Citation Nr: 21068803 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 15-16 778 DATE: November 12, 2021 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to service-connected bilateral hip, left knee, and left ankle disabilities, is remanded. Entitlement to service connection for a back disability, to include as secondary to service-connected bilateral hip, left knee, and left ankle disabilities, is remanded. REASONS FOR REMAND The Veteran had active service from March 1992 to March 1996. These matters come before the Board of Veterans' Appeals (Board) on appeal from May 2014 (denials of service connection for back and right knee disabilities). In February 2016, the Veteran testified at a decision review officer hearing held at the RO and a transcript of that hearing has been associated with the electronic claims file. In June 2018, the Veteran testified at a videoconference hearing held before the undersigned Veterans Law Judge and a transcript of that hearing has been associated with the electronic claims file. In April 2019, September 2020, and March 2021, the Board remanded the service connection claims for further development. In an April 2016 rating decision, a RO granted service connection for bilateral hip disabilities as secondary to the service-connected left knee and left ankle disabilities. Pursuant to Schroeder v. West, 212 F.3d 1265, 1271 (Fed. Cir. 2000), the Board will consider whether right knee and back disabilities are secondary to the bilateral hip disabilities. In a May 2021 medical opinion, a December 2019 VA examiner opined that the right knee and back disabilities were not related to service. Part of the basis of the opinion was that the right knee and back symptomatology began in 2010. A May 2013 VA treatment record reflects that the Veteran complained of pain in his back and both knees. At a May 2014 VA examination, the Veteran reported that the pain in his spine began in 1995 after his left ankle strain due to an altered gait. He further stated that his altered gait caused pain in both knees. A December 2014 VA treatment record reveals that the Veteran reported a 20-plus-year history of chronic back and knee pain that was exacerbated in a November 2014 injury. The assessments included chronic bilateral knee pain. The Veteran is competent to report his continuity of back and right knee symptomatology, and the Board finds him credible. An addendum to the medical opinion is necessary to address continuity of symptomatology regarding the arthritis of the lumbar spine and right knee. For secondary service connection, the Veteran claims that his right knee and back disabilities are secondary to altered gait and falls caused by the service-connected left knee and left ankle disabilities. The July and August 2021 VA medical opinions do not adequately address these theories of entitlement. A medical opinion is necessary to address whether the right knee and back disabilities are secondary to the service-connected bilateral hip disabilities. A March 2016 VA medical opinion reflects that a VA examiner opined the bilateral hip disabilities are at least as likely as not due to the service-connected left knee and left ankle disabilities. The March 2016 VA examiner noted that the left knee and ankle disabilities caused abnormal weight bearing that negatively affected the hips on a chronic basis. The December 2019 VA examiner should consider the finding by the March 2016 VA examiner in rendering the medical opinions in the addendum. The RO should obtain any additional treatment records from the VA New Jersey Health Care System from August 2021 to the present. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all treatment for his bilateral knee, bilateral hip, left ankle, and back disabilities, and obtain any identified records. Obtain the Veteran's VA treatment records from the VA New Jersey Health Care System for the period from August 2021 to the present. 2. After the development in 1 through 2 is completed, the RO should arrange for the Veteran's claims file to be reviewed by the VA doctor who examined the Veteran in December 2019 and provided the May and July 2021 VA medical opinions for preparation of an addendum opinion. If that doctor is unavailable, arrange for the claims file to be reviewed by an appropriate clinician. The Veteran should only be scheduled for another examination if the December 2019 VA examiner or the new clinician deems it necessary. Accepting the Veteran experienced back pain in service, the clinician must opine whether it is at least as likely as not that the lumbosacral strain diagnosed at the May 2014 VA examination is related to an in-service injury, event, or disease, including the in-service left knee and left ankle injuries and right upper back pain in April 1993. Accepting the Veteran experienced back pain in service, the clinician must opine whether it is at least as likely as not that the herniated discs are related to an in-service injury, event, or disease, including the in-service left knee and left ankle injuries and right upper back pain in April 1993. Accepting the Veteran's reporting of continuity of back pain symptomatology since service as credible, the clinician must opine on whether it is at least as likely as not that herniated discs (1) began during active duty, (2) manifested within one year after discharge from service in March 1996, or (3) was noted during service with continuity of the same symptomatology of back pain since service. Accepting the Veteran experienced right knee pain in service, the clinician must opine whether it is at least as likely as not that the osteoarthritis of the right knee is related to an in-service injury, event, or disease, including the in-service left knee and left ankle injuries. Accepting the Veteran's reporting of continuity of right knee pain symptomatology since service as credible, the clinician must opine on whether it is at least as likely as not that the osteoarthritis of the right knee (1) began during active duty, (2) manifested within one year after discharge from service in March 1996, or (3) was noted during service with continuity of the same symptomatology of right knee pain since service. With consideration of the March 2016 VA examiner's finding that the left knee and ankle disabilities caused abnormal weight bearing that negatively affected the hips on a chronic basis, the clinician must opine on whether it is at least as likely as not that the lumbosacral strain diagnosed at the May 2014 VA examination was (1) caused by or (2) aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, to include any abnormal gait or weight bearing due to any of these service-connected disabilities and any falls caused by any of these service-connected disabilities. If the clinician finds that the lumbosacral strain diagnosed at the May 2014 VA examination was aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, then the medical professional should quantify the degree of aggravation. With consideration of the March 2016 VA examiner's finding that the left knee and ankle disabilities caused abnormal weight bearing that negatively affected the hips on a chronic basis, the clinician must opine on whether it is at least as likely as not that the herniated discs were (1) caused by or (2) aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, to include any abnormal gait or weight bearing due to any of these service-connected disabilities and any falls caused by any of these service-connected disabilities. If the clinician finds that the herniated discs were aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, then the medical professional should quantify the degree of aggravation. With consideration of the March 2016 VA examiner's finding that the left knee and ankle disabilities caused abnormal weight bearing that negatively affected the hips on a chronic basis, the clinician must opine on whether it is at least as likely as not that the osteoarthritis of the right knee was (1) caused by or (2) aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, to include any abnormal gait or weight bearing due to any of these service-connected disabilities and any falls caused by any of these service-connected disabilities. If the clinician finds that the osteoarthritis of the right knee was aggravated by the service-connected bilateral hip disabilities, left knee disability, or left ankle disability, then the medical professional should quantify the degree of aggravation. The clinician must opine on whether it is at least as likely as not that the service-connected bilateral hip disabilities caused the Veteran to become obese, to include as due to a lack of exercise resulted from those hip disabilities. If the clinician finds that the obesity was caused by the bilateral hip disabilities, the clinician should opine as to whether it is at least as likely as not that the Veteran would not have had the lumbosacral strain diagnosed at the May 2014 VA examination but for the obesity caused by the service-connected bilateral hip disabilities. If the clinician finds that the obesity was caused by the bilateral hip disabilities, the clinician should opine as to whether it is at least as likely as not that the Veteran would not have had the herniated discs but for the obesity caused by the service-connected bilateral hip disabilities. If the clinician finds that the obesity was caused by the bilateral hip disabilities, the clinician should opine as to whether it is at least as likely as not that the Veteran would not have had the osteoarthritis of the right knee but for the obesity caused by the service-connected bilateral hip disabilities. 3. Thereafter, the RO should readjudicate the Veteran's claims. If any claim remains denied, the Veteran should be issued a supplemental statement of the case, with a copy to his representative, and afforded an opportunity to respond before the file is returned to the Board for further appellate consideration. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Cherry, 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.