Citation Nr: 18153805 Decision Date: 11/28/18 Archive Date: 11/28/18 DOCKET NO. 16-37 280 DATE: November 28, 2018 ORDER Entitlement to service connection for a left knee disability is granted. REMANDED Entitlement to an initial compensable rating for left hip bursitis is remanded. Entitlement to an initial compensable rating for right hip bursitis is remanded. FINDING OF FACT The Veteran has a current left knee disability that is related to service. CONCLUSION OF LAW The criteria for service connection for a left knee disability have been met. 38 U.S.C. §§ 1110, 5107 (2012); 38 C.F.R. § 3.303 (2017). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from October 2002 to December 2006. Service connection for a left knee disability The Veteran contends that she has a current left knee disability that is related to service. For the following reasons, the Board finds that service connection is warranted. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a link between the claimed in-service disease or injury and the present disability. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability was incurred in service. 38 C.F.R. § 3.303(d). The Veteran has submitted private treatment notes demonstrating that she has been diagnosed with left knee chondromalacia with tilting patella during the pendency of the appeal. Thus, the “current disability” element of her claim has been met. (The Board is aware that a September 2014 VA examination report did not provide a diagnosis for the Veteran’s left knee, instead indicating that she refused an examination of her left knee. Notwithstanding, the Board finds that the private treatment notes discussed above are more probative than the VA examination report, as the private records are based on physical examinations of the Veteran’s left knee, as well as considerations of her lay reports regarding her medical history.) The in-service incurrence element has been satisfied as well. The Veteran’s service treatment records reflect that she reported recurrent bilateral knee pain during her October 2006 separation examination. At that time, she reported that she had been doing physical training for over a year and had been experiencing knee “popping” as well as pain. The crucial question, therefore, is whether there is a causal link between the Veteran’s in-service symptoms and her current diagnosis. To that end, the Veteran has submitted numerous lay statements asserting that she began to have pain in her knees during active service. She has also stated that, “[s]ince separation from active duty, I have had varying degrees of left knee pain on a daily basis.” In addition, she submitted an opinion from her physician, supported by analysis of the Veteran’s lay statements and her medical history, stating that it is “more likely than not” that the Veteran’s current left knee disability is related to her service. On review, the Board finds that the preponderance of the evidence demonstrates that the Veteran’s current left knee disability was incurred in service. As noted above, there is evidence of an in-service left knee disability, a post-service diagnosis, credible lay statements of continuous left knee pathology since service, and a medical opinion, supported by an analysis of the evidence of record, indicating a causal link between the in-service symptoms and the Veteran’s current disability. There is no convincing negative evidence of record. According, the Board finds that the weight of the evidence supports the Veteran’s claim, and service connection for a left knee disability is therefore warranted. REASONS FOR REMAND Increased ratings for bilateral hip bursitis The Veteran contends that her bilateral hip disabilities warrant compensable ratings under the applicable criteria. See 38 C.F.R. § 4.71(a), Diagnostic Code (DC) 5252. The Veteran last underwent a VA examination for her hip disabilities in September 2014. Since that time, she has put forth evidence indicating that her symptoms have worsened. Specifically, a clinical note from a private physician dated in August 2016 reflects the Veteran’s reports of bilateral hip tenderness, painful motion, excess fatiguability, and interference with locomotion. Notably, these symptoms are more serious symptoms than those noted in the September 2014 VA examination report. Additionally, it appears the Veteran tried to schedule a VA examination to evaluate her hip disabilities in March 2017, but was unable to do so. For these reasons, the Board finds that a remand is warranted. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered “contemporaneous”). The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected bilateral hip disabilities (diagnosed as bursitis). The examiner should provide a full description of these disabilities and report all signs and symptoms necessary for evaluating the disabilities under the rating criteria. The examiner must also test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. In so doing, the examiner should specifically consider the Veteran’s lay statements regarding limitation of motion of her hips. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. The examiner is asked to describe whether pain significantly limits functional ability during flares, and if so, the examiner must estimate range of motion during flares. IF THE EXAMINATION DOES NOT TAKE PLACE DURING A FLARE, THE EXAMINER MUST GLEAN INFORMATION REGARDING THE FLARES’ SEVERITY, FREQUENCY, DURATION, AND FUNCTIONAL LOSS MANIFESTATIONS FROM THE VETERAN, MEDICAL RECORDS, AND OTHER AVAILABLE SOURCES. EFFORTS TO OBTAIN SUCH INFORMATION MUST BE DOCUMENTED. If there is no pain and/or no limitation of function, such facts must be noted in the report. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Minot, Associate Counsel