Citation Nr: 1553508 Decision Date: 12/23/15 Archive Date: 12/30/15 DOCKET NO. 12-03 079 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Winston-Salem, North Carolina THE ISSUE Entitlement to service connection for bilateral knee disability, to include as secondary to the service-connected bilateral flat feet. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran and his wife ATTORNEY FOR THE BOARD G. Fraser, Associate Counsel INTRODUCTION The Veteran served on active duty from September 1975 to September 1979. This appeal comes before the Department of Veterans Affairs (VA) Board of Veterans Appeals (Board) from a March 2010 rating decision of the VA Regional Office (RO) in Winston-Salem, North Carolina. In October 2015, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. REMAND By way of a March 2010 rating decision, the RO denied entitlement to service connection for bilateral knee disability. The Veteran has indicated disagreement with this decision. The Board finds that further development is needed prior to adjudicating the claim on its merits. In the course of his February 2010 VA examination, the Veteran reported a 30 year history of knee problems. He also indicated his belief that his service-connected flat feet contributed to his knee disabilities. The examiner reviewed the Veteran's outpatient treatment notes and complete claims file, and performed an examination of the Veteran's knees. Following his examination, the examiner diagnosed the Veteran with bilateral degenerative joint disease (DJD). However, the examiner then determined the Veteran's bilateral DJD was not caused by his pes planus. In support of this conclusion, the examiner stated pes planus does not cause bilateral DJD of the knees but did not provide a rationale. The examiner also determined the Veteran's right knee DJD was "less than likely" a progression of his in service complaints. In support of this conclusion, the examiner determined that based on the interval evidence of care during and following service, it is less than likely his current knee DJD is caused by the injury noted in service. A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008). In this regard, it should also be noted that examiners simply are not free to ignore a veteran's statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Initially, the Board notes the February 2010 VA examiner has only addressed a direct causal nexus relative to the Veteran's right knee DJD; however, a review of the Veteran's service treatment records (STRs) indicates he was also treated for left knee pain and swelling in April 1976. Further, the examiner's right knee direct causation medical opinion only addresses the injury the Veteran sustained while walking in February 1976. However, following a comprehensive review of the Veteran's STRs, the Board notes the Veteran was also treated for a right knee injury in October 1977, which was diagnosed as a contusion with effusion. This incident was not mentioned in the examiner's report. Further, the examiner did not provide any support for his conclusion that the Veteran's pes planus could not have caused his bilateral DJD and did not address aggravation. Based on the foregoing, a new examination and medical opinion is warranted. Finally, on remand all relevant and ongoing treatment records should be obtained. In this regard, the Board notes the Veteran submitted a VA Form 21-4142 in October 2015 acknowledging treatment for his bilateral knee disabilities at the Asheville, Charlotte, and Salisbury VAMCs. The RO or AMC should ensure all records related to treatment for his bilateral knee disabilities are obtained from these facilities. Accordingly, the case is REMANDED for the following action: 1. Obtain all VA treatment records for the Veteran dated from August 2011 to the present and associate them with the claims file. All efforts to obtain these records must be documented in the claims file. 2. Thereafter, obtain a new VA knee examination and medical opinion. The claims file and a copy of this remand must be made available to and be reviewed by the examiner. The medical opinion must indicate that the claims file was reviewed. The examiner should state whether it is at least as likely as not (50 percent probability or greater) that the Veteran's current bilateral knee disability began in service, was caused by service, or is otherwise related to service, to include the reports of right knee pain in February 1976, left knee pain and swelling in April 1976, and a right knee contusion with effusion in October 1977. If the above opinion is negative, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's knee disabilities were caused or aggravated by his service-connected pes planus disability to include on the basis of an altered gait. Aggravation is defined as a permanent worsening beyond the natural progression of the disability. A complete rationale must be provided for any opinion offered. 3. Thereafter, readjudicate claim. If the benefit sought is not granted, issue a Supplemental Statement of the Case and afford the Veteran and his representative an appropriate opportunity to respond. The case should then be returned to the Board, as warranted. 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 of Veterans' Appeals 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 2014). ______________________________________________ ROBERT C. SCHARNBERGER Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2014), only a decision of the Board of Veterans' Appeals 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) (2015).