Citation Nr: 21069576 Decision Date: 11/18/21 Archive Date: 11/18/21 DOCKET NO. 18-33 912 DATE: November 18, 2021 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a service-connected disability, is remanded. Entitlement to a rating in excess of 30 percent for a left knee disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from November 1964 to July 1987. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2020, the Board testified at a videoconference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the transcript has been associated with the Veteran's electronic claims folder. All matters are remanded. In December 2020, the Board remanded the matters for further development, to include obtaining VA examinations regarding the etiology and current severity of the claimed disabilities. In April 2021, the Veteran was afforded a VA knee and lower leg conditions examination where the examiner opined that it was less likely than not that the Veteran's right knee disability was related to a service-connected disability. The examiner reasoned that there was no evidence that injury to one joint would have an impact on another or opposite uninjured joint, unless it resulted in an obvious Trendelenburg gait which was not present in the instant case. The examiner further opined that it was less likely than not that the Veteran's right knee disability was related to active service because the Veteran gave inconsistent statements as to when his right knee problems began during the 1990s (at the examination) or during service (at the Board hearing). The examiner also listed the current severity of the Veteran's service-connected left knee disability. In an October 2021 Appellate Brief Presentation, the Veteran's representative challenged the adequacy of the April 2021 VA examination. Specifically, the representative found that the examiner mischaracterized the Veteran's episodes of flare-ups of the left knee. Further, the representative found that the examiner relied solely on the lack of in-service medical treatment records for a right knee disability and did not consider the Veteran's statements of continuous symptoms. The representative also stated that the exam report cited to medical literature but did not relate it to the Veteran's specific case. Based on the foregoing, the Board finds that a remand is necessary to obtain an addendum opinion, from an orthopedic specialist, which addresses all relevant and favorable evidence. The Veteran has contended that his knees, in part, contribute to his inability to obtain substantially gainful employment. Accordingly, the claims for entitlement to an increased rating for a left knee disability, entitlement to service connection for a right knee disability and TDIU are inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final Board decision on one issue cannot be rendered until the other issue has been considered). Therefore, the claim for a TDIU must be remanded pending the development and readjudication of the service connection and increased rating appeals. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from an orthopedic specialist regarding the etiology of the Veteran's right knee disability and the current severity of his left knee disability. The Veteran's electronic claims file, including a copy of this remand, must be made available to the examiner for review in connection with the opinion. The examiner is asked to offer opinions as to the following: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran's right knee disability was incurred in or is otherwise related to service. (b) If not, opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran's right knee disability was caused or aggravated by his service-connected left knee disability. If aggravation is found, the examiner should address the baselines manifestations and the increased manifestations due to the service-connected left knee disability. The examiner's attention is directed to the Veteran's testimony at the November 2020 Board hearing where he stated that his right knee was caused by the physical activities he endured during service. See Board Hearing Transcript, pp. 5-7. A complete rationale, with citation to appropriate medical principles, is requested. The examiner's attention is directed to the fact that the absence of contemporaneous medical evidence is a factor in determining credibility of lay evidence, but lay evidence does not lack credibility merely because it is unaccompanied by contemporaneous medical evidence. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Any and all indicated evaluations, studies and tests deemed necessary, including range of motion testing, should be conducted. The examiner should also opine the functional limitations the Veteran experiences due to the left knee disability. The examination report should also include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158 (2016)(38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint). 2. Thereafter, readjudicate the issues on appeal as noted above to include the TDIU issue. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable time period to respond. Michael A. Pappas Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Baskerville 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.