Citation Nr: 20029596 Decision Date: 04/28/20 Archive Date: 04/28/20 DOCKET NO. 10-19 688 DATE: April 28, 2020 REMANDED Entitlement to service connection for a low back disability, to include as secondary to degenerative joint disease (DJD) of the right knee is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1982 to January 1985. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Phoenix, Arizona. This matter was reopened and remanded by the Board in November 2011. The appeal was remanded in March 2014, November 2016, and August 2017. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in July 2011. A transcript of that hearing is of record. Entitlement to service connection for a low back disability, to include as secondary to DJD of the right knee is remanded. The Veteran seeks service connection for a low back disability, to include as secondary to DJD of the right knee. The Board most recently remanded this matter in August 2017 to obtain the Veteran’s vocational rehabilitation folder, which has been received, and to obtain an addendum opinion addressing the etiology of the Veteran’s back disability. In the remand directives, the Board asked that the January 2017 examiner provide an opinion addressing whether the Veteran’s back disability was directly related to service and to consider the Veteran’s lay statements when providing the opinion. The Board also asked the examiner to indicate whether the back disability was caused or aggravated by the Veteran’s service-connected DJD of the right knee. In January 2018, the examiner provided opinions addressing whether the back disability was directly related to service and he addressed whether the back disability was caused by the right knee DJD. The examiner did not address whether the right knee DJD has aggravated the back disability. As the Court of Appeals for Veteran’s Claims (Court) recently held, causation and aggravation are separate independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). On remand, an must be obtained addressing whether the Veteran’s back disability has been aggravated, or worsened, by the right knee DJD. The matters are REMANDED for the following action: 1. Refer the Veteran’s VA claims file to the examiner who conducted the January 2017 examination, or if unavailable, another suitably qualified VA medical professional, for an addendum opinion as to the etiology of the Veteran’s back disability. If, after review of the claims file, the examiner determines that another VA examination is necessary, such must be scheduled and the Veteran must be notified. Thereafter, the examiner must provide an opinion indicating whether it is at least as likely as not (50 percent or greater possibility) that the Veteran’s low back disability has been aggravated, or worsened beyond the normal progression of the disability, by the Veteran’s service-connected DJD of the right knee. The examiner must include in the examination report the rationale for any opinion expressed. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Amanda G. Alderman 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.