Citation Nr: 18154299 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-56 435 DATE: November 29, 2018 REMANDED Entitlement to service connection for bilateral total knee replacement is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1964 to April 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. Jurisdiction was transferred to the Winston-Salem, North Carolina, RO. Entitlement to service connection for bilateral total knee replacement is remanded. Under the Veterans Claims Assistance Act of 2000, VA is obliged to provide an examination when the record contains competent evidence that the claimant has a current disability or signs and symptoms of a current disability, the record indicates that the disability or signs and symptoms of disability may be associated with active service, and the record does not contain sufficient information to make a decision on the claim. See 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). The evidence of a link between current disability and service must be competent. Wells v. Principi, 326 F.3d 1381 (Fed. Cir. 2003). The types of evidence that “indicate” that a current disability “may be associated” with military service include, but are not limited to, medical evidence that suggests a nexus but is too equivocal or lacking in specificity to support a decision on the merits, or credible evidence of continuity of symptomatology such as pain or other symptoms capable of lay observation. McLendon, 20 Vet. App. at 83. The threshold for finding a link between current disability and service is low. Locklear v. Nicholson, 20 Vet. App. 410 (2006); McLendon, 20 Vet. App. at 83. VA records disclose that the Veteran underwent a left knee total knee replacement in 2010 and a right knee total knee replacement in 2011. See October 2014 VA Orthopedic Surgery Note. Post-service VA records also reveal that the Veteran was diagnosed with bilateral knee degenerative joint disease in August 2004. In an October 2016 VA Form 9, the Veteran contends that his bilateral knee disability is the result of walking on steel decking and navigating metal ladders that began to deteriorate the cartilage in his knees while he was stationed aboard a Navy destroyer. The Board finds that the Veteran is competent to testify to observable symptomatology, including knee pain. In addition, the Board finds that the medical record establishes a history of prior right and left knee surgeries. The Board also finds that the statements from the Veteran are a sufficient indication that his right and left knee conditions may be associated with his active service. However, the Veteran has not yet undergone a VA examination of his right and left knees. As such, there is insufficient competent evidence of record to decide the Veteran’s claims for service connection. McLendon, 20 Vet. App. at 83. Therefore, the Board finds that VA is duty-bound to afford the Veteran an examination to evaluate the etiology of his claimed right and left knee conditions. 38 U.S.C. § 5103A(d) (2012). The law provides that VA shall make reasonable efforts to notify a claimant of the evidence necessary to substantiate a claim and requires VA to assist a claimant in obtaining that evidence. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2018). Such assistance includes providing the claimant a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. §§ 5103, 5103A (2012); 38 C.F.R. § 3.159 (2018). The matter is REMANDED for the following action: 1. Copies of updated pertinent treatment records should be obtained and added to the claims file. 2. Following completion of the above, schedule the Veteran for a VA examination to determine the etiology of his right and left knee disabilities. The claims folder should be made available to the examiner for review in connection with the examination, and the examiner should acknowledge such review in the examination report. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any diagnosed right or left knee disabilities are of service onset or otherwise related to the Veteran’s active service. In rendering this opinion, the examiner should specifically identify and discuss all in-service risk factor(s). The examiner must provide a complete rationale for all opinions and conclusions expressed. The examiner is advised that the Veteran is competent to report injuries and symptoms and that his reports must be considered in formulating the requested opinions. If his reports are discounted, the examiner should provide a reason for doing so. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and whether there is additional evidence that would permit the opinion to be provided. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Grzeczkowicz, Associate Counsel