Citation Nr: 18157625 Decision Date: 12/13/18 Archive Date: 12/12/18 DOCKET NO. 16-24 595A DATE: December 13, 2018 REMANDED Entitlement to service connection for left knee degenerative joint disease (DJD) (left knee disability) is remanded. Entitlement to service connection for right knee strain (right knee disability) is remanded. Entitlement to total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1986 to May 1996. These matters come to the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in June 2017, when they were remanded for further development. Additional evidence has been received by the Board for which a waiver of initial RO consideration was provided. 38 C.F.R. § 20.1304. Service Connection for Right and Left Knee Disabilities Per the Board’s June 2017 remand, the RO obtained a supplemental medical opinion in September 2017 to determine the nature and etiology of his bilateral knee conditions. After reviewing the evidence of record, the examiner opined that it is less likely as not that the Veteran’s bilateral knee conditions are related to his service, as there is no in-service diagnosis or treatment for the knees. Specifically, the opinion relies entirely on an absence of diagnosis and treatment of bilateral knee disabilities in service. This narrow focus ignores the fact that service connection may be granted for any disease diagnosed after discharge, when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). When VA undertakes the effort to provide an examination, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds a new opinion is needed to adjudicate this appeal. The Board also notes that on the September 2017 examination report, the examiner indicated that he did not perform an in-person examination in the Acceptable Clinical Evidence (ACE) section of the report, but later indicated that he did in the Medical Opinion for Direct Service Connection section. On remand, the examiner is asked to correctly specify the method used to obtain medical information to complete the requested examination report. The development requested in connection with the foregoing claims could have bearing on whether an award of TDIU is proper. Hence, this final issue is not yet ripe for appellate review and must be deferred pending readjudication of those other remanded claims. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (noting that two or more issues are inextricably intertwined if the disposition of one claim could have a significant impact on the outcome of another). The matters are REMANDED for the following action: 1. Obtain a supplemental medical opinion from the September 2017 VA examiner (or another examiner, if the examiner is unavailable). Another medical examination is not necessary unless needed to provide the requested opinion. All relevant documents should be made available to and reviewed by the examiner in rendering the opinion. Based on review of the appropriate records, the examiner should provide opinions on the following: (a) Is it as likely as not (i.e., to at least a 50 percent degree of probability) that the current left knee disability, to include DJD, had its onset during service or was otherwise causally or etiologically related to service, to include any symptomatology, event, or incident therein? (b) Is it as likely as not (i.e., to at least a 50 percent degree of probability) that the current right knee strain had its onset during service or was otherwise causally or etiologically related to service, to include any symptomatology, event, or incident therein? A rationale should be provided for all opinions given, and the factors upon which each medical opinion is based should be set forth in the report. The examiner is advised that the absence of in-service diagnosis and treatment for any knee condition alone is not an adequate premise upon which to base the rationale. The examiner is also asked to identify the method used to obtain medical information necessary to complete the requested examination report. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Norwood, Associate Counsel