Citation Nr: 21066931 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 14-14 597 DATE: November 2, 2021 REMANDED Service connection for a left knee disability, as secondary to a right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1976 to November 1979. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2013 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). In a February 2013 Notice of Disagreement, the Veteran disagreed with this rating decision. In February 2017, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing has been associated with the claims file. This case was previously before the Board in January 2018 and February 2021. At those times, the Board remanded the case for additional development. Unfortunately, for the reasons discussed below, another remand is required. See Stegall v. West, 11. Vet. App. 268 (1998). Service connection for a left knee disability, as secondary to a right knee disability, is remanded. In the February 2021 remand, the Board ordered the RO to obtain a new VA opinion as to whether the Veteran's left knee condition was proximately due to or had been aggravated by his service-connected right knee condition. In an April 2021 VA opinion, the examiner opined that it was less likely than not that the Veteran's left knee was proximately due to or the result of his service-connected right knee. The examiner noted that it was impossible to determine a baseline level of severity of the left knee based on medical evidence available prior to aggravation or the earliest medical evidence following aggravation by the right knee. The examiner also opined that regardless of an established baseline, the Veteran's left knee was less likely than not aggravated beyond its natural progression by his service-connected right knee. For both opinions, proximate cause and aggravation, the examiner had the same rationale. The rationale was that there was no clear evidence from a review of orthopedic literature to suggest that an injury to one joint would have any significant impact, including aggravation, on another or opposite uninjured joint or limb, 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 5cm so that the individual's gait pattern had been altered to the extent that clinically there was an obvious "Trendelenburg gait." According to the VA examiner, this level of severity was not supported based on record review, history, or examination of the Veteran. The examiner explained that it was not unusual for two joints to share properties in the same person, but one joint's disease does not "spread" to another joint or cause damage to it. Therefore, the left knee pain/condition was less likely than not related to the right knee. In the June 2021 Informal Hearing Presentation (IHP), the Veteran's representative noted two problems with the April 2021 VA opinions. The first was that it was well documented in the Veteran's January 2020 VA examination report that he had an altered gait. The Veteran had a significant chronic gait impairment over many years requiring the use of a cane. The second issue with the gait analysis in the April 2021 opinion is that the VA examiner only referred to a "Trendelenburg gait." A "Trendelenburg gait" is an abnormal gait resulting from a defective hip abductor mechanism. While the Veteran is service connected for his right hip, he is not claiming that his right hip caused or aggravated his left knee, he is claiming that his right knee caused or aggravated his left knee. Because of this, a new VA examination is necessary to identify what kind of gait problem the Veteran has, and once identified, whether any gait problems caused by the right knee caused or aggravated the left knee. The matters are REMANDED for the following actions: 1. Please note that, by law, ALL remanded claims must be processed expeditiously. 2. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), contact the Veteran for additional information about treatment for his condition and make efforts to obtain all VA and private treatment records concerning this claim. 3. Schedule the Veteran for a VA orthopedic examination to determine the nature and cause of any diagnosed left knee condition. Prior to the examination, the claims folder and a copy of this remand must be made available to the examiner for review of the case. A notation to the effect that this record review took place should be included in the report. Based on his or her review, the examiner or consulting physician should provide an opinion as to whether the Veteran's service-connected right knee causes any gait abnormalities, and if so, whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran's left knee was proximately due to or aggravated by his service-connected right knee, to include any gait abnormalities caused by the right knee. 4. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Abrams, 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.