Citation Nr: 21042118 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 14-29 260 DATE: July 12, 2021 REMANDED Entitlement to service connection for a low back disorder is remanded. Entitlement to a rating in excess of 10 percent prior July 6, 2011 and in excess of 30 percent from September 1, 2012 (excluding the convalescent periods) for a left knee disorder is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1979 to March 1983. In August 2018, the Board remanded the current claims for additional development. 1. Entitlement to service connection for a low back disorder is remanded. In the August 2018 remand, the Board instructed the Regional Office (RO) to procure a VA examination to assess the etiology of the Veteran's low back disorder and whether it was proximately due to or aggravated by the his service-connected bilateral knee disabilities, right hip disability, and/or left ankle disability. The Board specifically indicated that a bare conclusion, without underlying reasoning, was not responsive to this question and the examiner must explain the conclusion. In an attempt to comply with the August 2018 remand directives, the RO procured a May 2019 VA examination and medical opinion. The VA examiner diagnosed the Veteran with degenerative arthritis of the lumbar spine and rendered a negative nexus opinion. The examiner stated that the conditions of the knee, hip, and ankles were not medically related to the back condition. This statement, however, is a bare conclusion and no underlying rationale was provided. For this reason, the Board finds the May 2019 VA medical opinion does not comply with the August 2018 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Accordingly, remand is warranted for a new VA medical opinion consistent with the directives herein. 2. Entitlement to an increased rating for a left knee disorder is remanded. The record reflects that the Veteran receives regular treatment for his knee disorders with a private doctor. However, more recent private treatment records have not been obtained or requested. Accordingly, remand is warranted for additional development to attempt to obtain these records. See 38 C.F.R. § 3.159(c)(1). The Veteran and his attorney are reminded that the Veteran must cooperate fully with VA's reasonable efforts to obtain records. If the Veteran does not respond to VA's reasonable requests, nothing further will be done with respect to obtaining his private treatment records. 3. Entitlement to a TDIU is remanded. Consideration of entitlement to a TDIU is dependent upon the impact of the Veteran's service-connected disabilities on his ability to obtain or retain substantially gainful employment. Accordingly, the matter of a TDIU is inextricably intertwined with the Veteran's claims remanded herein. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined TDIU claim is, thus, also required. The matters are REMANDED for the following actions: 1. With the Veteran's assistance, obtain outstanding private treatment records, particularly with respect to his service-connected left knee. All reasonable attempts to obtain such records should be made and documented. If VA attempts to obtain any outstanding records which are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). 2. Following the development above, obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's low back disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner as part of the medical opinion. The examiner must provide an opinion as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's low back disorder was caused or aggravated by his service-connected lower extremity disorders. Aggravation in this context is defined as any increase in disability. In rendering the above opinion, the examiner should consider and discuss the attorney's reports, by and on the Veteran's behalf, that the Veteran has been improperly ambulating due to his bilateral knees for decades and that every reputable website confirms that prolonged antalgic gait can advance the breakdown of other weight-bearing joints. See November 2020 Third Party Correspondence. A rationale for all requested opinions shall be provided. The rationale must include a discussion of the underlying medical principles specific to the facts of this case and not simply reference generic medical literature. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.