Citation Nr: 21008511 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 13-21 886 DATE: February 17, 2021 REMANDED Entitlement to service connection for right knee degenerative arthritis (right knee condition), as secondary to service-connected S/P laminectomy and transforaminal discectomy, lumbar degenerative disc syndrome (back condition) and total left knee replacement (left knee condition), is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from September 1965 to January 1971. In June 2017, the Board of Veterans’ Appeals (Board) remanded the issue of entitlement to service connection for a right knee condition for further development. Specifically, the Board instructed the regional office (RO) to schedule the Veteran for a VA examination pertaining to his claim. Upon review of the record, the Board finds that the claim must be remanded. The Board sincerely regrets the additional delay caused by this remand but wishes to assure the Veteran that it is necessary for a full and fair adjudication of his claim. Right knee condition The Board finds that a new examination and etiological opinion is warranted for the Veteran’s claim. The Veteran contends that his right knee condition is secondary to his service-connected back and left knee conditions. The Veteran appeared for a VA examination in May 2018, in which the Veteran reported increasing severity of pain in his right knee after his left knee surgery in 2008. The examiner opined the Veteran’s right knee condition was less likely than not proximately due to or the result of the Veteran’s service-connected back condition because arthritis in one joint does not cause arthritis in another joint and medical literature did not support such a relationship. Furthermore, it was less likely than not the Veteran’s right knee condition was aggravated by the service-connected back condition because the right knee osteoarthritis is a separate medical diagnosis from his back condition and there is no medical relationship or causality between the two conditions. In August 2019, the Veteran was afforded another VA examination with the May 2018 VA examiner. The Veteran again reported that he felt the leg length discrepancy after his left knee surgery in 2008, as well as his service-connected back condition, altered his gait and contributed to his right knee condition. The examiner reiterated her previous opinions that the Veteran’s right knee condition was less likely than not caused or aggravated by the service-connected back condition. She provided essentially the same rationale from May 2018 but added that there was no medical evidence of any change in weight-bearing status as the etiology of any joint arthritis and that aggravation was not medically possible beyond the normal progression of osteoarthritis. The Veteran underwent a further VA examination in September 2020. The September 2020 examiner opined that the Veteran’s right knee condition was less likely than not caused or aggravated by his service-connected back condition. He provided a rationale for his negative opinions, including an explanation that the leg length discrepancy between the Veteran’s right and left legs was too slight to result in significant gait abnormalities that would result in or predispose the Veteran to development of right knee osteoarthritis. The Board finds that none of the May 2018, August 2019, or September 2020 examiners provided an opinion as to a possible relationship between the Veteran’s right knee condition and his service-connected left knee condition, despite noting the Veteran’s assertions that he experienced increased pain in his right knee after his left knee surgery in 2008 and providing a rationale about gait alteration. Accordingly, a remand for a new examination and etiological opinion is warranted. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file updated treatment records. 2. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran’s right knee condition. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and conducting an examination of the Veteran, the examiner should respond to the following: (a.) The examiner should state whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran’s right knee condition was caused or aggravated by the Veteran’s service-connected back and left knee conditions. AN OPINION AS TO BOTH CAUSATION AND AGGRAVATION IS REQUESTED. The examiner must discuss the Veteran’s theory that he began to alter his gait due to his service-connected back and left knee conditions, which led to his right knee condition. (b.) If the examiner finds that the Veteran’s right knee condition was aggravated by his service-connected back condition and/or left knee condition, then he/she should specify the baseline level of disability of the right knee condition prior to aggravation due to the service-connected back and left knee conditions.  Note that aggravation means any incremental increase in disability in the non-service-connected connection (i.e., any additional impairment of earning capacity) resulting from the service-connected condition(s). The Board recognizes the practical difficulties of scheduling an examination in view of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran an opportunity for an examination. If an in-person examination cannot be provided, consider other appropriate alternatives, such as a telehealth examination. (Continued on the next page)   The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he 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, the examiner should identify the additional information that is needed. Zi-Heng Zhu Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. L. Park, 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.