Citation Nr: 18142478 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-29 549 DATE: October 15, 2018 REMANDED The claim of entitlement to service connection for a left knee disorder is remanded. The claim of entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1964 to February 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran has also perfected an appeal of entitlement to service connection for multiple myeloma. He requested a Board hearing in his May 2017 VA Form 9, and his representative affirmed this hearing request in a February 2018 statement. The hearing is in the process of being scheduled, and any action by the Board on this claim in the instant decision would be premature. 1. The claim of entitlement to service connection for a left knee disorder. 2. The claim of entitlement to service connection for a right knee disorder. Remand is required to afford the Veteran an examination. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with an examination for his claimed bilateral knee disability. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). The Veteran asserts he has a bilateral knee disorder as a result of wear and tear sustained during his military service. In a statement submitted with his March 2015 Notice of Disagreement, the Veteran described working on his knees and crawling through narrow spaces as part of his in-service occupation as an aircraft mechanic. He asserted that he suffered from knee pain during service and treated the pain with Tylenol. Post-service, as he aged, he reportedly treated his knee pain with Ibuprofen. January 2015 VA treatment records diagnose osteoarthritis of the knee. Private treatment records from December 2011 similarly diagnose arthritis of the knee. In addition, his DD 214 indicates that he served as an aircraft mechanic, and his description of working on his knees during the course of his duties are credible. Finally, a May 2015 letter from Dr. JB, the Veteran’s private physician, indicated that the Veteran’s medical history of osteoarthritis of the patella or degeneration was due to his previous job description with his physical examination showing the knee osteoarthritis. This opinion is not adequate to support the grant of service connection because there is no accompanying rationale. Nevertheless, there is evidence to indicate that the Veteran’s present bilateral knee disorder may be associated with his in-service wear and tear on his knees. An examination is thus required. Next, remand is necessary to obtain relevant records of treatment. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159(c) (2017). VA’s duty to assist also includes making reasonable efforts to obtain relevant private medical records. 38 C.F.R. § 3.159(c)(1). The May 2015 opinion by Dr. JB refers to an examination conducted showing the Veteran’s knee diagnoses and seemingly discussing his military history. Though some records from this treatment provider are associated with the Veteran’s file, the specific examination is not included. As such, the Board finds that remand is required to obtain outstanding private treatment records. VA treatment records are similarly sparse, and they should be obtained on remand as well. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his or her representative. 2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records pertaining to his claimed bilateral knee disorder. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his bilateral 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. The examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee disorder had onset in, or is otherwise related to, active military service. The examiner must specifically address the Veteran’s assertions of an in-service wear and tear on his knees as part of his occupation as an aircraft mechanic, his March 2015 description of in-service knee pain and post-service knee pain, and a May 2015 opinion from Dr. JB. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steve Ginski, Associate Counsel