Citation Nr: 18148728 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 14-31 341A DATE: November 8, 2018 ORDER Service connection for a medial meniscus tear of the left knee is granted. REMANDED An initial compensable rating for migraine headaches is remanded.   FINDING OF FACT A medial meniscal tear of the left knee was incurred in service. CONCLUSION OF LAW The criteria for service connection for a medial meniscal tear of the left knee have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1992 to September 2012. He also had an additional 1 year, 5 months and 11 days of active service. This case comes from a February 2013 rating decision. In October 2018, the Veteran appeared at a videoconference Board hearing. He submitted additional evidence and waived initial RO consideration. See 38 C.F.R. § 20.1304(c). The Board notes that in his substantive appeal, the Veteran limited the appeal to the issues reflected on the title page. Service Connection Service connection for a left knee disability. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service”—the so-called “nexus” requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Analysis The Veteran seeks service connection for a left knee disability. In his May 2012 pre-discharge claim, he noted left knee pain and limitation of motion, and maintains that the symptoms are a result of a left knee injury sustained during service. The Veteran’s service treatment records (STRs) note a left knee injury in October 1992, at which time tendonitis was suspected. In addition, complaints of left knee pain were noted at various times during service, to include between 2004 and 2010. Records in June 2010 and August 2010 note increased left knee pain with running, as well as use of a knee brace. In addition, and although the impression of x-ray examination of the left knee was normal tibia and fibula, a June 2010 examination report notes that the left knee symptoms were more than likely attributable to degenerative changes versus involvement of the lateral collateral ligament. Lending further support to the Veteran’s assertions are private orthopedic treatment records in September 2014 noting a 20-year history of left knee pain as a result of a twisting injury during service in 1992. The orthopedic surgeon noted that although the STRs reflect medications were prescribed following the injury, there was no contemporaneous work up. Further, and although the June 2012 VA examination report notes no meniscal condition of the left knee, the private records reflect the impression of x-ray examination of the left knee in August 2014 was likely degenerative medial meniscus tear, chronic. Moreover, the impression of magnetic resonance imaging (MRI) of the left knee in August 2014 was medial meniscus tear with reactive edema/inflammation surrounding the medial support structures, as well as chondral thinning/chondromalacia involving the medial and patellofemoral joint compartment articular cartilage, and joint effusion. The physician specifically concluded that the Veteran’s current left knee disability, manifested by pain, limitation of motion, and lateral instability, is more than likely due to a medial meniscus tear sustained during service. In reaching a determination, the Board has afforded the private orthopedic surgeon’s opinion the greatest probative value. The opinion is unequivocally stated, consistent with the record, and supported by cited evidence of record, to include the contemporaneous records and the Veteran’s statements. The evidence is in at least equipoise, and thus, resolving doubt in favor of the Veteran, service connection is warranted for a medial meniscus tear of the left knee. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. REASONS FOR REMAND An initial compensable rating for migraine headaches. The June 2012 VA examination report notes no characteristic prostrating attacks of migraines. However, in his May 2013 notice of disagreement (NOD), the Veteran stated that his migraines have increased in severity over the past several years with at least one prostrating attack per month. In addition, private records in February 2014 note migraine frequency monthly or less, at times severe, and for which medication was prescribed. Moreover, a September 2014 Disability Benefits Questionnaire notes prostrating and incapacitating migraines occurring every four to six weeks. Furthermore, at the October 2018 Board hearing, the Veteran recalled that there was a miscommunication regarding the severity of his headaches at the time of the June 2012 VA examination. As there is an indication that the Veteran’s migraines may be worse than set forth in the June 2012 VA examination report, the Veteran should be afforded a VA examination to assess the current extent and severity of his migraines. The matter is REMANDED for the following action: Schedule the Veteran for a VA examination to assess the severity of the service-connected migraines. In making this assessment, the examiner should consider the headaches log submitted by the Veteran in September 2014 and at the October 2018 Board hearing. A rationale should be provided for any opinion rendered. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Taylor