Citation Nr: 21005146 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 11-18 492A DATE: January 29, 2021 REMANDED Entitlement to service connection for a left wrist disability as secondary to both knees is remanded. Entitlement to service connection for a back disability as secondary to both knees is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had active Marine service from May 1991 to October 1992. These matters come to the Board of Veterans' Appeals (Board) on appeal from an April 2010 decision of the Regional Office (RO) in Los Angeles, California. In August 2014, the claims were remanded to provide the Veteran with a hearing. In August 2015, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the electronic claims file. In January 2017, the claim was remanded for additional development. Specifically, the Board ordered the AOJ to provide appropriate notice for the Veteran’s TDIU claim, obtain the Veteran’s Social Security Administration (SSA) records, and to provide the Veteran with a VA examination for the service-connected bilateral knee disability. On remand, the requested actions were completed by the AOJ. In October 2018 the issues of left wrist disability, low back disability, and TDIU were remanded for VA examinations. The case is once again before the Board for appellate consideration of the issues. Entitlement to service connection for a left wrist disability and low back disability as secondary to both knees is remanded. The Veteran contends that service connection is warranted for a back disability and left wrist disability, claimed as secondary to the service-connected bilateral knee disabilities. Specifically, the Veteran contends his service-connected knee caused a fall that injured the left wrist and that he has a current back disability due to the service-connected knees. Unfortunately, these issues must be remanded again to allow an examiner to discuss and consider the Veteran’s lay statements before rendering opinions and to provide rationales for the given opinions. The Board feels a remand is needed, because the September 2020 addendum that was supposed to correct the July 2020 medical opinions and rationales are also inadequate for rating purposes. The July 2020 examiner opined that the Veteran’s claimed conditions were less likely than not due to the claimed inservice event and injury that occurred during active service as the wrist occurred 4 years after discharge and records indicate substance abuse post discharge and cause of slip/fall accident in 1996 is unknown but could be due to intoxication and a missed step going downstairs. This opinion did not consider or discuss the Veteran’s statement on how and why he fell. The September 2020 medical addendum simply reported the left wrist and back sprain occurred 4 years post discharge and are new and separate conditions with no evidence of continuity of care from alleged service connected conditions. The examiner also opined the conditions were not permanently aggravated by service-connected conditions as they occurred 4 years later from a slip and fall incident. The examiner provided no rationales for these opinions. In December 1995 the Veteran’s service-connected right knee gave way and caused a fall down stairs injuring his left knee. The VA granted secondary service connection for the Veteran’s left knee as a result. The Veteran testified that a similar incident occurred in the winter of 1996, when his knee gave out while going down stairs and he injured his left wrist and back. As the examiners did not discuss this lay evidence or provide any rationale for the opinions, further examination is necessary. 1. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. The Veteran's claim for entitlement to a TDIU is inextricably intertwined with the issues of entitlement to service connection for a back disability and left wrist disability, which are being remanded for further adjudication. Therefore, a final decision on the issue of entitlement to a TDIU cannot be rendered at this time. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered) The matters are REMANDED for the following action: 1. Associate all VA treatment records since September 2020 with the electronic claims file. 2. After completion of the above-requested development, forward the claims file available to the examiner for review. The examiner need not examine the Veteran again but can do so if the examiner feels it would assist in rendering an opinion. The examiner may determine that review of the claims file is enough to render addendum opinions. The examiner is asked to provide the following opinions: a) Is it at least as likely as not that any current wrist and back disability was at least as likely as not (50 percent probability or greater) caused by the Veteran’s service-connected bilateral knee disabilities? The VA examiner must specifically comment on the Veteran’s contentions that his service-connected knees caused him to fall and injure the left wrist. b) If not caused by the service-connected disabilities, is it at least as likely as not (50 percent probability or greater) that any left wrist and back disability is aggravated (worsened in severity beyond the natural progression of the disease) by the Veteran’s bilateral knee disabilities? If the VA examiner opines that any left wrist disability is aggravated by the bilateral knee disabilities, he/she should indicate the degree of disability before aggravation and the current degree of disability. A rationale should be given for all opinions and conclusions rendered. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Black, 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.