Citation Nr: 21071050 Decision Date: 11/29/21 Archive Date: 11/29/21 DOCKET NO. 09-20 086 DATE: November 29, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to service-connected right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1982 to January 1993. This case has been before the Board multiple times, most recently in July 2021 when it was remanded for additional developments. There has not been substantial compliance with the remand directives and the claim must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). Entitlement to service connection for a left knee disability, to include as secondary to service-connected right knee disability is remanded. The claim must be remanded again because the August 2021 VA addendum opinion obtained on remand is inadequate for several reasons. Both the July 2021 and April 2021 remands identified that the proper standard for secondary service connection based on aggravation is any increase in disability. However, the August 2021 VA examiner again provided an opinion that addressed aggravation as beyond its natural progression. Additionally, the examiner provided an identical rationale as their prior May 2021 VA opinion that is based on an inaccurate factual premise. The examiner cited to an August 2005 medical paper that identified that an injury in one extremity rarely caused a major problem in the opposite extremity "except when damage to the leg results in major displacement of the center of gravity of the body while walking, significant shortening of the injured limb and the abnormal gait pattern has been present for an extended period of time." The examiner provided a negative rationale regarding aggravation due to numerous documents describing the Veteran has having a normal gait over many years. However, a September 2019 VA physical therapy record identified that the Veteran had an antalgic gait and walked with a cane. The Board again notes that the proper standard for secondary service connection based on aggravation is any increase in disability. Accordingly, a new opinion is necessary. Additionally, the Board directed the AOJ to confirm that the medical opinion obtained on remand complied with the remand and specifically uses the standard of any aggravation for secondary aggravation, and if not, to get an addendum. As the August 2021 VA addendum opinion once again used the beyond a natural progression standard, the AOJ failed to comply with this directive. Accordingly, a new opinion is necessary on remand. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a VA examiner other than the examiner who provided the May 2021 and August 2021 VA addendum opinions to determine the nature and likely etiology the Veteran's left knee disability. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. Based on the review of the record (and examination if needed), the examiner should answer the following: Is it at least as likely as not that the Veteran's currently diagnosed left knee disability is (i) caused or (ii) aggravated by (defined as any increase in disability) the Veteran's service-connected right knee disability? Why or why not? The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 2. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Eric Struening 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.