Citation Nr: 21068202 Decision Date: 11/09/21 Archive Date: 11/09/21 DOCKET NO. 20-06 382 DATE: November 9, 2021 REMANDED Entitlement to service connection for right total knee replacement is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) prior to May 31, 2018 is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1956 to January 1960. This case comes before the Board of Veterans' Appeals (Board) on appeal from June 2018 and November 2018 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). 1. Service connection- Right Knee While the Board regrets additional delay, remand is required to comply with the June 2021 remand directive. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. Service connection for the right knee was remanded for an aggravation opinion. The examiner was instructed to, "provide an appropriate rationale, to include consideration and discussion of the medical evidence and lay assertions of the Veteran." A July 2021 VA opinion was provided. The VA examiner noted evidence was reviewed including April 2018 VA examination and opinion, October 2020 VA opinion, service treatment records (STRs), and post-service medical records. The VA examiner opined the right knee disability was less likely than not aggravated beyond its natural progression by a service-connected condition. The examiner provided the following rationale: The veteran's bilateral knee diagnoses are DJD, status post bilateral TKA. It (they) is not caused by or aggravated by postural or gait accommodation due to the lumbar spine conditions. This is established medical knowledge and practice (Wheeless' textbook of orthopedics as well as the treatises cited above). Therefore, it is less likely than not that the veteran's right DJD, status post-TKA is due to or incurred in the veteran's back conditions. It is less likely than not that the DJD was aggravated beyond its natural course due to any cause, including the back conditions. The natural course of DJD is progression, commonly leading to TKA. First, the examiner failed to provide an adequate aggravation opinion rationale. The rationale provides a conclusion based entirely on established medical knowledge and practice. A medical rationale based solely on general medical literature without discussing the specific facts pertaining to a veteran's condition or individual circumstances is inadequate. See Bailey v. O'Rourke, 30 Vet. App. 54, 60 (2018). Second, the examiner did not discuss the Veteran's statements as instructed in the June 2021 remand directives. Lastly, the examiner discusses arthritis. Notably, all the past VA opinions discuss arthritis, but the Veteran's current diagnosis is total knee replacement. Clarification is required regarding the Veteran's diagnosis and/or symptoms that cause functional impairment. Accordingly, remand is required for an adequate examination and opinion. Service connection- Bilateral Hearing Loss Second, remand is required to comply with the June 2021 remand directives for bilateral hearing loss. The examiner was instructed to "address the Veteran's lay reports, including those in his November 2018 Correspondence to VA and November 2018 notice of disagreement." A June 2021 VA opinion was provided. The examiner did not address or even note the Veteran's statements regarding service. Accordingly, remand is required for a new opinion. Entitlement to TDIU prior to May 31, 2018 Lastly, remand is required because entitlement to TDIU is inextricably interwined with the pending service connection claims. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that issues are inextricably intertwined and must be considered together when a decision concerning one could have a significant impact on the other). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from June 2021 to Present. 2. Schedule the Veteran for a VA examination for his right knee. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a.) What is/are the Veteran's current right knee diagnoses apart from right lower extremity radiculopathy? If a diagnosis cannot be provided but the Veteran's right knee condition manifests in symptoms that are not attributable to right lower extremity radiculopathy, and cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. (b.) Is the right knee disability at least as likely as not proximately due to his service-connected back disability and/or service-connected right lower extremity radiculopathy? (c.) Is right knee disability at least as likely as not aggravated by his service-connected back disability and/or service-connected right lower extremity radiculopathy? The examiner should note service connection is warranted for any incremental increase in disability or any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence. Ward v. Wilkie, 31 Vet. App. 233 (2019). The examiner must specifically address the following: 1) The April 2018 VA examination stating right knee pain flexion and extension are secondary to a service-connected condition; 2) the April 2018 VA examination where the Veteran reported worsening knee pain after total knee replacement; 3) the March 2017 private treatment records that show right knee deep tendon reflexes +0; and 4) September 2020 VA nerve examination that showed right knee-deep tendon reflexes +1. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's bilateral hearing loss is at least as likely as not (50 percent or greater probability) due to the Veteran's acknowledged military noise exposure, including working on the flight line. The examiner must specifically address the Veteran's lay reports, including those in his November 2018 statement and November 2018 notice of disagreement (NOD). 4. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claim, and that the consequences for failure to report for a VA examination without good cause may include denial of the claim. 38 C.F.R. §§ 3.158, 3.655. If the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Bruton, C 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.