Citation Nr: 21001646 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-25 757 DATE: January 11, 2021 REMANDED The appeal for entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1972 to July 1983. This matter comes before the Board of Veterans' Appeals (Board) from an Agency of Original Jurisdiction (AOJ) decision of April 2013. The Veteran presented sworn testimony in support of his appeal during a hearing before the undersigned Veterans Law Judge in June 2019. In December 2019 the Board remanded the questions of entitlement to service connection for a left knee disability and a left hip disability for further evidentiary development. Upon remand, the AOJ grated service connection for a left hip disability and continued the denial of service connection for a left knee disability. Unfortunately, the evidentiary development requested by the Board with regard to the Veteran’s left knee claim was not fully completed, and another remand is necessary. The Veteran asserts that one of his hips is higher than the other, due to his back problems. They postulate that this asymmetry causes altered gait, which has affected his left hip and possibly his left knee. Their theory was validated as to the left hip upon remand, when a VA medical examiner opined that the Veteran’s service-connected low back disability had contributed to an altered gait, which the examiner termed a “Trendelenburg gait.” Based upon this opinion, the AOJ granted service connection for disabilities of the left hip and thigh. This examiner failed to render an opinion regarding whether this Trendelenburg gait affected the Veteran’s left knee impairment as well, however. In the Board’s December 2019 remand, the Board had ordered that, “IF a relationship between the Veteran's lumbar spine and hips is identified, the examiner should opine whether his currently-shown left knee degenerative joint disease is (1) proximately due to service-connected low back disability or (2) aggravated beyond its natural progression by service-connected low back disability.” Because the examiner who rendered the positive opinion regarding the Veteran’s hip failed to address his knee, the AOJ relied upon a prior negative opinion regarding the knee. Because that prior negative opinion had also been negative as to the hip, it does not fulfill the requirements set forth in the Board’s remand. Where the record before the Board is inadequate to render a fully informed decision, a remand to the AOJ is required in order to fulfill its statutory duty to assist the Veteran to develop the facts pertinent to the claim. Furthermore, the AOJ is required to fully complete the development ordered by the Board. Stegall v. West, 11 Vet. App. 268 (1998); Ascherl v. Brown, 4 Vet. App. 371, 377 (1993). Therefore, upon remand, additional medical opinion regarding the Veteran’s left knee should be obtained, premised upon the now-established left hip impairment aggravated by the service-connected back impairment. We observe that the Board remand also requested that the Veteran release private medical records to the VA so that examiners and medical reviewers could have a more complete understanding of the Veteran’s left knee situation. The AOJ sent two requests to the Veteran to release these records to VA; however, he did not do so. He did submit a copy of an October 2020 magnetic resonance study showing left knee joint effusion and chondrosis, however. As another remand is required, the Veteran is encouraged to complete the medical release forms at this point, so that VA can assist him in obtaining these records for review. The Veteran’s VA medical records should be updated for the file as well. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from August 2020 to the Present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left knee disability is more, less, or equally likely (1) proximately due to service-connected low back and/or left hip disability, or (2) aggravated (a medically discernible increase in disability even if temporary) beyond its natural progression by service-connected low back and/or left hip disability. In reviewing these questions, the reviewer is referred to the discussion regarding the Veteran’s Trendelenburg gait in the August 2020 VA examination report. IF the reviewer deems that a clinical examination and/or additional tests and studies would assist in reaching a fully informed conclusion, then such examination, tests, and studies should be arranged. (Continued on the next page)   Continued on next page T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Heather J. Harter, 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.