Citation Nr: 20060771 Decision Date: 09/15/20 Archive Date: 09/15/20 DOCKET NO. 13-27 208 DATE: September 15, 2020 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1975 to September 1979. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a September 2011 rating decision. In May 2016, this matter was remanded for a videoconference hearing before the Board. In December 2016, a videoconference hearing was held before the undersigned; a transcript is in the record. In September 2017 and March 2019, this matter was remanded for additional development. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability is remanded. The Board is aware that this case has been advanced on the docket, and that this matter was remanded twice before (and regrets the delay in final adjudication inherent with yet another remand). However, there has not been substantial compliance with the previous remand directives, and corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The March 2019 Board remand sought a medical opinion (with rationale) addressing whether the Veteran’s left knee disability was caused or aggravated by his service-connected right knee disability. The June 2019 medical opinion received in response, indicating “arthritis in one joint does not cause arthritis in another joint. Medical literature does not support this. A nexus has not been established” is conclusory. If does not explain why impairment of one knee joint would not at least contribute to the development of arthritis in the contralateral knee joint (due to additional stress on that joint, as has been alleged), and does not identify the “medical literature” invoked (that is suggested to have been reviewed). The consulting provider also stated that “arthritis tends to appear bilaterally in many cases because of genetic and developmental factors, and likewise regardless of injury, service-connected activity, etc.”, but does this conclusory statement is stated in general terms is nonspecific to the facts in the instant case. Notably, the previous Board remand explained that the prior opinion was deficient because the medical literature reviewed was not identified, and why (e.g.) instability or weakness in a lower extremity would not contribute to a fall or explain why gait impairment due to one lower extremity disability would not contribute to development of pathology in the contralateral joint was not explained. The opinion provided also did not respond to whether the left knee disability was aggravated by the service-connected right knee disability (whether the right knee disability caused or contributed to the May 2006 left knee workplace injury, as alleged, or adversely impacted on (impeded) recovery from that injury adding to the severity of the left knee disability). Accordingly, development for an adequate medical opinion remains necessary. The matter is REMANDED for the following: Arrange for the Veteran’s record to be forwarded to an orthopedist (not the provider of the December 2017 and June 2019 medical opinions) for review and a medical advisory opinion regarding the etiology of his left knee disability. [If further examination of the Veteran is deemed necessary for the opinions sought, such should be arranged.] The consulting provider is asked to: (a.) Identify (by diagnosis) each chronic left knee disability entity shown during the pendency of the instant claim. (b.) Identify the likely etiology for each left knee disability diagnosed. Is it at least as likely as not (a 50% or better probability) that the left knee disability was caused or aggravated by his service-connected right knee disability? All opinions must include rationale. The rationale must address both (i) whether the service-connected right knee disability (and related symptoms such as weakness, instability) caused or contributed to the May 2006 workplace left knee injury, (ii) impacted adversely on (impeded) his recovery from the workplace injury, or otherwise (e.g. by related gait abnormality) aggravated the left knee disability. If the repose to each of these is not, there must be explanation why that is so (with citation to supporting clinical data and medical principles). If medical literature is invoked in support of an opinion, it should be identified (cited). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Staskowski, Associate 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.