Citation Nr: 21021390 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 18-06 725 DATE: April 12, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1984 to March 1985. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2016 rating decision. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in February 2020. A transcript of that hearing is of record. These matters were previously remanded by the Board in April 2020 and July 2020. 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. Unfortunately, there has not been substantial compliance with the Board’s previous remand directives. Another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2020 remand instructed the agency of original jurisdiction (AOJ) to obtain an aggravation opinion, defining aggravation as any increase in disability. The October 2020 opinion related to whether the Veteran’s bilateral knee condition was aggravated beyond its natural progression, which is the incorrect standard. Upon remand, an opinion should be obtaining using the correct definition of aggravation as any increase in disability. Additionally, the Board notes that the April 2020 opinion finding that the Veteran’s bilateral knee disability was not caused by her service-connected hallux valgus is supported by the rationale that the Veteran’s gait is normal. However, gait abnormalities or gait training are noted in March 2016, May 2016, and June 2016 private treatment records, and an August 2017 Disability Benefits Questionnaire (DBQ) as to the spine notes abnormal gait, and the private physician completing the DBQ hand wrote “foot and ankle dysfunction” as a cause of the abnormal gait. In a May 2016 VA examination as to the feet, the Veteran reported that he tries to walk on the sides of his feet to ease the pressure on the balls of his feet. Upon remand, a new opinion should be obtained that considers these notations of abnormal gait. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s bilateral knee disability is at least as likely as not (50 percent or greater probability) (1) proximately due to service-connected hallux valgus and related gait changes, or (2) aggravated (defined as any increase in disability) by service-connected hallux valgus and related gait changes. Each opinion offered must be supported by a complete rationale. The clinician is advised that gait abnormalities or gait training are noted in March 2016, May 2016, and June 2016 private treatment records, and that an August 2017 Disability Benefits Questionnaire (DBQ) as to the spine notes abnormal gait, and the physician wrote “foot and ankle dysfunction” as a cause of that abnormal gait. In a May 2016 VA examination as to the feet, the Veteran reported that he tries to walk on the sides of his feet to ease the pressure on the balls of his feet. 2. The AOJ must confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Budd, 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.