Citation Nr: 18157838 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-53 698A DATE: December 13, 2018 REMANDED Entitlement to service connection for right knee associated with total knee arthroplasty, left knee with history of PO excision of medical meniscus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from October 1966 to September 1970. Entitlement to service connection for right knee associated with total knee arthroplasty, left knee with history of PO excision of medical meniscus is remanded. The Veteran asserts that his right knee condition developed as a result of his service-connected left knee disability. Service connection is in effect for the Veteran’s status post left knee replacement, which is rated as 30 percent disabling but for which service connection was established directly out of service with an effective date of service connection of September 2, 1970, the day after discharge. The Veteran was afforded a VA examination in February 2012 VA examination; however, the examiner did not address the secondary service connection aspect of this claim. In June 2016 the Veteran was provided another VA examination. The examiner opined that the Veteran’s claimed condition was at least as likely as not incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that the Veteran had an initial meniscus tear in the military. He had subsequent re-injuries and surgeries after that. She noted, not all surgeries were related to the military injury because he likely re-injured after the service. However, his subsequent TKA is likely at least partially due to his injury in military service of having a meniscal tear. The opinion provided addressed the wrong knee, accordingly an addendum opinion was requested. In July 2016, the June 2016 VA examiner provided an addendum medical opinion. The examiner opined, the Veteran’s right knee condition was not proximately due to or the result of the strain caused by antalgic gait resulting from the severity of the left knee. She reasoned the right knee condition is more likely due to obesity. She further noted that the Veteran was discharged from service in 1970 and the Veteran’s injury to the right knee was 41 years after military service. Additionally, the examiner determined that it was not feasible for her to give an opinion of the Veteran’s condition prior to the total knee replacement. The examiner stated, she could not provide an opinion regarding whether the Veteran’s right knee disability was not aggravated beyond its natural progression by his service-connected antalgic gait resulting from the severity of the left knee (prior to his total left knee replacement). She reasoned that it was not feasible for her to give an opinion of the Veteran’s condition prior to his total knee replacement because she did not see him prior to his total knee replacement. Further, the examiner stated that she could not provide an opinion based on another provider’s note of antalgic gait. She indicated she could only base her opinion on the Veteran’s current condition and anything else would be a guess or an assumption of condition. The Board finds the examination inadequate because the opinion is based on the Veteran’s left condition after his 2016 total left knee joint replacement and not based on his over 40 years of recurrent left knee problems. Service connection has been in effect since service and the Veteran competently and credibly reports that his left knee has long created additional strain on his right knee, which he maintains resulted in his right knee injury. As such, another VA examination is necessary to adjudicate this appeal. The matter is REMANDED for the following action: 1. Contact the Veteran and request that he identify any and all outstanding VA and private treatment records related to his right knee condition. After obtaining the necessary authorization forms from the Veteran, obtain any pertinent records and associate them with claims file. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service right knee symptomatology. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination to determine the nature, onset and etiology of any right knee impairment. Thereafter, the examiner should respond to the following inquiries: a. Diagnose all current right knee impairment. Provide an opinion for the following: b. Whether it is at least as likely as not that the Veteran’s right knee condition was caused by his service-connected left knee disability (ies)? c. Whether it is as likely as not that the Veteran’s right knee disability was aggravated by his service-connected left knee disability (ies)? Aggravation is defined for these purposes as a worsening of the underlying condition versus a temporary flare-up of symptoms. In offering this assessment, the examiner must assume as true, that the Veteran’s reports that his 40 years of recurrent left knee problems since service caused extra strain on the right knee and resulted in his right knee “failing him.” All indicated and necessary tests and studies must be performed. The examination report must include a complete rationale for all opinions expressed. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jacquelynn M. Jordan, Associate Counsel