Citation Nr: 22011815 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 08-34 714 DATE: March 2, 2022 REMANDED Entitlement to service connection for a left foot disability is remanded. Entitlement to service connection for a right foot disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The appellant is a Veteran who had active service from August 1972 to August 1976. This case is before the Board of Veterans' Appeals (Board) on appeal from December 2007 and May 2010 Department of Veterans Affairs (VA) rating decisions. In August 2021, the Board previously remanded these claims for further development. Unfortunately, for the reasons stated below, the Board finds another remand is warranted. 1. Entitlement to service connection for a left foot disability is remanded. 2. Entitlement to service connection for a right foot disability is remanded. 3. Entitlement to service connection for a left knee disability is remanded. The Veteran asserts that his left knee disorder and left and right foot disorders are secondary to his service-connected right knee disability. Alternatively, he asserts that his right knee disability resulted in weight gain/obesity, which in turn caused the claimed left knee and left and right foot disorders. The August 2021 Board remand of the claims of service connection for a left knee and left and right foot disabilities sought development for a medical opinion regarding the etiology of the claimed disabilities. Specifically, an opinion addressing whether the Veteran's right knee disability at least as likely as not caused or aggravated his weight gain/obesity was requested; an opinion addressing whether the Veteran's left knee and left foot and right foot disorders were at least as likely as not caused or aggravated by his obesity was also sought. In October 2021, a VA examiner reviewed the Veteran's claims file and opined that the Veteran's weight gain or obesity was less likely than not caused or aggravated by the Veteran's service-connected right knee disability. Unfortunately, the examiner did not discuss whether the Veteran's left knee disorder, left foot disorder, or right foot disorder were caused or aggravated by the Veteran's weight gain or obesity, as directed by the August 2021 Board remand. Accordingly, as the provider did not provide the opinion requested, the examination report/opinion is inadequate. See Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303, 310-11 (2007); 38 U.S.C. § 5103A(d)(1). Considering the state of the record, another opinion that thoroughly addresses secondary service connection is necessary. 4. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. The issue of entitlement to a TDIU is inextricably intertwined with the service connection claims, and therefore, entitlement to a TDIU must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain a VA opinion regarding the etiology of any left knee disorder, left foot disorder, and/or right foot disorder from a different VA examiner than the October 2021 VA examiner. The claims file should be made available and reviewed by the examiner, and the examiner should specifically note that such review was performed. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. Following consideration of the evidence of record (both lay and medical) and the results of the examination, the examiner is asked to address the following: a) Is it at least as likely as not (50 percent probability or more) that any left knee disorder, left foot disorder, and/or right foot disorder was caused or aggravated (increased in severity) by a service-connected disability, to include the Veteran's service-connected right knee disability? The examiner is asked to address both causation and aggravation. b) Is the Veteran's obesity an intermediate step between his service-connected right knee disability and the current any left knee disorder, left foot disorder, and/or right foot disorder? The examiner should consider whether the Veteran's right knee disability contributed to his obesity. If a diagnosed left knee disorder, left foot disorder, and/or right foot disorder is determined to not have been caused or aggravated by his service-connected right knee disability and/or weight gain or obesity, identify the etiology for the disability that is considered to be more likely, and explain why that is so. All opinions must include rationale that cites to supporting clinical data and medical principles and reflects consideration of the Veteran's lay statements in these matters, as well as the findings and opinions that are already in the record (with any conflicting conclusions reconciled). The VA examiner is asked to include copies of any literature/treatise information relied upon in rendering their opinion. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Boyd, 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.