Citation Nr: 18156353 Decision Date: 12/11/18 Archive Date: 12/07/18 DOCKET NO. 16-30 476 DATE: December 11, 2018 REMANDED Service connection for a left knee disorder is remanded. Service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1990 to November 1994. This matter is before the Board of Veterans’ Appeals (Board) on appeal of a February 2013 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran claims his bilateral knee disabilities are directly related to injury sustained during his active duty service or, alternatively, the secondary to his ankle disabilities. Specifically, during his October 2012 VA examination, the Veteran reported wearing bilateral ankle braces and indicated the left ankle “gives way with any type of physical activity or walking.” See also June 2016 VA treatment report noting the Veteran’s inquiry as to whether his knee issues could be/are related to his ankle injuries. Notably, service connection is in effect for left ankle sprain and right ankle sprain status post old ununited fracture. The Veteran’s service treatment records (STRs) show treatment for a March 1993 left knee injury and diagnosis of infrapatellar bursitis/patellar tendonitis resolving, possibly secondary to a mild ACL insufficiency and September 1994 treatment for right knee contusion. Although the Veteran underwent VA knee examination in June 2016, the opinion provided does not address secondary service connection and notes no right knee complaints/pathology shown in active military medical records. As such, the June 2016 opinion is insufficient for rating purposes because it is incomplete and based on an inaccurate factual premise. Remand is required for a new VA examination and opinion to address the etiology of the Veteran’s bilateral knee disorders. On remand, updated VA and private treatment records should be obtained. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding VA and non-VA records pertinent to the Veteran’s claims, to include complete/updated VA treatment records and, after obtaining necessary authorizations, private treatment records from L.I. Blecher, M.D. who has treated the Veteran since approximately 2003. 2. After the action requested in paragraph (1) is completed, please schedule the Veteran for an examination to determine the nature and etiology of his bilateral knee disorders. His claims-file must be reviewed by the examiner in conjunction with the examination. Any indicated tests or studies should be conducted. Based on review of the record, the examiner should provide an opinion that responds to the following: (a) Is it at least as likely as not (50 percent or greater probability) that any currently diagnosed left and/or right knee disorder had its onset in active service or is otherwise related to the Veteran’s active service? (b) If the response to (a) is that the Veteran’s left and/or right knee disorders were not initially shown in service and are not otherwise related to his active service, is it at least as likely as not (50 percent or greater probability) that his service-connected ankle disabilities caused any diagnosed left and/or right knee disorder? (c) If the response to (b) is that the Veteran’s service-connected ankle disabilities did not cause his left and/or right knee disorder, is it at least as likely as not (50 percent or greater probability) that the Veteran’s service-connected ankle disabilities aggravated any diagnosed left and/or right knee disorder? The term “aggravation” means any increase in the claimed disability. BOTH causation AND aggravation must be addressed for the opinion to be sufficient for adjudication purposes. If aggravation of any diagnosed left and/or right knee disorder by the Veteran’s service-connected ankle disabilities is found, the examiner must attempt to establish a baseline level of severity of the left and/or right knee disorder prior to the onset of aggravation, or by the earliest medical evidence created at any time between the onset of aggravation and the receipt of medical evidence establishing the current level of severity. In providing the requested opinions, in addition to reviewing the Veteran’s claims file, the examiner should consider and address as necessary: • The Veteran’s STRs showing treatment for a March 1993 left knee injury and diagnosis of infrapatellar bursitis/tendonitis resolving, possibly secondary to a mild ACL insufficiency and September 1994 treatment for right knee contusion. • Private treatment records showing bilateral knee injuries and surgery in 2007. • October 2012 VA knee examination report and opinion. • February 2013 letter from Dr. L.I.B. noting the Veteran had been a patient for 10 years and “he has had weak tendons since I’ve known him.” • The Veteran’s June 2016 VA Form 9, Appeal to Board of Veterans' Appeals, in which he reports continuing to have knee issues with twisting and falling after service separation and before knee surgery. • June 2016 note from the Veteran’s VA physician stating “ankle pain can change your gait, which might put more pressure on your knees.” A full rationale is to be provided for all stated medical opinions. If an opinion cannot be made without resort to   speculation, the examiner should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. M. C. GRAHAM Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Hughes, Counsel