Citation Nr: 18142838 Decision Date: 10/17/18 Archive Date: 10/16/18 DOCKET NO. 15-35 054 DATE: October 17, 2018 REMANDED Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1986 to May 1992. The Board of Veterans’ Appeals (Board) notes that the Veteran submitted a notice of disagreement in August 2016 disagreeing with the October 2016 rating decision which assigned a rating for his service-connected right knee disability. To date, a statement of the case has not been issued readjudicating this issue. As the RO has acknowledged the Veteran’s notice of disagreement, a remand is not warranted under Manlincon v. West, 12 Vet. App. 238 (1999). This matter is referred to the RO for continued development and the issuance of a statement of the case, and the Board will not address it at this time. 1. Entitlement to service connection for a left knee disability is remanded. The Board finds a remand is warranted because the record contains insufficient medical evidence to decide this claim for the Veteran’s left knee disability as discussed in more detail below. The Veteran was provided a VA examination in July 2015 to determine the etiology of his bilateral knee condition. See July 2015 VA Knee and Lower Leg Conditions Disability Benefits Questionnaire (DBQ). The examiner diagnosed the Veteran with bilateral patellar or quadriceps tendon rupture, specifically noting the date of diagnosis for a right knee as 1986 and left knee in 1995. Id. The examiner did not diagnose any osteoarthritis. The examiner further noted that the Veteran injured his right knee during active service in 1989 while playing basketball, and that he injured his left knee in 1995 while playing softball. The examiner provided a positive nexus opinion linking the Veteran’s bilateral knee condition to the Veteran’s active service injury from playing basketball and falling on his knees. Id. The stated rationale for the opinion was “supporting evidence of a persistent condition.” The examination is inadequate to the extent it is unclear whether the Veteran’s current left knee disability is related to active service treatment for a right knee rupture due to playing basketball. In fact, the Decision Review Officer discounted this opinion and stated that “[d]espite the physician’s linking the left knee to the in service event, the physician’s opinion referenced the event in which the left knee was involved as being in 1995. The post service records support a post service injury.” See August 2016 Statement of the Case. The examiner does not specifically address why the Veteran’s left knee disability is related to active service despite noting a post-service injury. The examination opinion is also inadequate because it fails to address whether the Veteran’s current left knee disability is related to notations in the Veteran’s service treatment records (STRs) of left hip pain in September 1986, left foot in April 1988, left thigh pain in April 1988, as well as a twisted left ankle in August 1988. See STR-Medical. Additionally, the examiner noted a persistent condition but did not address whether the Veteran has arthritis. In this regard the Board notes that an X-ray of the Veteran’s bilateral knees in December 2011 diagnosed degenerative joint disease of the left greater than right knee. See VA Radiographs X-ray report in CAPRI received in September 2013. Finally, the VA examiner failed to address whether the Veteran’s left knee disability was caused by or aggravated by his service-connected right knee disability. As it pertains to aggravation, the Board is interested in whether the right knee disability, in general, could have caused the Veteran’s present left knee condition, for instance by altering his gait or causing wear and tear on the knee. For the reasons stated above, Board finds that remand to obtain another VA opinion is necessary to determine the etiology of the Veteran’s left knee disability. 38 C.F.R. § 3.159 (2017). The matter is REMANDED for the following action: 1. The Regional Office (RO) should obtain any outstanding VA treatment records since August 2013 and private records and associate the records obtained with the claims file. 2. After completing the foregoing development, provide the entire claims file (including this Remand decision) to the October 2015 VA examiner if available and obtain new etiology and nexus opinion for the left knee disability claim. If the examiner determines that an opinion may not be offered without first examining the Veteran, then schedule the Veteran for an appropriate examination(s). Any clinically indicated testing and/or consultations should be performed. The examiner is requested to address the following: (a.) Is it at least as likely as not that the Veteran’s current left knee disability had its onset in or is otherwise related to the Veteran’s active service to include complaints of left ankle, foot, hip, and thigh pain as noted in his STRs? (b.) ) Is it at least as likely as not that the Veteran’s current left knee disability had its onset or manifested within one year of the Veteran’s discharge in May 1992? (c.) If arthritis is found to be present, the examiner is to address whether it is as likely as not (50 percent probability or greater) related to any incident of service and/or had its onset within one year of his separation from service. (d.) Whether it is at least as likely as not that the Veteran’s left knee disability, to include DJD is (a) caused by or (b) aggravated (permanently worsened) by service-connected right knee disability. (Continued on the next page)   Any opinion expressed by the VA examiner should be accompanied by a complete rationale. If medical literature is relied upon in rendering this determination, the VA examiner should identify and specifically cite each reference material utilized. If the VA examiner is unable to offer an opinion without resorting to speculation, a thorough explanation as to why an opinion cannot be rendered should be provided. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Lilly, Associate Counsel