Citation Nr: 21027715 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 17-42 863 DATE: May 6, 2021 REMANDED Entitlement to service connection for right knee patellofemoral syndrome, claimed as secondary to service-connected left knee patellofemoral syndrome, is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army National Guard with a period of active duty from December 2004 to August 2005. This case comes before the Board of Veterans Appeals (Board) on appeal of a November 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran participated in a June 2019 hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is associated with the claims file. The Board remanded the issue on appeal for further development in a January 2020 decision. Also remanded at that time was the issue of service connection for left knee patellofemoral syndrome. In a November 2020 rating decision, the RO granted service connection for left knee patellofemoral syndrome. As this award represents a full grant of the benefits sought with respect to this issue, the matter is resolved and is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Entitlement to service connection for right knee patellofemoral syndrome, claimed as secondary to left knee patellofemoral syndrome, is remanded. The Board remanded both the Veteran's left and right knee claims for further development in a January 2020 decision. Regarding the right knee, the Board directed that if the Veteran's left knee was determined to be service-connected, the examiner should also address whether her right knee disability was proximately due to her current left knee disability and/or aggravated beyond its natural progression by the current left knee condition. Pursuant to this remand, the Veteran underwent a VA Compensation and Pension (C&P) Examination in October 2020. After opining the left knee condition was at least as likely as not related to the claimed in-service injury, the examiner provided a negative nexus opinion regarding the right knee. Specifically, they selected the box stating the claimed condition which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event or illness. The examiner stated as their rationale that both knees had anatomic architecture which made them susceptible to anterior knee pain and instability issues. While the stress from running in the military made the susceptibility a reality in the left knee, the right knee was susceptible independent of her left knee and was not injured in the military. Thus, the examiner concluded, the right knee is less likely as not proximately due to or the result of the left knee. The Board finds this opinion to be inadequate. The examiner addressed whether the condition was a pre-existing disability, which was not a question raised in the remand instructions nor did the examiner provide any rationale for why they believed the condition to be a pre-existing disability. Further, they addressed whether the right knee was secondarily caused by or due to her service-connected disability but failed to address whether it was aggravated by that condition as directed in the remand. The language "due to", or "etiologically related", or "the result of" does not adequately address whether a non-service-connected disability was aggravated by a service-connected disability. See generally, El Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Therefore, remand for additional medical opinions is necessary pursuant to Stegall v. West, 11 Vet. App. 268 (1998). The matter is REMANDED for the following action: Obtain an addendum opinion regarding the nature and etiology of the Veteran's right knee condition. The Veteran's claims file (to include this decision) must be reviewed by the examiner. The examiner should provide an opinion responding to the following: (a.) Is it at least as likely as not (50 percent or better probability) that the Veteran's right knee condition is caused by his service-connected left knee condition? (b.) Is it at least as likely as not (50 percent or better probability) that the Veteran's right knee condition is aggravated by (worsened beyond its natural progression) by his service-connected left knee condition? A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Stuedemann, Angela L. 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.