Citation Nr: 18140093 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 10-00 302 DATE: October 2, 2018 REMANDED Service connection for a right knee disorder is remanded. Service connection for a left knee disorder, to include as due to a right knee disorder, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from March 1989 to March 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2008 rating decision by the Regional Office (RO) in St. Petersburg, Florida, which, in pertinent part, denied service connection for a left knee disorder. A February 2015 rating decision, in pertinent part, reopened and denied service connection for a right knee disorder. In June 2016, the Veteran testified at a Board Videoconference hearing from the RO before the undersigned Veterans Law Judge. A transcript of the hearing has been obtained. This case was before the Board in August 2016, where the Board, in pertinent, denied service connection for right and left knee disorders. The Veteran appealed the portion of the August 2016 Board decision that denied service connection for the right and left knee disorders to the United States Court of Appeals for Veterans Claims (Court). In a February 2018 Memorandum Decision, the Court partially vacated the Board’s decision. In compliance with the Court’s Orders, additional development is required in order to assist in development. See Forcier v. Nicholson, 19 Vet. App. 414 (2006) (holding that the duty to ensure compliance with a Court Order extends to the terms of the agreement struck by the parties that forms the basis of the JMR). 1. Service Connection for Right Knee Disorder The Veteran contends that the currently diagnosed bilateral knee disorder is related to service. At the June 2016 Board hearing, the Veteran testified to running and strenuous exercise during service, which injured the knees. A March 2016 VA examination report reflects the Veteran reported injuring the right knee while running during service. In the alternative, a June 2016 statement reflects the Veteran wrote that a left knee disorder was secondary to a right knee disorder, to include overuse of the left knee while compensating for right knee pain. In the March 2016 VA medical opinion, the VA examiner opined that a right knee disorder was less likely than not incurred in or caused by service. The March 2016 VA examiner reasoned that the service treatment records and the March 1992 service separation examination report did not reflect a right knee disorder, and that a right knee disorder was likely caused by obesity. The March 2016 VA examiner specifically considered a February 1990 service treatment record reflecting the Veteran reported injuring the right knee while running, diagnosed as “PFPS” (patellofemoral pain syndrome). Directly addressing the February 2018 Memorandum Decision, the March 2016 VA examiner’s opinion relied on the absence of evidence of a right knee disorder in the March 1992 service separation examination report and immediate post-service treatment records. The February 2018 Memorandum Decision also specifically noted that the March 2016 VA examiner did not consider the January 1992 report of medical history reflecting the Veteran reported swollen or painful joints and or the Veteran’s lay statements indicating that he self-medicated for right knee pain and was “forced to bear this condition since being in the military up until the present.” See February 2012 statement. Other lay statements include a February 2015 notice of disagreement (NOD) reflecting the Veteran advanced that a right knee replacement was the “result of my knee getting worse over the years,” and that the right knee symptoms he had experienced during service were the same symptoms that he had experienced “after leaving the service.” See February 2015 NOD. For the above reasons, the Board is remanding for a new VA medical opinion to assist in determining the etiology of the right knee disorder. 2. Service Connection for Left Knee Disorder The Veteran contends that a left knee disorder is due to a right knee disorder, to include overuse of the left knee while compensating for right knee pain. The February 2018 Memorandum Decision noted that the secondary service connection issue is inextricably intertwined with the issue of service connection for a right knee disorder. See Parker v. Brown, 7 Vet. App. 116 (1994); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (issues are “inextricably intertwined” when a decision on one issue would have a “significant impact” on a veteran’s claim for the second issue). As such, consideration of the issue must be deferred until the intertwined issue is either resolved or prepared for appellate consideration. The matters are REMANDED for the following action: 1. Request a new VA medical opinion. The relevant documents in the record should be made available to any examiner, who should indicate on the examination report that he/she has reviewed the documents. Examination of the Veteran is not required unless the examiner determines that an examination is necessary to provide a reliable opinion. If an examination is required, a detailed history of relevant symptoms should be obtained from the Veteran. A rationale for all opinions and a discussion of the facts and medical principles involved should be provided. The VA examiner should offer the following opinion with supporting rationale: A) Is it at least as likely as not (50 percent probability or greater) that a right knee disorder, to include, but not limited to, right knee arthritis, is causally related to the February 1990 right knee injury while running (diagnosed as patellofemoral pain syndrome) in service? In rendering the requested opinion, the VA examiner should address and comment on the January 1992 Report of Medical history reflecting the Veteran reported swollen or painful joints. The VA examiner should also address and comment on the Veteran’s lay statements and VA treatment records regarding the Veteran’s history of right knee symptoms. The term “at least as likely as not” does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. 2. Readjudicate the issues of service connection for the right and left knee disorders. If the benefit sought remains denied, the Veteran and representative should be issued a Supplemental Statement of the Case. J. PARKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Tenney, Associate Counsel