Citation Nr: 21020950 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 17-04 842 DATE: April 8, 2021 REMANDED Entitlement to service connection for a left knee condition, to include as secondary to a service-connected right knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the Air Force from November 1986 to February 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision. In September 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. The transcript of that proceeding is of record. 1. Entitlement to service connection for a left knee condition, to include as secondary to a service-connected right knee condition is remanded. The issue on appeal was before the Board in January 2020 when it was denied. The Veteran appealed the denial to the United States Court of Appeals for Veterans Claims (CAVC). In October 2020 the CAVC granted a joint motion for partial remand which vacated and remanded the Board’s January 2020 decision as it pertained to the left knee. VA examinations conducted in March 2005, May 2016, and November 2016 VA were inadequate, given that each examiner failed to address the question of aggravation. In a secondary service connection claim, a VA opinion is not adequate unless it rules out the possibility of aggravation. El-Amin, 26 Vet. App. at 140. None of the VA examinations above specifically address aggravation and therefore, they are inadequate. See Monzingo v.Shinseki, 26 Vet. App. 97, 106 (2012) (holding that a medical examination report is adequate “when [it] sufficiently inform[s] the Board of a medical expert’s judgment on a medical question and the essential rationale for that opinion”). Thus, a new VA examination with opinion is needed to determine whether the Veteran’s left knee was condition The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture 2. Arrange for the Veteran to undergo an examination by an appropriate examiner with respect to his claim of entitlement to service connection for a left knee condition. The entire claims file must be made available to and reviewed the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. The examiner must provide an opinion on the following: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a left knee disorder which was aggravated by her service-connected right knee condition. The examiner must provide a complete rationale for the opinion(s) in the examination report. The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it. “Aggravation” means any increase in severity of a nonservice-connected disease or injury that is proximately due to or the result of a service-connected disease, and not due to the natural progress of the nonservice-connected disease. In this regard, the CAVC held in a recent case, Ward v. Wilkie, 31 Vet. App. 233 (2019), that a “permanent worsening” of a non-service-connected disability is not required to establish secondary service connection on the basis of aggravation (i.e., aggravation can be established by a temporary, incremental worsening of a disability, including an increase in pain). If aggravation is found, the examiner should attempt to quantify the extent of additional disability resulting from the aggravation. (Continued on the next page)   The VA examiner should set forth all examination findings, along with complete rationale for the conclusions reached. In rendering the requested opinions, the VA examiner should consider all pertinent evidence, to include the pertinent medical evidence and lay statements from the Veteran. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hughes 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.