Citation Nr: 21011870 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 11-06 899 DATE: March 2, 2021 REMANDED Entitlement to service connection for a low back disorder, to include as secondary to a left knee disorder, is remanded. Entitlement to service connection for a bilateral hip disorder, status post-total hip arthroplasties (THP), to include as secondary to a left knee disorder, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to a left knee disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to September 1968. His service included a tour in the Republic of Vietnam (RVN) from February 1967 to February 1968. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a September 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in April 2014, February 2015, April 2016, September 2016, December 2017, and July 2019. In June 2016, the Veteran testified before the undersigned at a Board hearing. A transcript of that hearing has been associated with the virtual file and reviewed. The most recent Board decision was in July 2019, at which time the claims for a right knee disorder, a low back disorder, and bilateral hip disorder were denied. The Veteran appealed the 2019 denial to the United States Court of Appeals for Veterans Claims (Court). In August 2020, the Court issued an order granting a Joint Motion for Partial Remand (JMPR) and vacated the July 2019 decision. The case has again returned to the Board for action consistent with the JMPR. 1. Service connection for a low back disorder, to include as secondary to a left knee disorder is remanded. 2. Service connection for a bilateral hip disorder, status post-total hip arthroplasties (THP), to include as secondary to a left knee disorder is remanded. 3. Service connection for a right knee disorder, to include as secondary to a left knee disorder is remanded. The parties to the JMPR agreed that the Board erred in relying on an inadequate May 2015 VA examination regarding the Veteran’s right knee, low back, and bilateral hip claims, all to include as secondary to a left knee disorder. Specifically, the examiner’s rationale regarding secondary service connection addressed proximate causation, but did not address the issue of aggravation and whether the service-connect left knee could worsen the nonservice-connected disabilities. As such, there is not an adequate medical opinion regarding the theory of entitlement to secondary service connection on the basis of aggravation and a new medical opinion is necessary. El-Amin v. Shinseki, 26 Vet. App. 136, 140-141 (2013) (holding that VA must determine whether a disability is caused or aggravated by a service-connected disability). Based on the above, the Board finds that an addendum opinion or examination, if necessary, is warranted to address this contention. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician to address secondary service connection contentions regarding the Veteran’s right knee, low back, and bilateral hip disorders. An in-person examination is not required unless deemed necessary by the clinician. The clinician is to review the virtual file, including a copy of this Remand. The examiner is asked to provide a response to the following: Right Knee Disorder 1. Is the right knee disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected left knee disorder? The Veteran contends that weight shift and gait disturbance due to his left knee disorder has aggravated his right knee. Lower Back Disorder 2. Is a low back disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the left knee disorder? The Veteran contends that weight shift and gait disturbance due to his left knee disorder has aggravated his lower back. Hip disorder, status post-total hip arthroplasties 3. Is a hip disorder at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the left knee disorder? The Veteran contends that weight shift and gait disturbance due to his left knee disorder has aggravated his hip disorder. A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. 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). Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Cruz, 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.