Citation Nr: 18144454 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 16-29 851 DATE: October 24, 2018 REMANDED Service connection for a bilateral knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to October 1988; from August 1990 to September 1990; from February 1991 to April 1991; from March 2003 to July 2003; and from June 2005 to May 2007. He also had additional service in the United States Navy Reserve. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision. The Veteran was afforded VA examinations in January 2014 and January 2016 during which the examiners provided negative nexus opinions. However, the examiners did not consider the Veteran’s lay statements regarding the ongoing nature of his symptoms. In addition, the Board finds that it is unclear whether the Veteran was diagnosed with patellofemoral arthritis during service. In this regard, the January 2014 and January 2016 VA examiners both indicated that an October 1987 service treatment record showed a diagnosis of “PFA.” However, the January 2016 VA examiner stated that October 1987 x-ray findings were normal with the exception of right knee “OD” of the non-weight bearing aspect of the medial femoral condyle, which he opined was insignificant. The January 2016 VA examiner further stated that a May 1988 physical therapy consultation noted that x-rays were negative. For these reasons, a remand is necessary to determine the nature and etiology of the Veteran’s right and left knee disorders. The Veteran has also reported that his right and left knee disorders are related to his period of Reserve service. In an August 2000 dental questionnaire, the Veteran reported having painful joints. In addition, in an August 2000 report of medical history, the Veteran reported having “trick” or locked knee. It was also noted that the Veteran reported that his right knee “floats.” Therefore, on remand, the AOJ should attempt to verify all relevant periods of the Veteran’s Reserve service. Lastly, an August 2000 report of medical history noted that the Veteran received treatment from a private orthopedist for his right knee. On remand, the AOJ should attempt to obtain any outstanding private medical records. The matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for left and right knee disorders that are not already of record. A specific request should be made to obtain records from the private orthopedist identified by the Veteran in an August 2000 Reserve service treatment record. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. The AOJ should conduct appropriate development to verify the dates of any periods of active duty, active duty for training (ACDUTRA), and inactive duty for training (INACDUTRA) in the United States Navy Reserve in 2000. The AOJ should prepare a summary of the dates and types of service. The summary should be associated with the claims file. 3. After completing the above development, the AOJ should refer the Veteran’s claims file to a suitably qualified VA examiner for a clarifying opinion as to the nature and etiology of any current right and left knee disorders. A physical examination is only needed if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The Veteran has contended that he injured his right knee during a period of active duty in 1987. He has also asserted that his right and left knee disorders are a result of carrying heavy equipment, marching, and running during his active duty and Reserve service. See January 2014 VA examination report; May 2014 notice of disagreement; June 2016 substantive appeal. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s right and left knee disorders manifested during a period of active duty, active duty for training, or inactive duty for training or are otherwise causally or etiologically related to such a period of service, to include any injury or symptomatology therein. The examiner should also state whether the Veteran has arthritis that manifested in service or within one year of separation from active duty. In rendering this opinion, the examiner should address the October 1987 service treatment record that noted a diagnosis of “PFA” and that x-ray findings were within normal except for “OD” in the right knee non-weight bearing medial femoral condyle. The examiner should also consider the following: 1) the October 1987 service treatment records that noted the Veteran reported having left knee pain and giving way; 2) the May 1988 consultation that noted the Veteran complained of bilateral knee pain since September 1987; 3) the August 1988 report of medical history in which the Veteran reported having knee joint pain; 4) the August 2000 dental questionnaire in which the Veteran reported having painful joints; 5) the August 2000 report of medical history in which the Veteran reported having a trick or locked knee and that his right knee floated; and 6) the October 2012 private treatment record that noted the Veteran sustained an injury to his left knee in 2009 while stepping in a hole. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board 4. The AOJ should review the medical opinion to ensure that it is in compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Wulff, Associate Counsel