Citation Nr: 18145282
Decision Date: 10/26/18	Archive Date: 10/26/18

DOCKET NO. 16-25 658
DATE:	October 26, 2018
REMANDED
Entitlement to service connection for right knee degenerative changes of the patellofemoral joint is remanded.
Entitlement to service connection for left knee strain is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army and the United States Navy from May 1988 to May 1992, and from October 1993 to May 1996, respectively.
These matters come before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO) in St. Paul, Minnesota.
During the pendency of the appeal, the Board notes that in a March 2018 rating decision, the RO granted entitlement to service connection for migraine headaches.  As this represents a full grant of benefits sought, that issue is no longer on appeal.  
While the Board sincerely regrets the delay, additional development is required before the Veteran’s claims may be adjudicated on the merits.

Bilateral Knee Condition
In a November 2013 VA examination, the VA examiner stated that the X-rays of the Veteran’s right and left knees were normal, and as such the Veteran did not have a current disability.  Notwithstanding this fact, the VA examiner opined that the Veteran’s right and left knee condition were respectively less likely than not caused by her military service because there was no chronic bilateral knee condition recorded in the Veteran’s service treatment records.  Given this inconsistency, the Board finds the VA examiner’s opinion inadequate. When VA undertakes to provide a VA examination, it must ensure that the examination is adequate.  Barr v. Nicholson, 21 Vet. App. 303, 312 (2007).  
Further, the Board notes that a medical opinion based solely on the absence of documentation in the record is also inadequate, if it does not take into account the Veteran’s reports of symptoms and history (even if recorded in the course of the examination).  Dalton v. Peake, 21 Vet. App. 23 (2007).
Accordingly, the Board finds that it must remand the appeal for a new VA examination, to get a clear diagnosis, and to analyze the significance of all the information contained in the Veteran’s service treatment records, so as to determine whether the Veteran’s diagnosis is related to her military service. 
The matters are REMANDED for the following actions:
Schedule the Veteran for a VA examination to determine the nature and etiology of her left and right knee disabilities, including strain, sprain and arthritis. 
The examiner is asked to opine as to whether it is as least as likely as not (50 percent probability or more) that the Veteran’s left and right knee disabilities had their onset in service or are otherwise the result of an incident in service.
The examiner should consider all evidence, including lay statements, medical records, and other medical opinions of record.  Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record.
The examiner should discuss any lay statements made by the Veteran with respect to the etiology of her claimed disabilities.  If the examiner must resort to speculation for any of the requested opinions, an explanation as to why this is so, is required.
The Agency of Original Jurisdiction (AOJ) should ensure that any additional evidentiary development suggested by the examiner is undertaken so that a definite opinion can be obtained.
 
Michael J. Skaltsounis
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	J.B. King, Associate Counsel