Citation Nr: 22015591 Decision Date: 03/18/22 Archive Date: 03/18/22 DOCKET NO. 15-08 974 DATE: March 18, 2022 REMANDED Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1969 to May 1971. This case comes before the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO). In a December 2020 decision, the Board denied entitlement to service connection for a right knee disability. In August 2021, the Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court) where in an October 2021 order, the Court granted a Joint Motion for Partial Remand (JMPR) vacating the portion of the December 2020 Board decision denying this issue. The December 2020 Board decision also remanded issues of service connection for gastroesophageal reflux disease, a back disorder, hypertension, sleep apnea, and bilateral pes planus. They returned to the Board in May 2021 where the claim for service connection for bilateral pes planus was denied, and the remaining issues were remanded. In a December 2021 decision, the Board again remanded the remaining issues for further development, which is still pending, and will be considered in a subsequent Board decision. Entitlement to service connection for a right knee disorder is remanded. The parties agreed that the Board erred when it relied on a November 2019 VA examination, which was inadequate because the examiner provided an unclear rationale for his negative aggravation opinion. Specifically, the JMPR indicated that the VA examiner failed to provide a separate rationale to support the negative secondary aggravation opinion. Rather, he provided the "identical rationale for his negative secondary causation opinions." The parties point out that aggravation and causation are distinct issues, such that an opinion by a VA examiner on causation does not encompass an opinion on aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136, 140 (2013). Causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O'Rourke, 30 Vet. Appl. 74 (2018). In the JMPR, the parties agreed that a new VA examination was necessary. According, remand is needed for an examination and addendum opinions. By this remand the Board makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: Provide the Veteran with an appropriate examination to determine the etiology of the right knee disorder. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): An adequate medical opinion may not be predicated solely on the absence of literature supporting causation or aggravation without discussing those facts specific to this Veteran. NOTE (3): Causation and aggravation are independent concepts and should have separate findings and rationales. (a) First, the examiner should identify all currently diagnosed right knee disorders. If any previously diagnosed knee disorder, including, but not limited to right chondrocalcinosis and patellofemoral osteoarthritis are not found on examination, please address the prior diagnoses of record. (b) For each diagnosis, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder had onset in, or is otherwise related to, active military service. (c) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is caused by the service-connected right ankle mild degenerative changes, status post extra articular triple arthrodesis. (d) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is aggravated by the service-connected right ankle mild degenerative changes, status post extra articular triple arthrodesis. (e) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is caused by the service-connected left knee patellofemoral syndrome, degenerative joint disease. (f) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is aggravated by the service-connected left knee patellofemoral syndrome, degenerative joint disease. (g) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is caused by the back disorder. (h) For each diagnosis, the examiner must also provide an opinion whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder is aggravated by the back disorder. (Continued on the next page) The examiner should address the Veteran's assertions that each the above conditions cause an altered gait, which in turn affects the right knee disorder. The examiner should consider the January 2008 VA examination where the Veteran reported that the service-connected right ankle disability causes flare-ups which result in a limp/altered gait. SONJA S. AN Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Rogos 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.