Citation Nr: 21073507 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 18-51 126 DATE: December 8, 2021 REMANDED Entitlement to service connection for a right knee condition is remanded. REASONS FOR REMAND The Veteran served honorably on multiple periods of active duty, to include from August 1995 to November 1995, from March 2003 to July 2004, from September 2005 to October 2005, from December 2006 to April 2007, and from January 2008 to June 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from July 2018 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned Veterans Law Judge at a virtual Board hearing in March 2021. A transcript of the hearing has been associated with the record. By way of history, this claim has previously been before the Board in August 2021, at which time it was remanded to the agency of original jurisdiction (AOJ) for further evidentiary development. Unfortunately, for the reasons discussed below, the Board finds that an additional remand is warranted before adjudication. 1. Entitlement to service connection for a right knee condition is remanded. The Veteran contends her right knee condition is secondary to her service-connected left knee condition. Pursuant to the August 2021 Board remand mentioned above, a VA examination and opinion addressing the etiology of the Veteran's right knee disability was obtained in September 2021. The September 2021 VA examiner provided a negative nexus opinion on the secondary service connection theory of entitlement, finding that the Veteran's current right knee condition was not caused or aggravated by her service-connected left knee strain with meniscal tear and degenerative arthritis. However, the Board finds that the September 2021 VA opinion is inadequate for adjudication purposes. The September 2021 VA opinion is conclusory, simply stating that "arthritis in one joint does not cause arthritis in another joint." The VA examiner did not adequately discuss the Veteran's contentions regarding her right knee disability. Specifically, the Veteran testified during the March 2021 Board hearing that as a result of her service-connected left knee disability, she was forced to overcompensate and favor her right knee while ambulating and during physical activity. Medical evidence corroborates this testimony as the September 2021 VA examination reflects that the Veteran reported constant use of a cane as a result of her right knee condition. The September 2021 VA examiner did not address this contention in the rationale as to why the Veteran's right knee condition is unrelated to her service-connected left knee disability. Considering the foregoing, the claim must be remanded for an additional addendum opinion with an adequate rationale regarding the etiology of the Veteran's diagnosed right knee condition. This matter is REMANDED for the following action: 1. Obtain an opinion from an appropriate VA clinician regarding the etiology of the Veteran's right knee condition. The necessity of a VA examination is left up to the discretion of the examiner. The VA examiner is asked to provide the following medical opinions: (a.) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's right knee condition is proximately due to or caused by her service-connected left knee disability? (b.) Is it at least as likely as not (i.e., 50 percent or greater probability) that the Veteran's right knee condition has been aggravated by her service-connected left knee disability? Note that aggravation in this context means any incremental increase in the non-service-connected disability (i.e., any additional impairment of earning capacity) caused by the service-connected disability. The Veteran's lay contentions, to include statements made regarding her gait, and medical evidence of her use of a cane, must be considered and weighed in making the determination as to whether a nexus exists. See VBMS, document labeled Hearing Transcript, receipt date 3/31/2021, pages 3-5 of 9. The examiner is asked to explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Bethany L. Buck Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. M. Lowman, Associate 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.