Citation Nr: 18155530 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 13-36 337 DATE: December 4, 2018 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps June 2007 to May 2008 and had an initial period of active duty training from March 2006 to August 2006. He also served in the United States Marine Corps Reserve. The Board sincerely thanks him for his service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2017, the Board issued a decision remanding this case for further evidentiary development. The Board directed the Agency of Original Jurisdiction (AOJ) to confirm with the Veteran in which period of service he alleges his bilateral knee disability had its onset. The Board also directed the AOJ to conduct a medical exam and provide an opinion on the etiology of the Veteran’s diagnosed knee disabilities. Specifically, the Board requested that the examiner address the diagnoses already contained in the record at the time: bilateral knee arthralgia, bilateral chondromalacia patella, and bilateral patellar tendonitis. The Board requested an opinion as to whether each diagnosed disorder was at least as likely as not to have had its onset in service. Additionally, the Board requested that the examiner include in his rationale consideration of the Veteran’s lay statements, including statements that his knee pain began in service. The Board is obligated by law to ensure compliance with its directives, as well as those of the appellate courts. Where the remand orders of the Board or the courts are not complied with, the Board errs as a matter of law when it fails to ensure compliance. Stegall v. West, 11 Vet. App. 268, 271 (1998). Here, the AOJ did attempt to clarify the Veteran’s assertion regarding the onset of his knee pain in an October 2017 letter. There is no indication in the record that the Veteran responded. The AOJ also conducted a VA Exam in December 2017 at which time the examiner opined that there was no relation between the Veteran’s knee pain and service. However, the examiner did not comply with the requests in the prior remand. Namely, the examiner’s rationale does not include any consideration of the existing diagnoses of the Veteran’s knee issues; instead, the examiner stated “no diagnosis found.” Additionally, the examiner stated that the Veteran “does heavy physical work,” but in his Form 9 the Veteran argued that his construction job only involves driving and thus is not strenuous on his knees. The rationale does not include any analysis of the Veteran’s lay statements. As such, this medical opinion is inadequate because it does not appear that the examiner has considered all available evidence. Unfortunately, the Board must remand again for an addendum medical opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and non-VA treatment records pertaining to the knees. 2. Have an appropriate VA clinician provide an addendum opinion on the nature and etiology of the knee diagnoses noted during the course of the appeal, including bilateral knee arthralgia, bilateral chondromalacia patella, and bilateral patellar tendonitis. He or she is asked to opine whether it is as least as likely as not (50 percent probability or more) that any of these diagnoses, including bilateral knee arthralgia, bilateral chondromalacia patella, and bilateral patellar tendonitis had its onset in service or is otherwise related to service. In expressing his or her opinion, the opinion provider should address the Veteran’s lay statements, including that his knee pain began in service after jumping off a truck and that his current employment is not physically demanding. The Board notes that the December 2017 examiner stated there was no diagnosis. If the clinician disagrees with the three prior diagnoses in the record, he or she should   explain whether the above-mentioned diagnoses were correct and currently asymptomatic, or whether they are due to misdiagnosis. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. McCormick, Associate Counsel