Citation Nr: 18156077 Decision Date: 12/06/18 Archive Date: 12/06/18 DOCKET NO. 07-27 599 DATE: December 6, 2018 REMANDED Service connection for a bilateral knee disability is remanded. Service connection for a back disability, to include as secondary to a bilateral knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1964 to July 1967. The issues are on appeal from a January 2007 rating decision. In June 2017, the Board of Veterans’ Appeals (Board) denied entitlement to service connection for a bilateral knee disability, and entitlement to service connection for a back disability, to include as secondary to a bilateral knee disability. The Veteran appealed the decisions to the United States Court of Appeals for Veterans Claims (Court). In June 2018, the Court issued a Joint Motion for Remand (JMR), vacating the June 2017 denial and on remand, requiring the Board to obtain and rely upon adequate medical opinions with sufficient rationale. The Court found the Board had erred when it relied upon the July 2016 VA examination opinion and January 2017 addendum opinion when issuing the June 2017 denial for both claims. Both opinions had not sufficiently addressed the directives set out in an April 2012 Board remand regarding etiological questions. Service connection for a bilateral knee disability, and service connection for a back disability, to include as secondary to a bilateral knee disability, is remanded. As discussed above, the June 2018 Court JMR found the July 2016 Back (Thoracolumbar Spine) VA examination opinion and January 2017 addendum opinion inadequate. The Court found that both opinions did not take into consideration the Veteran’s lay statements of in-service and continuous pain since service, and in determining that his current conditions were not related to service, the examiners failed to state an adequate rationale for their findings. Specifically, the Court found that neither examiner had followed the directives on etiology set out by an April 2012 Board remand. Therefore, on remand, the Veteran must be scheduled for a new VA examination which specifically follows the directives listed below, and address the Veteran’s contentions regarding pain during service and continuing after separation. 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 bilateral knee disability. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee disability was caused by military service, to include his parachute jumps. The examiner must specifically address the Veteran’s assertions of in-service knee pain and knee pain since that time. The examiner should provide a complete and thorough rationale for all opinions offered. If the examiner cannot provide an opinion without resorting to mere speculation, then he or she must provide a complete and thorough rational as to why an opinion cannot be provided. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any back disability. The examiner must opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s back disability was caused by military service, to include his parachute jumps. The examiner must also provide an opinion whether it is as likely as not (50 percent or greater probability) that the Veteran’s back disability was caused or aggravated by his bilateral knee disability. The examiner must specifically address the Veteran’s assertions of in-service back pain, back pain since service discharge, and a 1993 VA x-ray report that noted a normal lumbar spine. “Aggravation” is defined as a permanent worsening of the pre-existing or underlying condition, as contrasted to temporary or intermittent flare-ups of symptoms which resolve with return to the previous baseline level of disability. The examiner should provide a complete and thorough rationale for all opinions offered. If the examiner cannot provide an opinion without resorting to mere speculation, then he or she must provide a complete and thorough rational as to why an opinion cannot be provided. 3. Readjudicate the appeals. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Lee, Associate Counsel