Citation Nr: 21023705 Decision Date: 04/21/21 Archive Date: 04/21/21 DOCKET NO. 11-26 366A DATE: April 21, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a bilateral hand disability, to include as secondary to the bilateral knee disabilities, is remanded. Entitlement to service connection for right Achilles tendonitis is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a left foot disability, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for a lumbar spine, to include as secondary to a service-connected disability, is remanded. Entitlement to service connection for an upper back disability, to include as secondary to a service-connected disability, is remanded. Entitlement to an effective date earlier than October 27, 2011, for the grant of entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service in the Army from March 1975 to July 1975, with additional service in the Army National Guard until January 1981. These matters are on appeal from June 2009, July 2009, and April 2012 rating decisions. In July 2015, the Veteran testified before the undersigned. In July 2018, the Board remanded the current issues on appeal to obtain adequate medical opinions. For the reasons discussed below, the Board finds that the most recent medical opinions are inadequate. As these opinions are inadequate, there has not been substantial compliance with the remand order, and the appeal must be remanded for new opinions. See Stegall v. West, 11 Vet. App. 268 (1998) 1. Entitlement to service connection for a right knee disability is remanded. The Veteran testified that he has had bilateral leg pain since service and injured his legs during an in-service motor vehicle accident. The Veteran’s service treatment records include notations for bilateral leg pain. The Board remanded the issue to afford the Veteran a VA examination and to obtain a medical opinion. The VA examiner was directed to address the Veteran’s motor vehicle accident. In May 2019, the Veteran was afforded a VA knee examination. The VA examiner diagnosed right knee instability and right knee degenerative arthritis. She opined that the Veteran’s right knee disability was less likely than not caused by his in-service motor vehicle accident. Her sole rationale was that there were no complaints in the service treatment records for knee pain. This rationale is inadequate because it is based on an inaccurate factual premise. The Veteran was seen in July 1978 after a Jeep accident and endorsed bilateral leg pain. In January 2011, the Veteran was seen at the VA medical center for bilateral knee pain that he attributed to his 1978 motor vehicle accident. A remand is required to obtain an adequate medical opinion. 2. Entitlement to service connection for a bilateral hand disability, to include as secondary to the bilateral knee disabilities, is remanded. The Veteran testified that he had arthritis of the bilateral hands and that his hands have hurt since his in-service motor vehicle accident. His service treatment records indicate that he injured his right wrist after falling. The Board remanded this issue to afford the Veteran a VA examination and to obtain a medical opinion. The VA examiner was directed to address the Veteran’s in-service fall and motor vehicle accident. In May 2019, the Veteran underwent a VA hand examination. The VA examiner diagnosed degenerative arthritis of the bilateral hands. She opined that it was less likely than not that the Veteran’s hand disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The VA examiner indicated that the Veteran was seen in the rheumatology clinic with hand pain. He had a motor vehicle accident 6 months prior and was noted to have marginal erosion of the proximal 5th phalanx with seronegative arthritis, gout, or less likely rheumatoid arthritis. This opinion is inadequate because it does not explain why it is less likely than not that the Veteran’s degenerative arthritis of the bilateral hands was caused by his in-service fall or motor vehicle accident. Additionally, in July 2020, the Veteran’s attorney submitted a brief asserting the Veteran’s degenerative arthritis of the bilateral hands may be caused or aggravated by falls that he has sustained due to his knees giving out. A remand is required to obtain an adequate medical opinion addressing the etiology of the Veteran’s degenerative arthritis of the bilateral hands. 3. Entitlement to service connection for right Achilles tendonitis is remanded. The Veteran testified that he has had right foot pain since service and that his right foot problems were overshadowed by his neck disability after his in-service motor vehicle accident. In September 2016, VA obtained a medical opinion regarding the nature and etiology of the Veteran’s right Achilles tendonitis. The VA examiner opined that it was less likely than not that the Veteran’s Achilles tendonitis caused or aggravated his right ankle sprain. In July 2018, the Board remanded the appeal to obtain an addendum opinion to consider Veteran’s hearing testimony that he has experienced right foot pain since service as a result of his in-service motor vehicle accident. In May 2019, the Veteran was afforded a VA examination. The VA examiner diagnosed right Achilles tendonitis. She opined that the Veteran’s right Achilles tendonitis was less likely than not incurred in service. The sole rationale for the opinion was that the 1980 separation examination was silent regarding right Achilles tendonitis. This opinion is inadequate because it does not address the Veteran’s lay statements regarding continued right foot pain since his separation from active service or the effects of his in-service motor vehicle accident. A remand is required to obtain an adequate opinion. 4. Entitlement to service connection for a left knee disability, to include as secondary to a service-connected disability, is remanded. 5. Entitlement to service connection for a left foot disability, to include as secondary to a service-connected disability, is remanded. 6. Entitlement to service connection for a lumbar spine disability, to include as secondary to a service-connected disability, is remanded. 7. Entitlement to service connection for an upper back disability to include as secondary to a service-connected disability, is remanded. In July 2018, the Board remanded the issues of entitlement to service connection for a left knee disability, a left foot disability, a lumbar spine disability, and an upper back disability, to include as secondary to service-connected disability to obtain adequate direct and secondary service connection opinions. The VA examiner was asked to address the notations of back and leg pain in the service treatment records and the gait disturbance caused by the Veteran’s service-connected disabilities. In May 2019, the VA examiner provided negative direct and secondary service-connection opinions. However, the VA examiner’s sole rationale was that she could not locate complaints of left knee pain in the service treatment records and that the Veteran sustained a worker’s compensation injury in 1995. These opinions are inadequate because they do not address the Veteran’s service treatment records or the effects of the Veteran’s service-connected disabilities on his left knee, left foot, and back disabilities. A remand is required to obtain adequate VA medical opinions. 8. Entitlement to an effective date earlier than October 27, 2011, for the grant of entitlement to a TDIU is remanded. Finally, because a decision on the remanded issues could significantly impact a decision on the issue of entitlement to an effective date earlier than October 27, 2011, the issues are inextricably intertwined. A remand of the earlier effective date claim is required. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right knee instability and right knee degenerative arthritis are at least as likely as not related to his in-service motor vehicle accident. In rendering the opinion, the VA examiner is asked to address the July 1978 service treatment records documenting bilateral leg pain and the January 2011 VA treatment records reflecting complaints of right knee pain that the Veteran attributed to his in-service motor vehicle accident. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s degenerative arthritis of the bilateral hands is at least as likely as not related to his in-service motor vehicle accident and in-service fall. The VA examiner is asked to address whether the Veteran’s degenerative arthritis of the bilateral hands is at least as likely as not proximately due to or aggravated by his knee disabilities, to include any falls caused by the buckling of his knees. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s right Achilles tendonitis is at least as likely as not related to his in-service motor vehicle accident. In rendering the opinion, the VA examiner is asked to address the Veteran’s November 2016 testimony regarding right foot pain since his separation from active service. 4. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left knee disability, left foot disability, upper back disability and lumbar spine disability are at least as likely as not (i.e. probability of 50 percent or greater) related to his in-service motor vehicle accident or treatment for bilateral pain and low back pain. If any opinion is negative, then the VA examiner is asked to opine whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s left knee disability, left foot disability, upper back disability and lumbar spine disability are proximately due or aggravated beyond its natural progression by the service-connected cervical spine disability. The VA examiner is asked to address the July 2012 VA treatment records that document the Veteran’s multilevel degenerative disc disease has been productive of gait disturbance that causes left knee pain and left plantar fasciitis. 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to an effective date earlier than October 27, 2011, for the grant of entitlement to a TDIU. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.R. Watkins, 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.