Citation Nr: 21073633 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 18-10 294 DATE: December 9, 2021 REMANDED The claim of entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Navy from May 1997 to September 1999. In January 2021, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. In June 2021, the Board remanded this matter for additional development. The claim of entitlement to service connection for a right knee disorder is remanded. The Board notes that a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In June 2021, the Board remanded the claim and instructed the AOJ to obtain a VA medical opinion to determine whether the Veteran's right knee disorder was caused or aggravated by her service-connected left knee disorder. Pursuant to the Board remand, a VA medical opinion was provided in September 2021. The examiner provided an opinion as to whether the Veteran's right knee disorder was caused by her service-connected left knee disorder, however, the examiner did not provide an opinion as to whether the right knee disorder was aggravated by the left knee disorder. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Accordingly, the Board finds that a remand is required to obtain another VA opinion. See Stegall, 11 Vet. App. 268 at 271. In addition, the September 2021 VA examiner opined that the Veteran's right knee disorder was more likely due to her weight, which aggravated both knees. An October 1998 service treatment record showed that the Veteran did not meet the Navy's body weight standards and was enrolled in a mandatory physical fitness program. Additionally, in April 2016, the Veteran complained that she was unable to lose weight. The VA treatment record indicated that she was not exercising because it aggravated her knees and hips. A January 2017 VA treatment record noted that the Veteran began doing yoga and exercising more in order to lose weight. It was noted that the increased physical activity aggravated her service-connected left knee disorder. At the January 2021 Board hearing, the Veteran testified that her service-connected left knee disorder hindered her ability to exercise. The Board notes that obesity is not a disease for which service connection can be granted; however, obesity can be considered an "intermediate step" in determining whether secondary service connection is warranted. See VAOPGCPREC 1-2017. In order for obesity or weight gain to qualify as that intermediate step, it must be determined whether: (1) the service-connected disability caused or aggravated the Veteran's obesity or weight gain; (2) the obesity or weight gain as a result of the service-connected disability, or, the aggravation of the obesity or the weight gain as a result of the service-connected disability was a substantial factor in causing the claimed disability; and (3) the claimed disability would not have occurred but for the obesity or weight gain caused or aggravated by the service-connected disability. See VAOPCGPREC 1-2017 (Jan. 6, 2017); Walsh v. Wilkie, 32 Vet. App. 300, 304 (2020). In light of the above, the Board finds that another medical opinion is needed to address whether the Veteran has obesity related to her service-connected disorders. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claims. If the AOJ deems the records do not exist or that any additional attempts to obtain these records would be futile, the record should be annotated to reflect such and the Veteran should be notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, the AOJ should obtain a medical opinion, or, if deemed necessary, afford the Veteran a VA examination by a physician with sufficient expertise to determine the nature and etiology of the Veteran's right knee disorder. All pertinent evidence of record must be made available to and reviewed by the examiner. Based on a review of the relevant records and lay statements, the examiner must provide an opinion as to the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right knee disorder began in or is otherwise related to the Veteran's active duty service. (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right knee disorder was caused or aggravated by her service-connected left knee disorder. (c) The examiner should specifically discuss each of the following: (1) whether the Veteran's service-connected left knee disorder caused or aggravated the Veteran's obesity or weight gain; (2) If the Veteran's service-connected left knee disorder caused the Veteran to become obese/overweight, was the obesity/weight gain a substantial factor in causing the Veteran's right knee disorder; and (3) whether the right knee disorder would not have occurred but for the obesity or weight gain caused or aggravated by the service-connected left knee disorder. The rationale for all opinions expressed must also be provided. If the examiner is unable to provide any required opinion, she or she should explain why. If an opinion cannot be provided without resorting to mere speculation, she or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, examiner should identify the additional information that is needed. 3. Then, readjudicate the issue on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and her representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.