Citation Nr: 18143475 Decision Date: 10/23/18 Archive Date: 10/19/18 DOCKET NO. 14-23 218 DATE: October 23, 2018 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for bilateral pes planus is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1979 to September 1983. These matters come to the Board of Veterans' Appeals (Board) on appeal from an August 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. 1. The issues of entitlement to service connection for left and right knee disabilities are remanded. The Veteran seeks service connection for left knee and right knee disabilities that he believes are related to the complaints for which he received treatment in service. In this regard, the evidence of record includes a June 2013 VA examination report in which the VA examiner opined that the claimed condition was less likely as not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that there was an isolated diagnosis and treatment of patellar strain present in the Veteran’s service treatment records (STRs) with normal examination and conservative treatment without objective residual or followup evident. The examiner further reasoned that the Veteran’s current symptoms are 30 years following with history of physically demanding work; therefore, it is more likely the result of aging and work stresses than the incident in 1982. The Board finds the June 2013 VA examiner opinion inadequate to adjudicate the Veteran’s claims. The examiner’s statement that there was an isolated diagnosis and treatment of patella strain present in the Veteran’s STRs with normal exam and without objective residual or followup evident is inaccurate. The Board notes that the Veteran complained of right knee pain during service in October 1981, June 1982, and September 1983. See Reonal v. Brown, 5 Vet. App. 458, 460-461 (1993) ("An opinion based upon an inaccurate premise has no probative value.") Further, the Veteran stated in his correspondence dated October 2014 that upon discharge he still had pains in his knees, but did not complain because he did not know what to do about it at that time. Additionally, the Board notes that the June 2013 VA examiner did not diagnose the Veteran with a left knee disability. However, the examiner did not address the Veteran’s complaint of left knee swelling and pain during service and his lay statements regarding ongoing left knee pain. Based on the foregoing deficiencies, the Board finds that this opinion is inadequate and an additional examination is needed. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007) ("A mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion."); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). 2. Entitlement to service connection for bilateral pes planus is remanded. The Veteran seeks service connection for bilateral pes planus that he believes was aggravated by his active military service. In this regard, the evidence of record includes a June 2013 VA examination report in which the examiner opined that the claimed condition, which clearly and mistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. The examiner reasoned that clear evidence existed for identified pes planus on the 1979 entrance examination as well as the 1983 separation examination. The examiner further reasoned that there were no symptoms found in the STRs, or the VA treatment records, therefore, aggravation could not be verified. The Board finds the June 2013 VA examiner opinion inadequate to adjudicate the Veteran’s claim. The statement that there were no symptoms found in the STRs or the VA treatment records is inaccurate. The Board notes that the Veteran’s STRs document pain on the medial aspect of the foot. The Board also notes that VA treatment records dated June 2014 document pes planus and VA treatment records dated November 2011 document left foot pain. See Reonal, 5 Vet. App. at 460-61 ("An opinion based upon an inaccurate premise has no probative value.") Based on the foregoing deficiencies, the Board finds that this opinion is inadequate and an additional examination is needed. See Stefl, 21 Vet. App. 120, 123 ("A mere conclusion by a medical doctor is insufficient to allow the Board to make an informed decision as to what weight to assign to the doctor's opinion."); see also Barr, 21 Vet. App. at 311 (once VA undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Schedule the Veteran, if necessary, for a VA examination to determine the nature and etiology of his left and right knee disabilities. The claims file (including any additional medical evidence obtained as a result of this Remand) should be made available to the examiner and review of the file should be noted in the requested report. The examiner should record the full history of the identified left and right knee disabilities, including the Veteran's competent account of his symptoms. Following review of the claims file and examination of the Veteran, if necessary, the examiner should respond to the following: (a.) Is it at least as likely as not (50 percent probability or greater) that the diagnosed left knee disability or right knee disability had its onset during active service, or within one year of the Veteran's separation from active service, or is otherwise related to service? The examiner is asked to specifically discuss the right knee pain (October 1981, June 1982, and September 1983); and left knee swelling and pain (October 1981) documented in the Veteran’s STRs. The examiner is also asked to specifically discuss the lay statements of record. 3. Schedule the Veteran for a VA flatfoot (pes planus) examination, if necessary. After reviewing the claims file, performing a physical examination of the Veteran, if necessary, and conducting any indicated tests, the examiner is asked to address the following: (a.) Is it at least as likely as not that the diagnosed bilateral pes planus was caused or aggravated by the Veteran's active military service? The examiner is asked to specifically discuss the Veteran’s complaint of pain on the medial aspect of the foot documented during service. The examiner is also asked to specifically discuss the pes planus and foot pain documented in the Veteran’s VA treatment records, and the lay statements of record describing the Veteran’s bilateral foot pain. (b.) If the examiner finds that the bilateral pes planus has been permanently worsened beyond normal progression (aggravated) by the Veteran's active military service, the examiner should attempt to quantify the degree of aggravation beyond the baseline level that is attributed to active military service. (Continued on the next page)   All findings and conclusions should be supported with a complete rationale and set forth in a legible report, which should reflect the examiner's consideration and analysis of both the medical and lay evidence of record. If it is not possible to provide an opinion without resort to speculation, the reason that is so should explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge. S. C. KREMBS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Smith-Jennings, Associate Counsel