Citation Nr: 21024784 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 14-20 242A DATE: April 26, 2021 REMANDED Entitlement to service connection for osteoarthritis of the right knee is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1969 to March 1971. This matter was most recently remanded by the Board of Veterans’ Appeals (Board) in August 2020 following a December 2019 decision by the Court of Appeals for Veterans Claims. It has now returned for adjudication. 1. Entitlement to service connection for osteoarthritis of the right knee is remanded. VA obtained a new medical opinion for the Veteran’s knee in November 2020. This opinion, however, is inadequate. The examiner offered an opinion on aggravation, but his rationale restated that the Veteran’s type of osteoarthritis was caused by aging. Aggravation looks beyond what causes a disability to include what can make the symptoms worse. A new opinion is necessary to consider the full scope of worsening and whether the Veteran’s service-connected disabilities made the osteoarthritis worse, even if they did not cause it. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s osteoarthritis of the right knee is at least as likely as not aggravated beyond its natural progression by service-connected disability. In so opining the examiner must consider not only what causes osteoarthritis, but what can make its symptoms worse. A rationale for all requested opinions shall be provided. Reference to findings from identified studies is preferred over reference to medical literature in the abstract. If the examiner relies on his or her medical experience as a rationale, it is appropriate to identify specifics such as an estimate of the number of patients the examiner has seen with similar conditions, the time the examiner has been practicing in the field, or any relevant specialized education or training experiences that go beyond the examiner’s degree or accreditation. (Continued on the next page)   If the examiner determines that an opinion cannot be rendered without result to mere speculation, then it should be clear in the examiner’s remarks whether it cannot be determined from current medical authority or if an opinion could be rendered if additional facts were known. If additional facts are needed, the examiner shall state what facts, if known, would impact his or her ability to render an opinion and how. Simply stating that an opinion cannot be provided without resort to mere speculation is not acceptable without a detailed reason as to why this is so. Amanda E.H. Gibson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Paul Saindon, Special 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.