veteran’s contention that his current right knee disability is the result of a November 2012 fall, which he alleges was due to vision problems caused by his service-connected cataracts. The examiner must provide a complete rationale for any opinion expressed that is based on the examiner’s clinical experience, medical expertise, established medical principles, and the evidence in the electronic claims file. If an opinion cannot be made without resort to speculation, the examiner must explain why this is so and note what, if any, additional evidence would permit an opinion to be made. MICHELLE L. KANE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Galante, Associate Counsel