Citation Nr: 18147405 Decision Date: 11/05/18 Archive Date: 11/05/18 DOCKET NO. 17-21 203 DATE: November 5, 2018 REMANDED Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to a disability rating in excess of 10 percent prior to April 6, 2017, and in excess of 20 percent thereafter for cervical spine strain with degenerative disc disease is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1964 to September 1969. In May 2018, the Veteran testified at a Board hearing. The transcript is of record. The Board notes that the Veteran’s claim of entitlement to service connection for peritoneal adhesions, status post abdominal stab wound, was granted in a March 2017 rating decision. As such, this issue is no longer on appeal and the Board does not have jurisdiction. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997) (holding that where an appealed claim for service connection is granted during the pendency of the appeal, a second notice of disagreement must thereafter be timely filed to initiate appellate review of the claim concerning "downstream" issues, such as the compensation level assigned for the disability and the effective date); see also 38 C.F.R. § 20.200 (2017). 1. Bilateral Knees Once VA undertakes the effort to provide an examination, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The Veteran underwent a VA examination in July 2013. The examiner diagnosed torn meniscus and osteoarthritis of the right knee but failed to address the left knee. Furthermore, an opinion as to the nature and etiology of the Veteran’s bilateral knee condition was not provided. The Veteran’s testimony regarding the onset and continuity of his bilateral knee injury is credible. As such, an opinion to determine the etiology of the Veteran’s bilateral knee condition is warranted. The Board notes the record contains a medical opinion from Dr. C.O. stating that the Veteran has severe degenerative arthritis of the knees and that competitive basketball players are prone to develop arthritis of the knee over time. Dr. C.O. opined that the Veteran’s participation in competitive basketball during service may have contributed at the very least to his chronic degenerative knee arthritis. While this opinion suggests a possible link, it is insufficient to establish that the Veteran’s bilateral knee condition is at least as likely as not related to active service. Therefore, a remand is necessary for a new VA examination that addresses the Veteran’s service connection claims for both his right and left knee conditions and provides a medical opinion regarding the nature and etiology of both knee conditions. 2. Cervical Spine The Veteran last underwent a VA examination in April 2017 for his cervical spine strain with degenerative disc disease. At the hearing in May 2018, the Veteran testified that his symptoms have increased since his last VA examination. Based on the contention that his symptoms worsened, a new VA examination is warranted to determine the current severity of the Veteran’s cervical spine strain with degenerative disc disease. The matters are REMANDED for the following action: 1. Obtain updated VA and/or private treatment records to the extent possible. If such records are unavailable, the Veteran’s claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 2. Schedule the Veteran for a VA examination with a medical professional with appropriate expertise to determine the nature and etiology of the Veteran’s left and right knee conditions. The examiner should review the Veteran’s claims file, including a copy of this remand. Based on a review of the record, the examiner must address the following: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s left and/or right knee condition is related to active service, or is caused by or aggravated by military service. The examiner must consider and address the Veteran’s testimony and any lay statements of record. Specifically, the examiner must note the Veteran’s credible testimony regarding his knee injury and participation in competitive basketball during active service. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. Additionally, the examiner should review the record and address the opinion of Dr. C.O. See Medical Treatment Record – Government Facility June 2018. A complete rationale for all medical opinions is required. The examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. Schedule the Veteran for a VA medical examination to determine the current severity of his service-connected cervical sprain with degenerative disc disease. The electronic claims file must be reviewed in conjunction with the examination. The examiner should elicit a full history from the Veteran and consider and address the testimony and lay statements of record. The Veteran is competent and credible to describe his symptoms. If there is a medical basis to support or doubt the history provided, the examiner should provide a fully reasoned explanation. All necessary testing should be conducted. In particular, the examination must include tests of all applicable ranges of motion in active motion, passive motion, weight-bearing, and non- weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (Continued on the next page)   In addition, if the examination is not conducted during a flare-up, the examiner must attempt to ascertain information, such as frequency, duration, characteristics, severity, and functional loss, regarding any flare-ups by alternative means. The examiner must provide an estimate of additional functional loss in terms of range of motion based on the Veteran's statements, available medical records, and other relevant sources. The examiner must also provide an assessment of the Veteran’s functional limitations due to his cervical spine sprain as it may relate to his ability to function in a work setting and to perform work tasks. However, the examiner should refrain from commenting on the Veteran’s employability. A complete rationale should be given for all opinions and conclusions rendered. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. A. Prinsen, Associate Counsel