Citation Nr: 18142730 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 15-03 923A DATE: October 16, 2018 REMANDED Service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1981 to 1985. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision. Service connection for a left knee disability is remanded. A remand is necessary to afford the Veteran an additional VA examination pursuant to the specific directives below. The matter is REMANDED for the following action: 1. Obtain any updated (from September 2015 to the present) VA treatment records for association with the claims file. 2. Ask the Veteran to identify any other knee treatment records and to authorize VA to obtain those records for association with the claims file. 3. Then schedule the Veteran for an examination with an appropriate examiner to evaluate the nature and cause of the claimed left knee disability. The Board regrets the need to remand the matter to the RO; however, the Board is unable to adjudicate the Veteran’s case until it has the requested information. Therefore, the Board must ask the VA examiner and the RO to ensure compliance with the instructions and directives below (that is, full and thoroughly explained answers to each of the questions) to avoid delays in adjudication. A new examination is necessary because the July 2014 negative opinion on direct service connection improperly relied on the absence of service treatment records documenting the claimed condition, and the September 2015 secondary service connection opinion does not address aggravation or the Veteran’s belief, as advanced in a March 2015 private medical letter, that an abnormal gait associated with the Veteran’s service-connected right knee disability caused or aggravated the current left knee disability. The Board notes, however, that the March 2015 positive nexus statement is not sufficient for the Board to grant to the claim because the physician did not provide a detailed explanation to support the opinion or indicate familiarity with the Veteran’s past medical treatment for left knee conditions, including worker’s compensation evaluation for post-service left knee meniscal tears. Examination Instructions The examiner should answer the following questions based on (1) a review of the claims file and (2) interview and examination of the Veteran. Please note that an opinion based solely on the lack of documented in-service treatment or the lack of medical literature supporting a claim would not be legally adequate for the Board to decide the claim. [The Board draws the examiner and RO’s attention to the November 2014 and December 2014 written statements and the September 2018 appellate brief where the Veteran and his representative described the Veteran’s in-service left knee injury, resulting pain, and belief that the current disability is either directly related to an in-service injury AND/OR was caused or aggravated by the Veteran’s service-connected right knee disability and associated altered gait.] a) Please identify any CURRENT (from February 2014 to the present) left knee disabilities, to include pain with associated functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, 2018 U.S. App. LEXIS 8467 (Undiagnosed conditions may be service connected if such conditions cause functional impairment.) b) Is it at least as likely as not (a 50 percent or better probability) that ANY current left knee disability (to include pain with functional impairment) had its onset in or is otherwise related to the Veteran’s service? c) Is it at least as likely as not (a 50 percent or better probability) that ANY current left knee disability (to include pain with functional impairment) was CAUSED by the service-connected right knee disability, to include an altered gait associated with the right knee disability? d) Is it at least as likely as not (a 50 percent or better probability) that any current left knee disability (to include pain with functional impairment) was AGGRAVATED by the service-connected right knee disability, to include an altered gait associated with the right knee disability? (Aggravation in this context means any increase in severity beyond the natural progression of the disability.) The examiner MUST specifically consider and address 1) the Veteran’s left knee symptoms and their onset AND 2) the Veteran’s history of post-service left knee injuries including meniscal tears with associated worker’s compensation evaluation. [CONTINUED ON NEXT PAGE] A detailed explanation (rationale) is requested and very much appreciated for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation.) VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Robinson, Associate Counsel