Citation Nr: 21077447 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 17-37 669 DATE: December 29, 2021 REMANDED Entitlement to a disability rating in excess of 30 percent for right femur, postoperative fracture, is remanded. Entitlement to a compensable rating prior to September 5, 2017 for right knee osteoarthritis, strain, and tendonitis with decreased right knee extension, is remanded. Entitlement to a disability rating in excess of 10 percent from September 5, 2017, for right knee osteoarthritis, strain, and tendonitis with decreased right knee extension, is remanded. Entitlement to a disability rating in excess of 10 percent for right knee osteoarthritis, strain, and tendonitis with decreased right knee flexion, is remanded. Entitlement to service connection for residuals of a stroke, as secondary to service-connected femur disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1966 to January 1969. These matters come before the Board of Veterans' Appeals (Board) on appeal from a December 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing conducted by the undersigned Veterans Law Judge in July 2021. While the issue of entitlement to an increased rating for the right femur disability was not specifically discussed at the hearing, the record does not contain a notice of withdrawal of the issue consistent with 38 C.F.R. § 19.55. Therefore, the Board will continue to adjudicate this issue. Femur and Right knee The Veteran was last provided VA examinations for his femur and knee disorder in September 2017. During the July 2021 hearing, the Veteran testified that his ability to walk and knee pain has worsened since that time. Thus, as there is evidence of a potential increase in severity of the Veteran's disabilities, the Board finds that new examinations are needed to fully and fairly evaluate his claim. See Snuffer v. Gober, 10 Vet. App. 400, 402-03 (1997). Stroke The Veteran contends that his stroke is related to his service-connected femur disability. Specifically, that his femur condition decreased the blood flow to his brain. The Veteran was provided with a VA examination in November 2015. The examiner found the Veteran's stroke disability less likely than not proximately due to or the result of his service-connected femur condition. However, the examiner did not explain why there was no link between his femur fractures and his stroke. The report also did not provide an opinion as to whether the Veteran's service-connected condition aggravated his stroke. A medical opinion addressing secondary service connection must address causation and aggravation. See El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013) Thus, a remand for an addendum opinion to address aggravation is necessary. Additionally, in July 2021, the Veteran testified that he received private treatment. The Veteran has not provided those records or authorized the VA to obtain those records on his behalf. Since the claim is being remanded for additional development, the Veteran should be afforded an additional opportunity to submit or authorize VA to obtain those private treatment records. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. The matters are REMANDED for the following action: 1. Contact the Veteran to determine if there are any outstanding, relevant private treatment records. If so, undertake all appropriate development necessary to obtain the records from each private treatment provider and/or facility identified by him. 2. Schedule the Veteran for an examination to determine the severity of his service-connected right femur and right knee disabilities. The electronic record must be made available to and reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. If any motion cannot be tested, explain why. If factors, such as pain, weakness, fatigability or incoordination limit range of motion or functional ability, discuss its impact in terms of the severity thereof. The examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flare-ups or repetitive use, and if so, estimate range of motion during flare-ups or repetitive use. If the examination does not take place during a flare-up or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flare-ups or repetitive use and provide the extent of motion loss described in terms of degrees based upon the lay and medical evidence of record. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the RO should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the RO should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. 3. Arrange for an appropriate health care provider to review the Veteran's claims file and provide an opinion as to whether the Veteran's stroke was at least as likely as not (50 percent probability or greater), (A) caused or (B) aggravated beyond its normal progression by his service-connected right femur disability. Aggravation means an increase in disability any additional impairment of earning capacity of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. If the reviewing health care provider finds that physical examination or telehealth interview of the Veteran and/or diagnostic testing is necessary, such should be accomplished. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E.V. Palatt, 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.