Citation Nr: 18158750 Decision Date: 12/18/18 Archive Date: 12/17/18 DOCKET NO. 16-45 594 DATE: December 18, 2018 REMANDED Service connection for a right knee condition as secondary to service-connected postoperative medial meniscectomy of the left knee is remanded. REASONS FOR REMAND The Veteran had active service from January 1980 to May 1982. This appeal comes before the Board of Veterans’ Appeals (Board) from a January 2016 rating decision by the Department of Veterans Affairs (VA) in Buffalo, New York. Entitlement to service connection for a right knee condition as secondary to service-connected postoperative medial meniscectomy of the left knee is remanded. The Veteran argues that his right knee condition is secondary to his service-connected postoperative medial meniscectomy of the left knee. See March 2016 Notice of Disagreement. However, the medical evidence of record is inadequate to decide whether the claimed condition is secondary to the service-connected disability of the left knee. A February 2016 private medical opinion found that it was “reasonable to attribute” the Veteran’s right knee condition to his left knee service-connected disability. However, the examiner’s ultimate conclusion is entirely too speculative to adequately support a decision on this claim. See Bloom v. West, 12 Vet. App. 185, 187 (1999) (a medical statement using the term “could,” “may,” or “possibly,” without supporting clinical data or other rationale, is too speculative to provide the degree of certainty required for medical nexus evidence). Moreover, the medical opinion did not provide sufficient reasoning to give the conclusion probative value. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (stating that a medical opinion “must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions”). Additionally, there are two VA medical opinions. A October 2015 VA medical opinion reflects that the Veteran’s right knee “condition claimed is less likely than not (less than 50% probability) proximately due to or the result of the Veteran’s service connected condition.” In support of the conclusion, the examiner noted that the Veteran had an acute medial meniscus tear and “a history of ACL tear noted on the right knee [and that] the injury is a type of acute injury with an actual meniscal tear, it is unknown as to the exact mechanism or circumstance of injury.” Id. An August 2016 VA medical opinion reflects that the Veteran’s right knee disability “is less likely than not (less than 50% probability) proximately due to or the result of the Veteran’s service connected condition.” The examiner, among other things, took into account (1) the Veteran’s history of knee surgeries, (2) a July 2012 right knee arthralgia that showed negative plain films, (3) the February 2016 private medical opinion, (4) the onset of the right knee injury, as noted by SOS, taking place in May 2015, and (5) the Veteran’s lay statements concerning his right and left knees. The above VA medical opinions, however, do not address whether there is aggravation of the right knee condition as due to the service-connected disability of the left knee. Therefore, the medical opinions are inadequate. See Allen v. Brown, 7 Vet. App. 439 (1995). As such, in view of the record and the Veteran’s statements, the Board finds that a new examination is required. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all non-VA medical providers that treated his right knee condition. Make two requests for the authorized records from identified sources, unless it is clear after the first request that a second request would be futile. 2. Obtain all relevant VA treatment records dated from November 2016 to the Present. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of his right knee condition. The clinician should opine on the following: (a) Whether the Veteran’s right knee condition is proximately due to the service-connected left knee disability; and (b) Whether the Veteran’s right knee condition is aggravated by the service-connected left knee disability. In addition, the examiner should address the theory of altered gait or other disturbances of weight distribution or locomotion as causing or contributing to the Veteran’s right knee condition. 4. Ensure that the VA medical opinion obtained include a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Griffey, Associate Counsel