Citation Nr: 21015586 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 11-09 328 DATE: March 17, 2021 REMANDED Entitlement to service connection for right knee disability, including osteoarthritis/ degenerative arthritis, to include as secondary to service-connected bilateral hip disabilities and low back disability, is remanded. Entitlement to service connection for left knee disability, including osteoarthritis/ degenerative arthritis, to include as secondary to service-connected bilateral hip disabilities and low back disability, is remanded. REASONS FOR REMAND The Veteran had active service from October 1979 to January 1981. The Veteran testified at a Board hearing at the local Regional Office (RO) in May 2014 before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. The remaining issues on appeal were previously remanded by the Board in November 2014, June 2016, October 2017 and October 2019. Unfortunately, the Board regrets the additional delay, but finds that another remand is necessary to obtain an adequate medical opinion concerning the etiology of the Veteran’s right and left knee disabilities. The Board notes that the issues of service connection for bilateral hip disabilities as well entitlement to a total disability rating due to individual unemployability based on service-connected disabilities (TDIU) were also previously remanded by the Board. However, service connection for the Veteran’s bilateral hip disabilities was granted, effective October 27, 2008, in an August 20, 2020 rating decision and a TDIU was granted, effective the date of award of service connection, October 27, 2008, in a September 2020 rating decision; representing a full grant of the benefits sought on appeal. See Delrio v. Wilkie, 32 Vet. App. 232, 236 (2019). The Board previously characterized these issues as one issue described as entitlement to service connection for a bilateral knee disability. However, on remand, for clarification purposes, the agency of original jurisdiction (AOJ) separated this matter into two separate issues. As such, the Board has described the issues as set forth above. Entitlement to service connection for right knee disability and left knee disability, including osteoarthritis/ degenerative arthritis, to include as secondary to service-connected bilateral hip disabilities and low back disability, is remanded. The Veteran is seeking service connection for her right and left knee disabilities. The Board previously remanded this issue for a VA examination with opinion. The February 2020 VA examiner found that the Veteran’s bilateral knee disabilities were not incurred in or caused by service, to include the slip and fall injury; or secondary to the Veteran’s service-connected back disability. The only rationale provided to support all these findings was that the Veteran’s osteoarthritis was likely due to normal aging process. Importantly, a secondary service connection claim has two prongs: causation and aggravation. 38 C.F.R. § 3.310. To be adequate, a VA opinion must provide separate rationales for both causation and aggravation. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). Moreover, the examiner failed to discuss pertinent evidence of record, including the January 2010 and October 2018 private opinions as directed by the Board. As the examiner provided the same rationale for all opinions and did not address relevant evidence of record as directed, the Board must find that opinions with rationales are inadequate. As such, an addendum opinion must be obtained to comply with the prior Board remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Moreover, the Veteran has asserted that her bilateral knee disabilities are secondary to her now service-connected bilateral hip disabilities. The examiner did not proffer an opinion with respect to this matter. Likewise, the Veteran’s representative has asserted that the Veteran’s knee disabilities are due to her gait abnormalities caused by her hip disabilities. The Board notes that the Veteran uses a walker regularly due to her hip disabilities. Thus, an opinion with rationale is necessary to address whether the Veterans knee disabilities are secondary to her now service-connected bilateral hip disabilities. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate examiner to determine the nature and etiology of any right knee disability and left knee disability. The examiner must review the entire claims file. The need for another examination is left to the discretion of the examiner. The examiner is asked to address the following: (a) Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s currently diagnosed right and left knee disabilities were incurred in service or are otherwise related to service, to include the slip-and-fall injury in October 1980? (b) Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s currently diagnosed right and left knee disabilities are caused by the service-connected lumbar spine disability and/ or service-connected bilateral hip disabilities, to include any impaired gait caused by such disabilities? (c) Is it at least as likely as not (i.e., 50 percent probability or greater) that the Veteran’s currently diagnosed right and left knee disabilities are aggravated (any incremental increase regardless of permanence) by the service-connected lumbar spine disability and/ or service-connected bilateral hip disabilities, to include any impaired gait caused by such disabilities? All opinions are to be accompanied by a rationale consistent with the evidence of record. A discussion of the pertinent evidence, including the January 2010 and October 2018 private opinions, relevant medical treatises, and generally accepted medical principles is requested. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J.N. Moats 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.