Citation Nr: 21000300 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 19-08 197 DATE: January 5, 2021 REMANDED Entitlement to service connection for osteoarthritis, right hand (claimed as swelling), to include as secondary to service-connected prostate cancer and/or service-connected fracture, right navicular bone, is remanded. Entitlement to service connection for right knee condition, to include as secondary to service-connected prostate cancer, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1953 to January 1973, with service in the Republic of Vietnam. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Veteran testified before the undersigned Veterans Law Judge during a Board video conference hearing. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for osteoarthritis, right hand (claimed as swelling), to include as secondary to service-connected prostate cancer and/or service-connected fracture, right navicular bone, is remanded. 2. Entitlement to service connection for right knee condition, to include as secondary to service-connected prostate cancer, is remanded. The Veteran contends that he is entitled to service connection for right hand swelling and right knee condition. Specifically, he contends that in August 1971 he fell from an Army military vehicle and landed on his right side. In two separate January 2019 Statements in Support of Claim, he stated that his right wrist, right hand and right knee have been painful since the fall. Alternatively, the Veteran contends that his right hand swelling, and right knee condition were aggravated by his service-connected prostate cancer treatment. During a July 2015 VA examination he stated that all his joints became swollen and tender after radiation therapy. He stated that the swelling and tenderness has gone away, except for the right hand and that the swelling in the joints has gone down over the years but the right knee has remained larger and more tender. Review of the record reveals that during the pendency of this claim and appeal, the theory of entitlement to service connection for right hand swelling as secondary to his service-connected fracture, right navicular bone was raised during the August 2020 Board hearing. The RO denied the Veteran’s claim for service connection as secondary to prostate cancer on the basis of a July 2015 VA opinion in which the examiner opined that it is less likely than not the Veteran’s right hand swelling or right knee condition is proximately due to or a result of his prostate cancer. The VA examiner reasoned there is no direct evidence that the new conditions right hand swelling, and right knee condition are in any way related to the Veteran’s service-connected prostate cancer treatment. However, the July 2015 VA examiner did not address the aggravation element of the Veteran’s secondary service connection claim, i.e., whether it is likely the Veteran’s right hand swelling or right knee condition is aggravated by his service-connected prostate cancer treatment. See Allen v. Brown, 7 Vet. App. 439, 449 (the phrases “caused by” and “related to” do not address the aggravation aspect of secondary service connection). Therefore, the July 2015 VA opinion with respect to service connection as secondary to prostate cancer is inadequate, and an addendum opinion is needed. Additionally, the evidence of record shows that the Veteran sustained injuries to his right wrist and shoulder while in service. See August 1972 Separation Examination. During the hearing, the Veteran’s representative raised the issue of whether the Veteran’s right hand swelling is secondary to the service-connected fracture of the right navicular bone. The matters are REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion which addresses the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed right hand degenerative joint disease, osteopenia, and swelling had causal origins in service or is otherwise related to the Veteran’s active duty service. (b.) Is it at least as likely as not, (50 percent probability or greater), that the Veteran’s right hand disability was (A) caused or (B) aggravated beyond its normal progression by the service-connected prostate cancer. (c.) Is it at least as likely as not, (50 percent probability or greater), that the Veteran’s right hand swelling was (A) caused or (B) aggravated beyond its normal progression by the service-connected fracture, right navicular bone. Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. In rendering an opinion, the examiner should consider the Veteran’s relevant lay statements of record. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion which addresses the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed right knee condition had causal origins in service or is otherwise related to the Veteran’s active duty service. (b.) Is it at least as likely as not, (50 percent probability or greater), that the Veteran’s right knee condition was (A) caused or (B) aggravated beyond its normal progression by the service-connected prostate cancer. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. In rendering an opinion, the examiner should consider the Veteran’s relevant lay statements of record. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. After undertaking any additional development deemed appropriate and giving the Veteran full opportunity to supplement the record, adjudicate the Veteran’s pending claim in light of any additional evidence added to the record. If any benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a Supplemental Statement of the Case and be afforded the applicable opportunity to respond before the record is returned to the Board for further review. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Aston, Deborah L., 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.