Citation Nr: 21066131 Decision Date: 10/28/21 Archive Date: 10/28/21 DOCKET NO. 17-11 532 DATE: October 28, 2021 REMANDED Entitlement to service connection for a right knee disorder, to include as secondary to service-connected left hip disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1964 to August 1968. This appeal comes to the Board of Veterans Appeals (Board) from a July 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In December 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. In February 2021, the Board remanded the claims of entitlement to service connection for lung disability, left hip disability, and right knee disability. See BVA Decision (February 2021). During remand status, an August 2021 rating decision granted service connection for bronchiectasis with chronic obstructive pulmonary disease and total left hip replacement. As the RO granted in full the benefit sought by the Veteran in those matters, there is no remaining allegation of error of fact or law for appellate consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). The RO sent to the Veteran an August 2021 supplemental statement of the case that addressed the above remaining issues on appeal. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The Board expressly defers a credibility determination in these matters until the development has been completed to the extent feasible. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected left hip disability is remanded. The Veteran, and his representative, contends that his current right knee disorder stems from injury incurred during his service. The Veteran believes that it is due to or the result of an in-service automobile accident. See Hearing Transcript (December 2019). He has also reported that he injured his knee during military combat training that frequently required him to fall down hard on his knees. See C&P Exam (June 2021). In the alternative, the Veteran contends that his right knee disorder is secondary to his service-connected left hip disability. See Appellate Brief (September 2021). First, a remand is needed to ensure compliance with the terms of the previous Board remand directives. Where remand orders of the Board are not complied with, the Board errs in failing to ensure compliance. Stegall v. West, 11 Vet. App. 268 (1998). Where VA provides an examination or obtains an opinion, it must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). This claim was initially remanded in March 2020 and again in February 2021 for among other things, a new VA examination and medical opinion. The record now contains a June 2021 VA knee examination and medical opinion reports. However, the Board finds that the VA medical opinion is inadequate, and a remand is warranted. In this regard, the Board previously noted that the medical evidence included findings of degenerative arthritis in the right knee and specifically instructed the examiner to address the etiology of whether it is at least as likely as not manifested within one year after discharge or was noted during service with continuity of the same symptomatology since service. See BVA Decision (February 2021). However, VA examiner failed to address the questions posed by the Board's regarding degenerative arthritis as a chronic disease. Instead, the June 2021 VA examiner concluded that the Veteran's right knee disability, diagnosed as right knee strain, was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Although the June 2021 VA examination report confirms the record contained x-ray evidence of degenerative arthritis in the right knee and reflects a diagnosis of right knee degenerative arthritis, the medical opinion only addresses the diagnosis of right knee strain. The medical opinion is incongruous with the objective medical findings noted in the medical records and on examination and fails to address the questions posed by the Board's remand directives. See Stegall, 11 Vet. App. at 268; supra; Barr, 21 Vet. App. at 303. Given the above, the Board may not rely on the VA medical opinion in its present form and, therefore, finds the opinion is inadequate for adjudicative purposes. Accordingly, as the Board has a duty to ensure compliance with the terms of its remand, remand is again required. Stegall, supra. Next, the Veteran recently asserted that he had a right knee disability that is secondary to his left hip disability. See Appellate Brief (September 2021). The Veteran's representative had previously referenced medical literature about development of osteoarthritis in knee joints secondary to gait changes. See Appellate Brief (January 2021). Private medical records show that the Veteran has ambulated with a left-sided antalgic gait throughout pendency of appeal. See Medical Treatment Record - Non-Government Facility (July 2021). In addition, a recent VA hip examination report shows the Veteran favors his left side because of unstable gait and minimal weight-bearing with the left hip. See C&P Exam (May 2021). As the Veteran is now service-connected for left hip disability, an addendum medical opinion regarding new medical opinion regarding secondary service connection must be obtained on remand. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is prohibited from exercising its own independent judgment to resolve medical questions). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an appropriate clinician to address the nature and etiology of any right knee disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician(s). Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with right knee disability. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should opine on: (a.) Whether any right knee disability is at least as likely as not related to an in-service injury, event, or disease. Consider and expressly address whether the disability is related to an in-service automobile accident as well as physical demands of training. (b.) For arthritis of the right knee, opine on whether it at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Consider and expressly address the Veteran's lay statements concerning continuity of right knee symptomatology. (c.) Whether the Veteran's right knee disorder is at least as likely as not (1) proximately due to service-connected left hip disability, or (2) aggravated beyond its natural progression by service-connected left hip disability, to include consideration of altered gait mechanics. Provide a rationale that deals with causation and aggravation as independent concepts. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): An adequate medical opinion may not be predicated solely on the absence of literature supporting causation or aggravation without discussing those facts specific to this Veteran. 2. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. M., 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.