Citation Nr: 20006745 Decision Date: 01/27/20 Archive Date: 01/27/20 DOCKET NO. 16-13 468 DATE: January 27, 2020 REMANDED Entitlement to service connection for a right shoulder disability, as secondary to the service-connected right knee disability, is remanded. Entitlement to service connection for a left knee injury, secondary to the service-connected right knee disability, is remanded. Entitlement to service connection for a spine disability, secondary to the service-connected right knee disability, is remanded. Entitlement to service connection for cervical myelopathy, secondary to the service-connected right knee disability, is remanded. Entitlement to service connection for neuropathy of the bilateral lower extremities, secondary to the service-connected right knee disability, is remanded. Entitlement to service connection for bilateral hearing loss is remanded.   REASONS FOR REMAND The Veteran served on active duty from August 1951 to August 1955. These matters are before the Board of Veterans’ Appeals (Board) on appeal from September 2013 and May 2015 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The case was previously before the Board in April 2018 when it was remanded for further development. Service connection for a left knee disability, right shoulder disability, a spine disability, cervical myelopathy, and neuropathy of the bilateral lower extremities, secondary to the service-connected right knee disability In the April 2018 remand, the Board remanded the above claims for a VA examination addressing the etiology of the Veteran’s disabilities of the left knee, right shoulder, spine, cervical myelopathy, and neuropathy of the bilateral lower extremities. The examiner was specifically asked to address whether it was at least as likely as not that the disabilities were aggravated (that is, any increase in severity beyond the natural progression of the condition) by the Veteran’s right knee disability. In July 2019, a VA examiner opined that it was less likely than 50 percent that the Veteran’s left knee, right shoulder, spine, cervical myelopathy and neuropathy of the lower extremities were related to his service-connected right knee and/or fall. The opinion did not address whether the disabilities were aggravated by the right knee disability. In a September 2019 addendum opinion, the examiner opined that it was less likely than not that the left knee, right shoulder, spine, cervical myelopathy and neuropathy of the bilateral lower extremity disabilities were aggravated (that is, any increase in severity beyond the natural progression of the condition) by the Veteran’s right knee disability. The examiner noted that the claims file and relevant information was reviewed previously, and inserted the rationale from the July 2019 opinion. The rationale addressed whether the disabilities were caused by the right knee disability, including a 2008 fall, however it did not address whether they were aggravated by the right knee disability. As there was no rationale addressing whether the disabilities were aggravated by the right knee disability, there was not substantial compliance with the Board’s remand order and the claims must be remanded for a new opinion with a rationale addressing aggravation. Stegall v. West, 11 Vet. App. 268, 271 (1998). Bilateral Hearing Loss The Board remanded the claim in April 2018 for an opinion addressing the etiology of the Veteran’s hearing loss in light of the finding that the Veteran was exposed to hazardous noise in service while serving on a flight line. The Board noted that if the examiner could not provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. A September 2019 VA examination report reflects that the examiner stated that she could not determine a medical opinion regarding the etiology of the Veteran’s right or left ear hearing loss without resorting to speculation. As a rationale, the examiner listed evidence, but did not provide an explanation as to why an opinion could not be made without resorting to speculation, as requested in the Board’s remand. Therefore, there was not substantial compliance with the Board’s remand order and the claim must be remanded for a new opinion with a complete rationale. Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s (i) left knee disability; (ii) right shoulder disability; (iii) spine disability; (iv) cervical myelopathy; and (v) neuropathy of the bilateral lower extremities were aggravated beyond their natural progression (i.e., any increase in the condition by its natural progression) by his service-connected right knee disability. The examiner should address the Veteran’s reported 2008 fall and a November 2014 Disability Benefits Questionnaire in which a physician stated the Veteran’s right knee disability had accelerated stenosis of the spine. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s bilateral hearing loss is at least as likely as not related to an in-service injury, event, or disease, to include exposure to hazardous noise on the flight line. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination.   Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Marenna, 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.