Citation Nr: 20005682 Decision Date: 01/23/20 Archive Date: 01/23/20 DOCKET NO. 15-25 290 DATE: January 23, 2020 REMANDED Entitlement to service connection for a left knee disorder, claimed as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a right hip disorder, claimed as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a left hip disorder, claimed as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a right shoulder disorder, claimed as secondary to service-connected right knee disability, is remanded. Entitlement to service connection for a left shoulder disorder, claimed as secondary to service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to January 1972. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in December 2013 by a Department of Veterans Affairs (VA) Regional Office. In June 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In November 2018, the Board remanded the case for additional development and it now returns for further appellate review. 1. Entitlement to service connection for a left knee disorder, claimed as secondary to service-connected right knee disability. 2. Entitlement to service connection for a right hip disorder, claimed as secondary to service-connected right knee disability 3. Entitlement to service connection for a left hip disorder, claimed as secondary to service-connected right knee disability. 4. Entitlement to service connection for a right shoulder disorder, claimed as secondary to service-connected right knee disability. 5. Entitlement to service connection for a left shoulder disorder, claimed as secondary to service-connected right knee disability. As noted in the November 2018 remand, the Veteran contends that his service-connected osteoarthritis of the right knee spread to his other joints, resulted in an altered gait and stature, and/or caused numerous falls, thereby negatively impacting his left knee, bilateral hips, and bilateral shoulders. At such time, the Board remanded the case in order to obtain an addendum opinion addressing the nature of the Veteran’s claimed disorders and whether such were caused or aggravated by his right knee disability. In September 2019, a VA physician provided an addendum opinion, at which time she reported that she could not confirm a diagnosis of rheumatoid arthritis of the claimed joints based on objective testing; rather, she found that the evidence supported a diagnosis of osteoarthritis or degenerative joint disease of the bilateral shoulders, bilateral hips, and left knee. She further found that the Veteran’s right knee osteoarthritis did not spread to his other joints, and there was no documentation of an altered gait and stature and/or that such resulted in numerous falls, so as to negatively impacted the other joints. In this regard, the VA physician cited to a May 2013 VA examination report, which she reported “showed no major issue with left knee and no documentation of abnormal gait.” She further opined the service-connected right knee disability is not associated with the development of any other arthritis or osteoarthritis in any remote joints, and the Veteran’s hip, shoulder, and left knee conditions are not affected by the right knee condition. Per medical literature, right knee osteoarthritis cannot spread to the other joints as it is a degenerative disease of cartilage and results in overgrowth of bone underneath the cartilage. According to the VA physician, a traumatic joint injury in some people can lead to osteoarthritis, while in others genetics may play a role. The disease usually begins with a single large joint, such as a hip or knee. Finally, in connection with the Veteran’s claimed left knee disorder, she found that the evidence indicates that an injury in one extremity rarely causes a major problem in the opposite or uninjured extremity except when damage to the leg results in a major displacement of the centre of gravity of the body while walking, significant shortening of the injured limb, and an abnormal gait pattern present for an extended period of time. In offering such opinion, Board notes that the VA physician relies, at least in part, on the absence of evidence of an altered gait and stature at the May 2013 VA examination. However, such examination indicates that the Veteran used a cane and brace and favored the left knee, and did not specifically comment on his gait. Further, VA treatment records dated in November 2014 reflect findings of an impaired gait and ambulation with an antalgic pattern while using a rolling walker. Consequently, a remand for an addendum opinion is warranted for the examiner to reconsider her opinion in light of such evidence. The matters are REMANDED for the following actions: Return the record to the VA examiner who offered the September 2019 opinion regarding the nature and etiology of the Veteran’s claimed left knee, bilateral hip, and bilateral shoulder disorders. The record and a copy of this Remand must be made available to the examiner. If the September 2019 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinion. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a full review of the record, the examiner should offer an opinion as to whether the Veteran’s left knee, bilateral hip, and/or bilateral shoulder disorders, diagnosed as osteoarthritis or degenerative joint disease, is caused or aggravated by his service-connected right knee disability due to an altered gait and stature. For any aggravation found, the examiner should state, to the best of his or her ability, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology. In offering such opinion, the examiner must address the May 2013 VA examination report indicating the Veteran was using a cane and brace and favored the left knee, and the November 2014 findings of an impaired gait and ambulation with an antalgic pattern while using a rolling walker. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. M. Celli, 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.