Citation Nr: 21010188 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 15-33 805 DATE: February 24, 2021 REMANDED Entitlement to service-connection for a left knee disability is remanded. Entitlement to service-connection for a back disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from October 1993 to February 1994. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, denied service connection for a left knee disability and a back disability. The Veteran was afforded a hearing by videoconference before the undersigned Veterans Law Judge in December 2018. A transcript has been associated with the claims file. In May 2019, the Board remanded the matter for additional evidentiary development. The issues on appeal previously included service connection for a right knee disability and an acquired psychiatric disability. While the matter was in remand status, in an October 2020 rating decision, the RO granted service connection for right knee sprain and post-traumatic stress disorder (PTSD). The RO assigned initial 10 percent and 100 percent ratings, respectively, effective June 2, 2010. The Board finds that the award of service for right knee sprain and PTSD constitutes a full award of the benefit sought on appeal with respect to the claims of service connection for a right knee disability and an acquired psychiatric disability. See Grantham v. Brown, 114 F.3d 1156, 1158 (Fed. Cir. 1997) (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements such as the disability rating or effective date assigned). 1. Entitlement to service-connection for a left knee disability is remanded. 2. Entitlement to service-connection for a back disability is remanded. The Veteran contends that he developed a left knee disability as secondary to his service-connected right knee disability. Furthermore, the Veteran contends that he developed a back disability secondary to his knee disabilities. During his December 2018 hearing, he explained that, due to his knee problems, when lifting and loading Howitzer ammunition, he would lift with his back rather than with his legs. He testified that he went to sick call for his back and was issued Motrin. Despite continuing symptoms, the Veteran testified that he waited many years for back treatment and surgery because he did not have health insurance. Because the February 2012 VA medical opinions were inadequate, the Board remanded the matter in May 2019 in order to obtain adequate opinions. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Unfortunately, however, the October 2020 opinions pursuant to the Board’s remand instructions are also inadequate because the examiner issued conclusory negative opinions. As such, unfortunately, remand is again warranted. Barr, supra. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician as to the nature and etiology of the Veteran’s left knee disability. Access to the claims file should be made available to the examiner for review. After reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the current left knee disability had its inception during active service or is otherwise proximately due to or the result an in-service disease or injury? (b) If not, is it at least as likely as not (50 percent or greater probability) that the current left knee disability is proximately due to or the result of the Veteran’s service-connected right knee disability? (c) If not, is it at least as likely as not that the current left knee disability was aggravated (made worse) by the Veteran’s service-connected right knee disability? If aggravation is found, the examiner must attempt to establish a baseline level of severity of the left knee disability prior to aggravation. In providing the requested opinions, the clinician should review the relevant evidence of record, to include the Veteran’s December 2018 testimony. In providing the requested opinions, the clinician should consider the Veteran’s reported symptoms in service and thereafter, including the nature, onset, progression and severity of the Veteran’s reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how the current left knee disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? If the clinician determines that an examination of the Veteran is necessary, one should be scheduled. 2. Obtain a medical opinion from an appropriate clinician as to the nature and etiology of the Veteran’s back disability. Access to the claims file should be made available to the examiner for review. After reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s back disability had its onset in service or is otherwise related to the Veteran’s active service? (b) If not, is it at least as likely as not that the current back disability is proximately due to or the result of the Veteran’s service-connected right knee disability? (c) If neither, is it at least as likely as not that a back disability was aggravated (made worse) by the Veteran’s service-connected right knee disability? If aggravation is found, the examiner must attempt to establish a baseline level of severity of the back disability prior to aggravation. In providing the requested opinions, the clinician should review the relevant evidence of record, to include the Veteran’s December 2018 testimony regarding being issued Motrin for in-service back complaints and his reports of continuity of symptomatology. In providing the requested opinions, the clinician should consider the Veteran’s reported symptoms in service and thereafter, including the nature, onset, progression and severity of the Veteran’s reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service represented the onset of his current back disability, this should be noted. Stated another way, do the Veteran’s reports about his injury and symptoms align with how the current back disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? If the clinician determines that an examination of the Veteran is necessary, one should be scheduled. K. Conner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.D. Hobbs, 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.