Citation Nr: 21004588 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 14-28 796 DATE: January 27, 2021 REMANDED Entitlement to service connection for right hip disability, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. Entitlement to service connection for right knee disability, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from February 1979 to February 1982. The issues come before the Board of Veterans’ Appeals (Board) on appeal from a June 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). These issues were before the Board in September 2017, April 2019, and July 2020. The issues were previously remanded for further development. Entitlement to service connection for right hip disability and right knee disability, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. The Veteran contends his right hip disability and right knee condition are related to active military service, to include as secondary to his service-connected left knee disability. Although the Board regrets further delay, another remand is necessary to provide the Veteran with every possible consideration. Further development is necessary prior to appellate review to provide the Veteran with an adequate VA medical opinion. Pursuant to the most recent Board remand, the Veteran underwent VA examinations to address his right knee and right hip disabilities in October 2020. The VA examiner provided the medical opinion that the Veteran’s claimed right hip and knee conditions were less likely than not incurred in or caused by the Veteran’s claimed in-service injury, event, or illness. The examiner reviewed the Veteran’s service treatment records extensively and noted the record was silent for any right hip or right knee condition or symptoms during service. The VA examination also provided the medical opinion that the Veteran’s claimed right hip and knee conditions were not related to the Veteran’s current service-connected left knee medial meniscal tear with chondromalacia and osteoarthritis. Specifically, the VA examiner provided an opinion that the Veteran’s claimed conditions were less likely than not proximately due to or the result of the Veteran’s service-connected left knee condition. Remand is needed to provide the Veteran a medical opinion with adequate rationale addressing whether the Veteran’s service-connected left knee condition aggravated the Veteran’s right hip and knee disabilities. See El-Amin v. Shinseki, 26 Vet. App. 136, 138-40 (2012). The July 2020 Board remand directives guided the VA examiner to provide a medical opinion addressing the December 2019 VA examiner’s statement that the Veteran’s obesity was related to the Veteran’s right hip and knee disabilities. The October 2020 examination provided that the Veteran’s service-connected left knee disability is less likely than not the direct cause of his obesity. However, the VA examiner did note that it was plausible that the Veteran’s left knee disability attributed to the Veteran’s current obesity due to his inability to be active. The VA examiner further opined that the Veteran’s obesity resulted in his current right hip and right knee disabilities, citing to medical literature noting the prevalence of osteoarthritis is directly attributable to the rise in obesity. The Board must account for evidence that it finds to be persuasive or unpersuasive and provide the reasons for its rejection of any material evidence favorable to the claimant. Buczynski v. Shinseki, 24 Vet. App. 221, 224 (2011). The VA examiner’s discussion of the plausibility of the contention that the Veteran’s service-connected disabilities attributed to the Veteran’s obesity is favorable to the Veteran. However, qualifying or contradictory opinions may affect the probative value of any medical opinion. See generally McCray v. Wilkie, 31 Vet. App. 243 (2019). The Board requires a clarifying opinion from the October 2020 examiner to address the opinion that the Veteran’s service-connected left knee disability may plausibly attribute to the Veteran’s current obesity. An opinion addressing the potential aggravation of the Veteran’s obesity attributed to the Veteran’s service-connected disability is also required to adjudicate the Veteran’s claim for secondary service connection. The matters are REMANDED for the following action: Obtain an addendum opinion from the examiner who provided the October 2020 VA opinion, or, if not available, another appropriately qualified VA orthopedic clinician. If the examiner determines that an examination is needed to provide the requested opinion, then such examination should be scheduled and may be conducted via telehealth or similar service during the social distancing restrictions of the COVID-19 pandemic. The claims file should be reviewed in conjunction with the examination. A copy of this remand should be made available to the examiner. Following a review of the entire record, the Veteran’s competent lay statements, as well as the Veteran’s report regarding the onset and progression of his current symptomatology, the examiner should opine as to the following: a. Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right hip disability is aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis. b. Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right knee disability is aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis. The reviewing clinician must address the October 2020 medical opinion that the Veteran’s left knee lateral medial meniscal tear with chondromalacia and osteoarthritis plausibly attributed to his current obesity. c. The examiner shall opine as to whether it is at least as likely as not (50 percent probability or more) that the Veteran’s current obesity was aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis. The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. JENNIFER HWA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.V. Bona, 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.