Citation Nr: 21005528 Decision Date: 02/01/21 Archive Date: 02/01/21 DOCKET NO. 17-44 959 DATE: February 1, 2021 REMANDED Entitlement to service connection for left knee disability as secondary to right knee arthritis is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps from June 2002 to November 2012. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO); this case is in the Board’s legacy appeals system. Entitlement to service connection for left knee disability Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). In the present case, VA obtained an examination and opinion of September 2019 which failed to address the question of whether or not the Veteran’s left knee condition was aggravated beyond its natural progression by his service-connected right knee disability. In September 2020 the Board remanded this issue to obtain an addendum opinion addressing the possibility of aggravation. VA obtained two addendum opinions in October 2020. The first failed to mention the possibility of aggravation. The second opined that the Veteran’s left knee condition was less likely than not aggravated beyond its natural progression by his service-connected right knee disability. Unfortunately, the Board finds, however, that the second addendum opinion is inadequate for rating purposes. The second October 2020 examiner explained that patellofemoral pain syndrome, the Veteran’s diagnosis for his left knee, “appears to be multifactorial, resulting from a complex interaction among intrinsic anatomic and extrinsic training factors,” with the most commonly cited causes including overuse, malalignment, and trauma. They opined that because the Veteran’s physically taxing job as a mechanic, history of right ankle fracture, and his noted weight gain would cause overuse, those are known factors that are “equally or more compelling that may be the cause of … aggravation to the left knee.” The examiner’s explanation citing the Veteran’s right ankle fracture as a likely contributing cause to his left knee condition implies that favoring his right leg would contribute to overuse of his left knee, which is a commonly cited factor in causing patellofemoral pain syndrome. The examiner did not explain why overuse from favoring the right knee would be less likely to cause aggravation of the Veteran’s left knee than over use from favoring his right ankle. A new opinion—based on full review of the record and supported by stated rationale—is needed to fairly resolve the appellant’s claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left knee disability is at least as likely as not aggravated (any incremental increase in disability or any additional impairment of earning capacity regardless of its permanence) by his service-connected right knee disability. In proffering this opinion, the examiner should discuss the October 2020 VA opinion on aggravation which cited the Veteran’s history of a right ankle fracture as a likely contributor to his left knee condition, as well as the Veteran’s contentions that his left knee disability is due to favoring his right knee. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Zimmerman 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.