Citation Nr: 1322053 Decision Date: 07/10/13 Archive Date: 07/18/13 DOCKET NO. 13-03 164 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Detroit, Michigan THE ISSUE Entitlement to service connection for a left knee disability, to include as secondary to a service-connected lumbar spine disability. REPRESENTATION Veteran represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL Veteran ATTORNEY FOR THE BOARD N. L. Northcutt, Counsel INTRODUCTION Pursuant to 38 C.F.R. § 20.900(c), the appeal has been advanced on the Board's docket. The Veteran has verified active service from October 1976 to February 1977, as well as three years and four months of prior active service, reportedly from June 1967 to October 1970. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2011 rating decision by the Regional Office (RO) of the United States Department of Veterans Affairs (VA) in Detroit, Michigan. In April 2013, the Veteran appeared at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing is in the Veteran's file. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the Veteran if further action is required. REMAND The Veteran seeks service connection for a left knee disability, which he contends is either the result of his in-service knee injuries, or related to or worsened by his service-connected lumbar spine disability. The Veteran has reported sustaining two in-service knee injuries, one during his period of active service from 1967 to 1970 and one during his period of active service from 1976 to 1977. However, the Veteran's service treatment records from his first period of service have not been obtained; therefore, efforts to obtain these records must be undertaken. The Veteran was afforded a VA orthopedic examination in owever, the record fails to reflect January 2011, and the VA examiner stated that the Veteran's current left knee disability is unrelated to his service-connected lumbar spine disability. However, the examiner failed to provide an opinion as to whether the Veteran's service-connected lumbar spine aggravated his left knee disability, to include what effect, if any, the Veteran's reported lumbar-related antalgic gait produces on his left knee disability. Thus, a new VA medical opinion addressing a theory of secondary service connection must be obtained. The Veteran recently testified that he injured his left knee twice during service, sustaining one injury during each period of active service. During a 1994 VA general medical examination, at which time he was diagnosed with left knee osteoarthritis, the Veteran also reported injuring his knees during service. The consistency of the Veteran's reports indicate their credibility. Given the competent, credible reports of knee injuries during service, a VA medical opinion addressing a theory of direct service connection must be obtained. The Veteran also testified that he is receiving ongoing VA treatment for his left knee disability. Recent records must be obtained. Accordingly, the case is REMANDED for the following action: 1. Request the Veteran's service treatment records for his first period of active service with the Air Force, reportedly from June 1967 to October 1969. 2. Obtain the Veteran's VA treatment records from February 2010 to the present. 3. Then, schedule the Veteran for a VA orthopedic examination by an appropriate medical professional. The entire claim file (i.e., the paper claim file and any medical records contained in Virtual VA, CAPRI, and AMIE) must be reviewed by the examiner. If the examiner does not have access to Virtual VA, any relevant treatment records contained in the Virtual VA file that are not available on CAPRI or AMIE must be printed and associated with the paper claim file so they can be available to the examiner for review. The examiner is to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's left knee disability is directly related to service, or caused or aggravated by his service-connected lumbar spine disability. The examiner is to consider any documentation of a left knee injury reflected in his service treatment records, but is advised that the Veteran's reports of his in-service knee injuries must be viewed as fact for the purposes of this opinion. When rendering an opinion as to whether the Veteran's left knee disability is caused by or permanently worsened by his service-connected lumbar spine disability, the examiner is to clarify whether the Veteran's antalgic gait is related to his lumbar spine disability, and if so, comment on the effect of his gait on his left knee disability. The examiner is advised that the term "aggravation" means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 4. Review the claims file to ensure that all of the foregoing development has been completed, and arrange for any additional development indicated. Then readjudicate the claim on appeal. If the benefit sought remains denied, issue a supplemental statement of the case and provide the Veteran and his representative an appropriate period of time to respond. The case is to then be returned to the Board for further appellate review. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).