Entitlement to a rating in excess of 10 percent for right knee chondromalacia with degenerative joint disease is remanded.

Citation Nr: 26001414 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 16-29 776 DATE: January 30, 2026 REMANDED Entitlement to a rating in excess of 10 percent for right knee chondromalacia with degenerative joint disease is remanded. Entitlement to a rating in excess of 10 percent for left knee chondromalacia with degenerative joint disease is remanded. Entitlement to a total rating based on individual unemployability due to service connected disabilities (TDIU) is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to service connected right knee chondromalacia with degenerative joint disease and/or service connected left knee chondromalacia with degenerative joint disease, is remanded. Entitlement to service connection for right leg length discrepancy, to include as secondary to service connected right knee chondromalacia and/or service connected left knee chondromalacia, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1981 to September 1993, to include service in Southwest Asia. He received the Combat Action Ribbon. Regrettably, the Veteran died in February 2020. The appellant is his surviving spouse and has been granted substitution in this matter. See April 2023 Notification Letter. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that the Veteran requested a hearing in the Appeal to Board of Veterans' Appeals (VA Form 9) submitted in June 2016. In a signed statement submitted in May 2023, the appellant withdrew the hearing request. Thus, the Board finds that this hearing request has been withdrawn. The Board most recently remanded the claims for an increased rating for right knee chondromalacia with degenerative joint disease, left knee chondromalacia with degenerative joint disease, entitlement to a TDIU and service connection for a right hip disorder and right leg length discrepancy in June 2023 to send the appellant proper notice of what is needed to substantiate a TDIU claim, to provide the appellant with an opportunity to obtain any outstanding treatment records and to obtain adequate VA medical opinions regarding the etiology of the Veteran's claimed right hip disorder and right leg length discrepancy. In September 2023, the appellant submitted an Application for Increased Compensation Based on Unemployability (VA Form 21-8940). In December 2024, the appellant submitted the Veteran's private treatment records. While a VA medical opinion was associated with the claims file in July 2024, the Board finds that the opinion is inadequate. Thus, further remand is required as explained below. Stegall v. West, 11 Vet. App. 268, 270-71 (1998). 1. Entitlement to a rating in excess of 10 percent for right knee chondromalacia with degenerative joint disease is remanded. 2. Entitlement to a rating in excess of 10 percent for left knee chondromalacia with degenerative joint disease is remanded. 3. Entitlement to a TDIU is remanded. The Veteran, prior to his passing, sought increased ratings for his right knee chondromalacia with degenerative joint disease and left knee chondromalacia with degenerative joint disease as his symptoms were more severe than as reflected by the currently assigned ratings. See January 2015 Correspondence. Prior VA examinations are non-compliant with the United States Court of Appeals for Veterans Claims (Court) holdings in Correia and Sharp. See Correia v. McDonald, 28 Vet. App. 158 (2016) (holding that "to be adequate, a VA examination of the joints must, wherever possible, include the results of range of motion testing" for active range of motion, passive range of motion, weight bearing range of motion, and nonweight bearing range of motion). See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) (holding that if a VA examination was not being conducted during a flare-up, the examiner should provide an opinion based on estimates derived from the information as to the additional loss of range of motion that may be present during a flare-up). Here, the July 2014 and December 2016 VA examiners did not conduct passive range of motion testing, weight bearing range of motion testing, and nonweight bearing range of motion testing. Furthermore, the VA examiners did not provide range of motion testing during repeated use over time. Finally, the July 2014 VA examiner did not provide range of motion testing that may be present during a flare-up. The examiners provided no explanation for the inability to conduct such testing beyond that to do so would be mere speculation. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (an opinion that does not consider all relevant evidence, including lay statements, is inadequate). Accordingly, the Board concludes that addendum opinions should be obtained to determine the severity of the Veteran's right knee chondromalacia with degenerative joint disease and left knee chondromalacia with degenerative joint disease. Where VA provides a veteran with an examination in a claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On remand, such opinions should be obtained. The Board is also remanding the claim for entitlement to a TDIU, rather than to adjudicate the claim in a piece-meal fashion. See Smith v. Gober, 236 F.3d 1370, 1372 (Fed. Cir. 2001) (explaining that, "in the interests of judicial economy and avoidance of piecemeal litigation," claims that are "intimately connected" should be adjudicated together). 4. Entitlement to service connection for a right hip disorder, to include as secondary to service connected right knee chondromalacia with degenerative joint disease and/or service connected left knee chondromalacia with degenerative joint disease, is remanded. 5. Entitlement to service connection for right leg length discrepancy, to include as secondary to service connected right knee chondromalacia and/or service connected left knee chondromalacia, is remanded. The Veteran, prior to his passing asserted, that his right hip disorder was due to stepping in a hole during service. See May 2017 Correspondence. In the alternative, he asserted that his right hip disorder was secondary to his service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease as he altered his gait due to his knee disorders. See April 2014 Correspondence. He also stated that during service he leaned to the right as his right leg was one inch shorter than his left leg. See January 2014 Correspondence. A July 1982 service treatment record notes that the Veteran had a limp. An August 1991 service treatment record noted the Veteran limped while walking. A June 2024 VA medical opinion was associated with the claims file in July 2024. The examiner opined that the Veteran's right hip disorder was less likely than not proximately due to his service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease. The rationale provided was that records support the right hip disorder was secondary to the right leg length discrepancy. The examiner also opined that it was less likely than not that the Veteran's right leg length discrepancy was proximately due to and/or aggravated by his service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease. The rationale provided was that the service connected knee disorders do not lead to leg length discrepancy, which instead is typically genetic and/or due to significant fracture or destruction of bone tissue unilaterally, which then leads to leg length discrepancy. The Board finds the June 2024 VA medical opinion incomplete to decide the claims. In this regard, the examiner did not address direct service connection. Furthermore, the examiner did not address whether the Veteran's right hip disorder was aggravated by service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease. Finally, the causation and aggravation secondary opinions for right leg length discrepancy were identical. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013). As such, the Board finds that a remand is necessary in order to obtain addendum opinions regarding the etiology of the Veteran's right hip disorder and right leg length discrepancy. Where VA provides a veteran with an examination in a service connection claim, the examination and etiology opinion must be adequate. Barr v. Nicholson, supra. On remand, such opinions should be obtained. The matters are REMANDED for the following actions: 1. Return the claims file to an examiner with appropriate expertise to obtain retrospective opinions of the Veteran's service connected right knee chondromalacia with degenerative joint disease and left knee chondromalacia with degenerative joint disease, from January 2014 to February 2020. After reviewing the record, including this Remand, the examiner should provide an estimate, if at all possible, as to the Veteran's range of motion of the left and right knees, to specifically include range of motion during flare-ups. In doing so, the examiner should discuss the historical severity of the Veteran's range of motion with both active and passive motions as well as in weight-bearing and nonweight-bearing, to include during any flare-up episodes or with repeated use over time. If factors, such as pain, weakness, fatigability or incoordination limited range of motion or functional ability, discuss its impact in terms of the severity, frequency and duration thereof. If possible, the examiner should provide an estimate of his range of motion in degrees. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 2. Return the claims file to an appropriately qualified clinician to determine the etiology of the Veteran's claimed right hip disorder. The record, to include a copy of this Remand, should be made available to the examiner. The examiner is asked to furnish an opinion with respect to the following questions: (A) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right hip disorder had its onset and/or is otherwise etiologically related to service? The examiner should address the Veteran's report that his claimed right hip disorder had its onset during his active service, due to stepping in a hole during service. (B) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right hip disorder was aggravated by his service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease? The examiner should address the Veteran's contention that he altered his gait due to his service connected knee disabilities. A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Return the claims file to an appropriately qualified clinician to determine the etiology of the Veteran's claimed right leg length discrepancy disorder. The record, to include a copy of this Remand, should be made available to the examiner. The examiner is asked to furnish an opinion with respect to the following questions: (A) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right leg length discrepancy disorder had its onset and/or is otherwise etiologically related to service? The examiner should address the Veteran's report that during service he leaned to the right as his right leg was one inch shorter than his left leg. The examiner should address a July 1982 service treatment record noting that the Veteran had a limp. An August 1991 service treatment record noting that the Veteran limped while walking. (B) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's right leg length discrepancy disorder was aggravated by his service connected right knee chondromalacia with degenerative joint disease and/or left knee chondromalacia with degenerative joint disease? A rationale should be provided for all opinions offered. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resorting to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Kuhn, 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.