Citation Nr: 21002506 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 16-04 339 DATE: January 13, 2021 REMANDED Entitlement to service connection for right knee osteoarthritis, to include as secondary to service-connected left knee osteoarthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1987 to November 1997. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of an August 213 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Veteran testified before the undersigned Veterans Law Judge at a Board hearing. The hearing transcript has been associated with the claims file. In August 2019, the Board denied service connection for sleep disturbances, and remanded claims for service connection for bilateral knee, chronic lumbar, and plantar warts conditions. During the pendency of the appeal, in a June 2020 rating decision, the RO granted service connection for left knee, lumbar, and plantar warts conditions and assigned applicable ratings and effective dates. To date, the Veteran has not indicated disagreement with the initial ratings or effective dates assigned. As a grant of service connection represents the full benefit sought on appeal, these matters are no longer before the Board. 1. Entitlement to service connection for right knee osteoarthritis, to include as secondary to service-connected left knee osteoarthritis, is remanded. In October 2020 a VA examiner opined that the Veteran’s right knee osteoarthritis is less likely than not proximately due to or the result of his service-connected left knee ostearthritis. As rationale, the examiner referenced service treatment records showing ladder and basketball injuries, but no right knee injury. Post-service medical records document treatment for the left knee, but no simultaneous treatment for the right knee. Instead, the examiner attributed right knee osteoarthritis to body mass index and post-service work as a merchant marine. When VA undertakes to provide an examination in a service connection claim, it must ensure that the examination and opinion are adequate for decision-making purposes. See 38 C.F.R. § 3.159 (c)(4); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Board finds the October 2020 medical opinion inadequate. Although the examiner provided an opinion on causation, the examiner did not address whether the Veteran’s service-connected left knee osteoarthritis aggravated, or worsened, his right knee osteoarthritis beyond its natural progression. An opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 138 (2013); Atencio v. O’Rourke, 30 Vet. App. 74, 90-91 (2018). As such, the claim is remanded for an addendum medical opinion, including a clear aggravation opinion. The matter is REMANDED for the following action: 1. Arrange for an appropriate health care provider to review the Veteran’s claims file and provide an opinion as to whether it is at least as likely as not, (50 percent probability or greater), that the right knee osteoarthritis was (A) caused or (B) aggravated beyond its normal progression by the service-connected left knee osteoarthritis. 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. 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. Readjudicate the issue on appeal. If any benefit sought is not granted, then the Veteran and his representative should be furnished with a Supplemental Statement of the Case and afforded an 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 Amanda Baker, 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.