Citation Nr: 20039929 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 09-01 651 DATE: June 11, 2020 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to service-connected left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1991 to June 1997. This case has been before the Board multiple times, most recently in November 2019 when it was remanded for additional developments. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a right knee disability, to include as secondary to service-connected left knee disability is remanded. The December 2019 VA opinion obtained in accordance with the November 2019 remand is inadequate as to secondary service connection because the examiner addressed an incorrect standard for aggravation; “beyond its natural progression.” by his service-connected left knee disability. Aggravation in the context of secondary service connection under 38 C.F.R. § 3.310 means any increase in disability. Accordingly, a new opinion is necessary. Additionally, in their May 2020 brief, the Veteran’s representative asserted that cryoglobulinemic vasculitis diagnosed in service contributed to his right knee disability. On remand, the VA opinion should address all theories of entitlement. In a January 2020 statement, the Veteran also reported that he was has continued to received VA treatment for his right knee disability, and was scheduled for a right knee MRI in February 2020. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. The matters are REMANDED for the following action: 1. Obtain the names and addresses of all medical care providers who treated the Veteran for right knee complaints since service not already associated with the record. After securing the necessary release, take all appropriate action to obtain these records, including any VA treatment records since June 2018, to specifically include records of his February 2020 right knee MRI. 2. After the completion of the above, obtain an addendum opinion (with examination or telehealth interview if deemed necessary by the provider) from the examiner who provided the December 2019 VA opinion, (or from another appropriate provider if the December 2019 examiner is unavailable). Copies of all pertinent records, including this remand, must be made available to the examiner for review. Based on the review of the record (and examination if needed), the examiner should answer the following: (a.) Identify all right knee disabilities diagnosed since November 2005, including chondral defect of the medical femoral condyle. (b.) For each diagnosed right knee disability, is it at least as likely as not related to an injury, event or disease, to include his June 1991 in-service diagnosis of cryoglobulinemic vasculitis? Why or why not? (c.) If the answer to (b) is no, is it at least as likely as not that any of the Veteran’s right knee disabilities is caused or aggravated (defined as any increase in disability) by his service-connected left knee disability? Why or why not? The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Eric Struening 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.