Citation Nr: 21062262 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 11-13 211 DATE: October 6, 2021 REMANDED Entitlement to service connection for left knee disability, to include as secondary to service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1977 to March 1980. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a March 2009 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case for further development in July 2014, June 2017, and May 2018. The Board notes that the Veteran testified at hearing before a Veterans Law Judge (VLJ) in March 2012. The transcript of the hearing is of record but the VLJ who presided over the hearing is no longer employed by the Board. In August 2021, the Veteran was notified that he had a right to another Board hearing before a different VLJ and that he had 30 days from the date of the letter to respond, and that if no response was received the Board would assume that he did not want another hearing. As no response was received, the Board assumes that the Veteran does not desire another Board hearing. Service Connection for Left Knee Disability The Veteran contends that his left knee disability is due to active service. Specifically, he contends that he injured both his knees while working in the mud following a mudslide. See March 2012 hearing transcript. Alternatively, he contends that his left knee disability is secondary to his service-connected right knee disability. Pursuant to the Board's May 2018 remand directives, the matter was remanded to obtain an addendum medical opinion addressing whether the Veteran's left knee disability was aggravated by his service-connected right knee disability, as no such opinion had been obtained. A September 2020 VA examiner opined that the Veteran's left knee disability was less likely than not aggravated beyond its natural progression by his service-connected right knee disability. She explained that the two conditions are not medically related. She further noted that there is no clear evidence from review of orthopedic literature to suggest that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb. This is true unless the injury resulted in a major muscle or nerve damage causing partial or complete paralysis or shortening of the injured limb resulting in length discrepancy of more than five centimeters, so that the individual's gait pattern has been altered to the extent that clinically there is an obvious Trendelenburg gait. The examiner noted that no Trendelenburg gait has been documented to date. The Board finds that the September 2020 VA medical opinion may have relied on a higher standard than "at least as likely as not" as the examiner stated that there was "no clear evidence." As it is possible that the examiner may have applied a higher standard, further clarification is needed before the matter can be adjudicated. Accordingly, the matter must be remanded for a supplemental opinion. The matter is REMANDED for the following action: 1. Obtain any updated VA treatment records. 2. Thereafter, obtain an addendum medical opinion by an appropriate medical examiner to determine the nature and etiology of the Veteran's left knee disability. If the examiner determines that another physical examination is necessary, such an examination should be scheduled. Following a review of the claims file, the examiner is asked to opine as to the following: a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's left knee disability was caused by his service-connected right knee disability? Please explain why or why not. b) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's left knee disability was aggravated by his service-connected right knee disability? Please explain why or why not. (Continued on the next page) If the examiner finds that the disability was aggravated by the service-connected disability, the examiner must identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. A complete rationale must be provided for all opinions expressed. If the examiner is unable to provide an opinion without resort to speculation, an explanation as to why this is so should be provided and any additional evidence that would be necessary before an opinion could be rendered should be identified. S. HENEKS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Robinson, 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.