Citation Nr: 21030450 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 14-12 119A DATE: May 18, 2021 REMANDED Entitlement to a compensable disability rating prior to February 5, 2019, and in excess of 30 percent thereafter, for service-connected adjustment disorder is remanded. Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran had active service with the United States Army from February 1996 to October 2002. This matter is before the Board of Veterans' Appeals (Board) on appeal from a December 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO) (hereinafter Agency or Original Jurisdiction (AOJ)). The appeal was remanded in February 2018 for further development. In a July 2020 rating decision, the Veteran was assigned a rating of 30 percent for his adjustment disorder, effective February 5, 2019. The appeal has since returned to the Board for adjudication. Although the Board regrets the additional delay, upon review of the claims file, the Board believes that additional development on the claims on appeal is warranted. Adjustment Disorder In the February 2018 Board remand, the AOJ was instructed to obtain a VA examination assessing the current severity of the Veteran's psychiatric disability. In a February 2019 VA examination, the examiner noted symptoms of chronic sleep impairment and disturbances of motivation and mood, however, the examiner indicated there was no evidence of panic attacks or any significant social or occupational impairment. The examiner also noted that the Veteran had only occasional irritability. In May 2021, the Veteran submitted a claim for symptoms he asserts are secondary to his service-connected adjustment disorder. Specifically, he has asserted that he experiences panic attacks multiple times a week, nervousness, and irritability. He also asserted that experiences excessive worrying, difficulty concentrating, difficulty breathing, and daily worries and fears about everyday situations. In a July 2020 VA psychiatric consult, the Veteran reported episodes of loss of energy, poor concentration, and worry. The examiner noted that the Veteran presented with depressive features such as insomnia, sadness, and fatigue. Given the Veteran's more recent reports of increased symptomatology, the Board finds a remand is necessary to obtain an additional VA examination to determine the current severity of his service-connected adjustment disorder. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Bilateral Knee In an August 2012 opinion, N.V. (initials used to protect privacy), the Veteran's physician, indicated that the Veteran may have developed weight bearing problems, bad posture, and loss of correct alignment as a result of his service-connected back disability. The examiner indicated that as a consequence, there could be degenerative changes in other articulations and that it was more probable that the Veteran's knee disability, among other disabilities, is secondary to his back problem. October 2009 VA treatment records also noted that the Veteran had arthralgia and that the pain he experienced with prolonged standing suggests a problem with weight bearing, which could be secondary to chondromalacia. In a March 2010 VA treatment record, the Veteran reported that his bilateral knee pain increased after bending or walking long distances, and he referred to an exacerbation of pain on the lower back area. Numerous VA treatment records also document that the Veteran reported experiencing both back and knee pain. See May 2011, September 2012, and April 2016 VA treatment records. In a November 2012 VA opinion, the VA examiner opined that it was less likely than not that the Veteran's knee condition, among other conditions, was proximately due to or the result of the Veteran's service-connected lumbar spine disability. The examiner explained that the knee condition, among other conditions, has a different onset, pathophysiology, and anatomical location unrelated to the Veteran's service-connected lumbar spine disability. However, the examiner did not opine as to whether the Veteran's bilateral knee disability was aggravated by his service-connected lumbar spine disability. Where an opinion as to secondary service connection is provided, the opinion must address both proximate causation and aggravation. El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). As such, a remand is warranted for an addendum opinion that adequately addresses the Veteran's secondary service connection claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Associate with the claims folder updated VA treatment records. 2. Schedule the Veteran for a VA examination to ascertain the current severity and manifestations of his service-connected adjustment disorder. The examiner is asked to consider the July 2020 VA psychiatric consult record where the Veteran presented with depressive features such as insomnia, sadness, and fatigue, and his May 2021 VA Form 21-526EZ Claim Form, where he reported symptoms secondary to his adjustment disorder, including panic attacks, excessive worry, nervousness, and irritability. The examiner should set forth all examination findings, along with the complete rationale for any conclusions or opinions reached. 3. Obtain an addendum opinion that addresses whether the Veteran's bilateral knee disability was caused or aggravated by his service-connected lumbar spine disorder. The entire claims file must be made available to the designated examiner. If another examination is deemed necessary, one should be provided. The examiner is specifically requested to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral knee disability was: (1) caused by his service-connected lumbar spine disability or (2) that his service-connected lumbar spine disability results in any additional functional impairment associated with his bilateral knee disability (e.g., a medically discernible increase in frequency, duration and/or severity, even if temporary, above the degree associated with that expected from his baseline current bilateral patellofemoral pain syndrome). In rendering this opinion, the examiner should address the August 2012 opinion issued by N.V. that indicates that the Veteran's lumbar spine disability causes weight bearing problems and the October 2009 VA treatment record which also suggests a weight bearing problem. The examiner should set forth all examination findings, along with the complete rationale for any conclusions or opinions reached. 4. The AOJ should conduct any other development that may be indicated as a consequence of the actions taken in the preceding paragraphs. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Saikh, 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.