Citation Nr: 18145406 Decision Date: 10/29/18 Archive Date: 10/26/18 DOCKET NO. 15-18 738 DATE: October 29, 2018 REMANDED The issue of entitlement to service connection for right knee disability is remanded. The issue of entitlement to service connection for left knee disability is remanded. The issue of entitlement to a higher initial rating for traumatic brain injury (TBI) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1972 to July 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a September 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In May 2018, the Veteran testified in a videoconference hearing before the undersigned Veterans Law Judge. A copy of the transcript of the hearing is included in the record and has been reviewed. 1. The issue of entitlement to service connection for right knee disability is remanded. 2. The issue of entitlement to service connection for left knee disability is remanded. The Veteran underwent VA examination of his legs in June 2013. In the report, the examiner indicated that he focused on the shins rather than the knees. In an August 2013 addendum medical opinion from a different examiner, it is stated that knee disability was likely unrelated to service. The record shows that the Veteran has current knee disability – in September 2016, he underwent total knee arthroplasty. Further, service treatment records indicate that he injured his lower knee area during service. Based on these facts, the Veteran should be provided a comprehensive VA compensation examination to include a report and medical nexus opinion provided by the examiner. The record contains a June 2018 medical report from the Veteran’s private treating physician. In the report, the physician states that current knee disability is “strongly” related to the complaints of pain during service. The physician did not explain the medical conclusion. An addendum opinion should be sought from this physician. 3. The issue of entitlement to a higher initial rating for TBI is remanded. The Veteran underwent VA examination into TBI in June 2013. In July 2016, VA notified the Veteran that he was eligible for a new examination because the June 2013 examination was not conducted by a neurologist, psychiatrist, physiatrist, or neurosurgeon. In June 2017, the Veteran requested a new examination. In response, VA provided a new TBI examination in February 2018. The examination was conducted by an orthopedic surgeon. During the May 2018 hearing, the Veteran and his representative questioned the adequacy of the examination, indicating that the examiner was not qualified to evaluate TBI. Further, they argued that the examiner did not evaluate all aspects of TBI. Based on the foregoing, the Veteran should be provided a comprehensive VA compensation examination of his TBI conducted by a neurologist, psychiatrist, physiatrist, or neurosurgeon. In June 2018, the Veteran underwent VA examination into a service connection claim for psychiatric disability secondary to TBI. The primary focus of the report is psychiatric disability. Further, the report relies on findings in the February 2018 report conducted by the orthopedic surgeon. As such, the June 2018 report is not an adequate substitute for a comprehensive VA TBI examination and report. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims. Include in the record any outstanding VA treatment records, the most recent of which are dated in June 2018. All records/responses received must be associated with the electronic claims file. 2. Instruct the Veteran to obtain from the Veteran’s treating private physician, if possible, an addendum medical opinion explaining the June 2018 opinion that current knee disability relates to the complaints of leg pain during service. The opinion should be supported by a full rationale. 3. Schedule the Veteran for a VA compensation examination to determine the nature and etiology of his bilateral knee disability. The examiner should review the claims folder, and then respond to the following question. Is it at least as likely as not (i.e., probability of 50 percent or greater) that knee disability is related to a disease, event, or injury during service? In answering this question, review and consider the STRs documenting in-service lower leg problems, the lay assertions from the Veteran, his friends, and his family members, and the supportive private medical evidence. Please support any opinion provided with a full explanation. 4. Schedule the Veteran for a VA compensation examination (conducted by a neurologist, psychiatrist, physiatrist, or neurosurgeon) to determine the nature and severity of his TBI. After examining and interviewing the Veteran, and reviewing the claims folder, the examiner should detail any type of cognitive, physical, and emotional/behavioral problems associated with TBI. The examiner should perform all necessary clinical testing in accordance with the Compensation and Pension Examination TBI Examination Guidelines. See 38 C.F.R. § 4.124a, Diagnostic Code 8045 (2018). Please support any opinion provided with a full explanation. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Christopher McEntee, Counsel