Citation Nr: 20003846 Decision Date: 01/15/20 Archive Date: 01/15/20 DOCKET NO. 17-31 067 DATE: January 15, 2020 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability, claimed as secondary to right knee disability, is remanded. Entitlement to service connection for a spine/low back disability, to include as secondary to right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2000 to April 2002. This matter comes before the Board of Veterans Appeals (Board) on appeal from a September 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. In a February 2019 Board decision, the claims were remanded for further evidentiary development. A supplemental statement of the case (SSOC) was most recently issued in September 2019. The Veteran’s VA claims file has been returned to the Board for further appellate proceedings. 1. Entitlement to service connection for a right knee disability is remanded. Pursuant to the February 2019 Board Remand, the Veteran was afforded a VA examination and medical opinion in July 2019 as to his claimed right knee disability. The July 2019 VA examiner opined that the Veteran’s current right knee medial meniscus tear and degenerative arthritis were less likely than not incurred in or caused by an in-service injury, event, or illness. While the examiner noted the Veteran was seen for knee pain on one occasion during service, he stated that it is more likely the Veteran injured his right knee after service, given the normal knee examination during service and that there was no evidence of a meniscal tear in service. The Board finds this opinion is inadequate because the examiner did not consider all relevant facts in this case. Indeed, the examiner did not address the Veteran’s competent lay assertions of continued right knee pain since service, which are reflected in his private treatment records; nor did the examiner provide an adequate basis for attributing the Veteran’s current right knee disability to a post-service injury, given that there is no lay or medical evidence establishing, or even suggesting, that he injured his right knee after service. Therefore, a remand is needed to obtain an addendum medical opinion. 2. Entitlement to service connection for a left knee disability, claimed as secondary to right knee disability, is remanded. The Veteran has asserted that his current left knee disability was caused as a result of his right knee disability. Therefore, this claim is inextricably intertwined with the right knee claim being remanded and consideration of this matter must be deferred pending resolution of the right knee claim. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Nevertheless, the Board notes that the July 2019 VA examiner opined that the current left knee disability was not likely due to, the result of, or aggravated by the right knee disability, noting that the evidence shows he injured his left knee in 2014 after a fall. The Board notes that the rationale provided in support of the examiner’s conclusion is inadequate because it merely addresses the initial onset or cause of the left knee disability, without consideration of (1) whether the injury or cause of the injury was due to giving way in the Veteran’s right knee, which he has alleged, or (2) whether the left knee disability is or has been aggravated by the right knee disability, to include any functional impairment caused thereby, such as altered gait. Therefore, if the development requested with respect to the right knee disability results in the grant of service connection, an addendum opinion will be needed regarding the left knee disability. 3. Entitlement to service connection for a spine/low back disability, to include as secondary to right knee disability, is remanded. In February 2019, the Board remanded this claim to obtain an opinion that addressed whether the Veteran’s current spine disability is likely related to an in-service injury, including a fall to the catwalk as noted in the service treatment records (STRs). The Board also requested an opinion addressing whether the spine disability was due to or aggravated by the right knee disability. In July 2019, the VA examiner provided an opinion regarding the secondary service connection aspect of this claim, but he did not address whether the spine disability is directly related to an event or injury during service, as requested. The Board also notes that the rationale provided in support of the aggravation aspect of the secondary service connection inquiry is inadequate, as it only addresses the etiology of the spinal disability without consideration of whether the spinal disability is or has been aggravated by the right knee disability, to include any functional impairment caused thereby. Therefore, a remand is needed to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Request that an appropriate medical professional review the claims file and provide an addendum opinion regarding the Veteran’s right knee disability. The claims file must be reviewed, and the examination report must reflect that such review was accomplished. The examiner is requested to provide an opinion as to the following: a. Is it at least as likely as not (i.e., a 50 percent or greater probability) that the current right knee disability was incurred in or as a result of his military service, including the fall from the flight deck to a catwalk as noted in the STRs, any other fall during service described by the Veteran, or the complaint of pain also noted in the STRs. b. In answering the foregoing, the examiner must consider and address the service treatment records, the post-service treatment records, and the Veteran’s report that he has experienced right knee pain since service. If the answer to (a) is yes, opinions must be provided with respect to the following: c. Is it as likely as not (50 percent or greater probability) that the Veteran’s left knee disability obstructive is/was caused OR aggravated by his right knee disability, to include any manifestations thereof? d. Is it as likely as not (50 percent or greater probability) that the Veteran’s spine disability is/was caused OR aggravated by his right knee disability, to include any manifestations thereof? e. A well-reasoned rationale must be provided in support of each opinion offered. 2. Request that an appropriate medical professional review the claims file and provide an addendum opinion regarding the Veteran’s spinal disability. The claims file must be reviewed, and the examination report must reflect that such review was accomplished. The examiner is requested to provide an opinion as to each of the following: a. Is it at least as likely as not (i.e., a 50 percent or greater probability) that the current spinal disability was incurred in or as a result of his military service, including the fall from the flight deck to a catwalk as noted in the STRs or any other fall during service described by the Veteran. b. A complete, clearly-stated rationale must be provided for each opinion offered, with consideration of the lay and medical evidence of record. 3. Readjudicate the issues on appeal based on all evidence associated with the claims file since the September 2019 supplemental statement of the case (SSOC) and issue an updated SSOC. Katherine Kiemle Buckley Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Turnipseed, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.