Citation Nr: 21003180 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 17-14 195 DATE: January 19, 2021 REMANDED Entitlement to service connection for bilateral knee osteoarthritis, to include as secondary to service-connected bilateral pes planus, is remanded. REASONS FOR REMAND The Veteran served on active duty July 1943 to September 1943. The matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Veteran presented testimony at a video conference hearing before the undersigned Veterans Law Judge. The claim was previously remanded in August 2019 for additional development. It has since been returned to the Board for further appellate consideration. This appeal has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.900(c) (2018). 38 U.S.C. § 7107(a)(2) (2012). 1. Entitlement to service connection for bilateral knee osteoarthritis, to include as secondary to service-connected bilateral pes planus, is remanded. Remand is required for substantial compliance with the prior April 2019 Board remand. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In the April 2019 remand, the Board requested the RO obtain an addendum opinion that considers the medical literature submitted by the Veteran and his representative at the May 2019 hearing. The Board directed the examiner to provide an etiological opinion regarding the Veteran’s bilateral knee osteoarthritis, to include if the bilateral knee osteoarthritis is caused or aggravated by the Veteran’s service-connected bilateral pes planus. The Board directed the examiner to address the Veteran’s assertions of wear and tear associated with abnormal weight bearing due to his pes planus. The Veteran received a VA examination in October 2020. The examiner opined that it was less likely than not that the Veteran’s bilateral knee osteoarthritis was incurred in or caused by active service. Further, the examiner opined the Veteran’s bilateral knee osteoarthritis clearly and unmistakably existed prior to service and was clearly and unmistakably not aggravated beyond its natural progression by service. The examiner noted to a July 1943 service treatment record (STRs) noting the Veteran had flat feet upon entering active duty. First, the examiner’s rationale for the secondary opinion focused on the same factors that supported the direct service connection opinion. Second, the examiner failed to address the Veteran’s statements of wear and tear associated with abnormal weight bearing due to his pes planus. Remand is once again necessary. The matters are REMANDED for the following action: Obtain an addendum opinion regarding the etiology of the bilateral knee osteoarthritis from a VA examiner. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. First, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee osteoarthritis had onset in, or is otherwise related to, active military service. Second, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee osteoarthritis is caused or aggravated by the service-connected bilateral pes planus. The examiner must address the following: 1) the Veteran’s assertions of wear and tear associated with abnormal weight bearing due to his pes planus; 2) the 2016, 2017, and 2020 VA examinations and opinions; 3) the medical literature submitted in May 2019; and 4) the 2014 VA feet examination. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Braxton, 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.