Citation Nr: 21008303 Decision Date: 02/16/21 Archive Date: 02/16/21 DOCKET NO. 14-06 370 DATE: February 16, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to chronic subjective dizziness associated with posttraumatic stress disorder (PTSD) with alcohol use disorder, is remanded. REASONS FOR REMAND The Veteran had active service from March 1970 to March 1974. This matter comes before the Board of Veterans’ Appeals (BVA or Board) from a December 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran requested a hearing before the Board. The requested hearing was conducted in April 2015 by the undersigned Veterans Law Judge. A transcript is associated with the claims file. In September 2015, March 2017, and April 2020, the Board remanded this claim for additional development. Entitlement to service connection for a left knee disability. The Veteran seeks entitlement to service connection for a left knee disability as due to a combat injury during service, or in the alternative, as secondary to his service-connected dizziness. As noted in the prior Board remands, treatment records document at least 15 separate fall incidents, with at least one of the numerous reports of falls indicating the Veteran fell on his knee. In particular, in January 2010, the treatment note specifically stated, “unlike in the past where he was falling on his face, he now falls on his knees.” See January 2010 VA treatment note. Importantly, the Board notes that the Veteran was granted service connection for a left shoulder disability and left hip disability as proximately due to falls as a result of his service-connected dizziness. A December 2013 VA medical opinion stated that the etiology of the Veteran’s falls had not been clearly linked to his chronic dizziness problem. A September 2015 Board remand instructed the RO to obtain another VA medical opinion regarding whether the Veteran’s left knee disorder was proximately due to or aggravated by his falls. A November 2015 VA opinion was obtained; however, the examiner again opined the Veteran’s left knee disorder was less likely than not aggravated by his service-connected dizziness because it could not be determined whether his falls were due to his intoxication or his service-connected dizziness without speculation. A March 2018 Board remand directed the examiner to assume the falls were due to his service-connected dizziness and noted that treatment records documented at least 15 separate fall incidents. A VA opinion was obtained in August 2019. The examiner again questioned whether the evidence indicated the Veteran fell on his knee, and as a result, opined that the Veteran’s left knee disorder was not proximately due to or aggravated by his service-connected dizziness. An April 2020 Board remand found the August 2019 opinion to be inadequate and again instructed the examiner to assume the Veteran has fallen on his knee as a result of his service-connected dizziness. A VA medical opinion was obtained in May 2020. The examiner noted that falls on the knee due to service-connected dizziness were conceded; however, the examiner opined that the Veteran’s total knee arthroplasty was less likely than not proximately due to or aggravated by the falls. The examiner explained that a total knee arthroplasty is performed due to severe degenerative joint disease, which would not be related to falls, either due to cause or by way of aggravation. The examiner then stated that all diagnoses prior to the total knee replacement are subsumed in the total knee replacement. An addendum opinion is necessary. The Board acknowledges that the Veteran now has a total left knee replacement, however, prior to the Veteran’s total knee replacement, during the course of this appeal, the Veteran was diagnosed with status post chondroplasty, medial meniscectomy, and popliteal cyst removal. See May 2014 VA examination. A medical opinion is necessary regarding whether these diagnosed disorders were proximately due to or aggravated by falls due to his service-connected dizziness. The matters are REMANDED for the following action: Obtain an addendum opinion for the Veteran’s claimed left knee disorder. The claims folder must be made available to the examiner for review. The examiner is asked to review all pertinent records associated with the claims file. The examiner should offer comments and an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s left knee disorder prior to his total knee arthroplasty (previously diagnosed as status post chondroplasty, medial meniscectomy, and popliteal cyst removal) was proximately due to OR aggravated (beyond a natural progression) by falls caused by his service-connected chronic subjective dizziness associated with PTSD with alcohol use disorder. The examiner should indicate whether any pathology/disease process of the knee (prior to the total knee replacement) is consistent with the mechanism of injury claimed by the Veteran. *The examiner should assume that the Veteran has fallen on his knee due to his service-connected dizziness, on at least one occasion (see, e.g., January 2010 VA treatment record), with at least 15 documented falls throughout VA treatment records. *The examiner should consider and discuss the Veteran’s statement in the January 2010 VA treatment record that unlike in the past where he was falling on his face, he now falls on his knees, as well as the theory that his current left knee disorder is proximately due to or aggravated by his many falls. All opinions must be supported by a clear rationale and should include a discussion of the facts and medical principles involved. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Andersen, 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.