Citation Nr: 21073494 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 13-09 080 DATE: December 8, 2021 REMANDED Entitlement to service connection for a cervical spine disability, to include as secondary to service-connected bilateral knee disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1960 to December 1986. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2009 rating decision. In March 2017, the Veteran, his spouse, and his daughter testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. The Veteran's claim for service connection was remanded in August 2017, March 2020, and April 2021. Unfortunately, the Veteran's claim must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide his claim, so he is afforded every possible consideration. Entitlement to service connection for a cervical spine disability, to include as secondary to service-connected bilateral knee disabilities is remanded. The Veteran's claim for service connection was remanded in April 2021 to obtain an adequate medical opinion addressing whether his cervical spine disability is proximately due to or aggravated beyond its natural progression by his service-connected bilateral knee disabilities. See 38 C.F.R. § 3.310. The Board directed the examiner providing the medical opinion to consider whether an altered gait resulting from his knee disabilities caused his cervical spine disability. Subsequently the Veteran was afforded an August 2021 medical opinion that states he has diagnoses of cervical degenerative disc disease and cervical fusion. The medical opinion provides that there is no known causal relationship between his knee pathologies and his cervical degenerative disc disease. The claim is arbitrary and merely speculative. Regarding aggravation, the medical opinion provides that the Veteran's cervical disability is not aggravated by his knee disability. The Board finds that the August 2021 medical opinion is inadequate because it is conclusory and without sufficient rationale. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The examiner did not cite to medical literature, principles, objective medical evidence, or lay evidence to support the above conclusions. Accordingly, the medical opinion does not form a sufficient foundation upon which to base a denial of entitlement to service connection. See Wilson v. Derwinski, 2 Vet. App. 614 (1992) (reflecting that the Board is free to assess medical evidence and is not obligated to accept a physician's opinion); see also Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991) (the Board is not competent to substitute its own opinion for that of a medical expert). Therefore, an addendum medical opinion is warranted to consider whether the Veteran's cervical spine disability is proximately caused by or aggravated by his service-connected bilateral knee disabilities. The matter is REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from August 2021 to the present. 2. After the above development is completed, obtain an addendum medical opinion from an appropriate clinician to determine the nature and etiology of the Veteran's current cervical spine disability. The clinician must review the Veteran's claims folder. The clinician must: (a.) Opine whether the Veteran's current cervical spine disability is at least as likely as not (50 percent probability or greater) proximately due to his service-connected residuals, status post total left knee replacement; right knee chondromalacia patella with degenerative arthritis; left knee chondromalacia patella with degenerative arthritis or associated altered gait. (Continued on the next page) (b.) Opine whether the Veteran's cervical spine disability is at least as likely as not (50 percent probability or greater) aggravated beyond its natural progression by his service-connected residuals, status post total left knee replacement; right knee chondromalacia patella with degenerative arthritis; left knee chondromalacia patella with degenerative arthritis or associated altered gait. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mussey, Sean 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.