Citation Nr: 21031570 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 15-07 356 DATE: May 24, 2021 REMANDED 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a left knee disability, claimed as secondary to a right knee disability is remanded. 3. Entitlement to service connection for degenerative disc disease (DDD) of the lumbar spine, claimed as secondary to a right knee disability, is remanded. REASONS FOR REMAND The appellant is a Veteran who served from July 1979 to July 1983. The matter of service connection for a right knee disability is before the Board of Veterans' Appeals (Board) on appeal from a June 2010 Department of Veteran Affairs (VA) Regional Office (RO) rating decision. The matter of service connection for a left knee disability is on appeal from a July 2010 rating decision. The matter of service connection for lumbar spine DDD is before the Board on appeal from a March 2012 rating decision. In January 2017, a videoconference hearing was held before the undersigned; a transcript is in the record. In June 2017 and July 2020, these matters were remanded for additional development 1. Entitlement to service connection for a right knee disability. The Board is aware that this matter was remanded twice before (and regrets the delay inherent with yet another remand). However, the responses to prior remands received have not been substantially compliant with instructions in the previous remands, and corrective action is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The July 2020 Board remand sought a medical opinion by a clinician experienced in orthopedics regarding the likely etiology of the Veteran's right knee disability. The examiner was specifically asked to consider/discuss the right knee injury in service, right knee complaints noted at separation, and the contention that the right knee injury in service-pre-disposed the Veteran to subsequent injury of the right knee. The examiner was also asked to comment on (express agreement or disagreement with) the December 2017 VA examiner and 2018 private provider opinions (explaining the reasoning for agreement or disagreement with each). In the December 2020 VA opinion received in response to the latest remand, the consulting provider (a nurse practitioner, not shown to have experience in orthopedics), noted that at the time of separation (following the right knee strain in service) he still had occasional stiffness and clicking, but opined (without rationale or citation to supporting clinical data) that the Veteran's right knee injury in service was acute only. While she opined that she agreed with both December 2017 and the 2018 opinions, and noted that both state that the right knee injury was not serious enough to cause the resulting degenerative changes, the Board notes the 2018 private opinion (although based on an incomplete record) did opine that the Veteran had a significant right knee injury in service (a meniscus team) and that it caused his right knee traumatic arthritis. The consulting provider also did not address the allegation that the injury in service-pre-disposed the Veteran to subsequent right knee injury of the right knee. The opinion does not reflect consideration of the entire record, and is nonresponsive to the Board's remand directives. Corrective action is necessary. See Stegall, 22 Vet. App. at 271. 2. 3. Entitlement to service connection for a left knee disability and DDD of the lumbar spine. Service connection for left knee and lumbar spine disabilities is claimed as secondary to the claimed right knee disability. Accordingly, these matters are inextricably intertwined with the claim of service connection for a right knee disability, and consideration of these issues must be deferred pending resolution of the service connection for a right knee disability claim. The matters are REMANDED for the following: Arrange for the Veteran's record to be forwarded to an appropriate clinician (one experienced in orthopedics) for review and a medical advisory opinion regarding the etiology of his current right knee disability. [If further examination is deemed necessary, it should be arranged.] The entire record must be reviewed by the consulting provider. The consulting provider should: 1. Identify (by diagnosis) each right knee disability entity found/or shown by the record during the pendency of the instant claim. 2. Identify the likely etiology for each right knee disability entity diagnosed. Specifically, is it at least as likely as not (a 50% or greater probability) that it is etiologically related to the Veteran's military service, to include as due a 1982 right knee injury therein, and continuing complaints noted at separation (and alleged to have continued thereafter)? Specifically address the contention that the injury in service-pre-disposed the Veteran to subsequent injury of the right knee. 3. If a diagnosed right knee disability is determined to not be etiologically related to the Veteran's service, identify the etiology that is considered to be more likely (and explain why that is so). 4. If a right knee disability is found to be related to service, opine further whether it is his at least as likely as not that the Veteran's left knee and back disabilities, each, were (i) caused or (ii) aggravated by (increased in severity due to) his right knee disability? [The opinion must address aggravation.] 5. If a right knee disability did not cause, but aggravated, a left knee and/or lumbar spine disability, specify, to the extent possible, the degree of disability (symptoms/impairment) that has resulted from such aggravation. Include rationale with all opinions. Specifically comment on (express agreement or disagreement with) the opinions by the December 2017 VA examiner and 2018 private provider (explaining the reasoning for the agreement or disagreement with each). GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Naumovich, Associate 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.