Citation Nr: 18142933 Decision Date: 10/17/18 Archive Date: 10/17/18 DOCKET NO. 13-31 562 DATE: October 17, 2018 REMANDED Issue of service connection for a left knee condition, to include left knee degenerative arthritis, status post left knee surgery, is remanded. Issue of service connection for a right knee condition, to including right knee strain and degenerative joint disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to February 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision issued by the Department of Veterans Affairs (VA). The Veteran perfected his appeal. See April 2013 Notice of Disagreement; September 2013 Statement of the Case; October 2013 VA Form 9. The Veteran testified before the undersigned Veterans Law Judge in an November 2016 hearing. A transcript of the hearing is associated with the claims file. In October 2017, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) for further development of the Veteran’s claims of service connection for his left and right knee conditions. The AOJ further developed the case and an August 2018 Supplemental Statement of the Case was issued. 1. Issue of service connection for a left knee condition, to include left knee degenerative arthritis, status post left knee surgery. The Board cannot make a fully-informed decision on the issue of service connection for a left knee condition because clarification is needed by an appropriate VA medical professional as to whether it as least as likely as not the Veteran’s current left knee conditions were incurred or otherwise related to service. In October 2017, the Board remanded this issue to obtain a VA orthopedic specialist opinion as to whether the Veteran had a current left knee condition that was at least as likely as not incurred in or otherwise related to any disease or injury incurred in service. The Regional Office (RO) obtained a November 2017 VA orthopedic specialist opinion, but clarification on whether there is a medical nexus between the Veteran’s current left knee disability and service is needed. The VA orthopedic specialist opined that there is no relevant connection between the Veteran’s service and meniscus-related symptoms, and that there is no service connected disability issue relative to the knee. However, the VA orthopedic specialist then opined that is is “at least as likely as not that this left knee disorder, to include variously diagnosed as left knee medial cartilage or meniscus tear, and any right knee disorder, which the vetern now has, DID NOT have its onset during service or is otherwise related to any disease or injury occurred in the service.” This latter statement suggests that there may still be a 50 percent chance that that the left knee conditions were incurred or are otherwise related to service, which would warrant granting service connection. See 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55-56 (1990). Given the conflicting statements, the Board finds that clarification is needed. The Board recognizes that there is a November 2016 private treatment provider opinion from P L M, M.D., that indicates the Veteran’s current knee osteoarthritis is related service. However, Dr. P L M bases his opinion on the Veteran’s reported muscle imblance injuries to his thigh musculature while in service. Dr. P L M cites to no supporting medical evidence of a muscle imbalance or knee osteoarthritis during service, and only indicates it “may” have contributed to development of osteoarthritis. In addition, Dr. P L M’s opinion that the muscle imbalance is a contributory factor for subsequent development of osteoarthritis is unclear as whether the Veteran’s current knee osteoarthritis incurred during service or after separation as secondary to a muscle imbalance. The Board notes that the Veteran does not have a service connected disability related to muscle imbalance to establish a secondary service connection. Thus, the Board finds the opinion insufficient to establish a medical nexus for his asserted bilateral knee disabilities. 2. Issue of service connection for a right knee condition, to include right knee strain and degenerative joint disease. The Board cannot make a fully-informed decision on the issue of service connection for a right knee condition because clarification is needed by a VA orthopedic specialist as to whether it is as least as likely as not the Veteran’s current right knee conditions were incurred or otherwise related to service. Similar to the Veteran’s claim of service connection for his left knee condition, it is unclear from the November 2017 VA orthopedic specialist’s opinion as to whether there is a medical nexus between the Veteran’s current right knee condition and service due to the conflicting statements. Accordingly, the Board finds that clarification is needed as to the right knee as well. The matters are REMANDED for the following action: 1. If possible, obtain an addendum opinion from the same orthopedic specialist who provided the November 2017 opinion. If not possible, obtain an opinion from an appropriate medical professional. The opinion should address the nature and cause of the Veteran’s left knee condition, to include degenerative arthritis and status post left knee surgery, and his right knee condition, to include right knee strain and degenerative joint disease. If the medical professional determines that it is necessary, schedule the Veteran for a VA examination regarding the etiology of his left and right knee conditions. The medical professional should respond to the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s left knee condition, to include degenerative arthritis and status post left knee surgery, and his right knee condition, to include right knee strain and degenerative joint disease, began in or is otherwise related to the Veteran’s military service? The examiner may also opine that it is more likely than not (greater than a 50 percent probability) or less likely than not (less than a 50 percent probability) that the Veteran’s left and right knee condition began in or is otherwise related to service. The medical professional should consider and discuss the Veteran’s lay testimony and assertions regarding any pertinent complaints and symptoms, in particular his testimony during the November 2016 hearing that he pulled his hamstrings during basic training that led to his current knee conditions. The medical professional should also specifically address his May and June 1968 service treatment records showing a leg injury after carrying a 150 pound man and diagnosis for a pulled hamstring. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. (b) If either his left or right knee condition is deemed to be unrelated to service, the medical professional should, if possible, identify the cause considered more likely and explained why that is so. 2. Advise the Veteran that he may submit a supplemental medical opinion from a treating physician or any other medical professional that addresses whether his left knee condition, to include degenerative arthritis and status post left knee surgery, and his right knee condition, to include right knee strain and degenerative joint disease, began or is otherwise related to his service. If such an opinion is provided, the treating physician (or any other medical professional) should set forth in the medical report a fully articulated rationale for the opinion expressed. The report should consider and discuss the Veteran’s medical history and relevant clinical data that apply in this case, which may reasonably explain the medical guidance in the study of this case. (Continued on next page) 3. After the above development has been completed, review the record and ensure that all development sought in this remand has been completed. Arrange for any further development indicated by the results of the development requested above and re-adjudicate the claims. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Lin, Associate Counsel