Citation Nr: 18161177 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 15-23 665 DATE: December 28, 2018 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to a service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran served honorably on active duty with the United States Army from February 1982 to February 1985. Although the Board regrets the delay, remand is necessary to afford the Veteran an additional VA examination in connection with his claim, as the examination currently of record is inadequate for rating purposes. The Veteran contends that he has a left knee disability that is etiologically related to service on a direct basis or as secondary to his service-connected right knee disability. Service treatment records (STRs) show the Veteran sought treatment for left knee pain while on active duty in August 1983. VA treatment records show the Veteran has been treated periodically in recent years for “chronic left knee pain,” for which he has been prescribed arthritis pain relief cream and stretching exercises. The evidence also indicates that he wears a left knee brace. The Veteran was last afforded a VA examination in October 2012. The examiner declined to provide a nexus opinion after finding “no significant disorder of the left knee.” The Board finds this opinion to be inadequate in light of the Veteran’s more recent reports of chronic knee pain leading to functional limitation, as evidenced by his use of a knee brace and arthritis cream. Even if the Veteran does not have a current diagnosable disability, VA must consider whether he has functional impairment for which service connection may be granted. See Saunders v. Wilkie, 886 F.3d 1356, 1363 (Fed. Cir. 2018) (indicating that the term “disability” refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). Accordingly, the matter is REMANDED for the following actions: 1. Obtain and associate with the claims file any outstanding VA treatment records. All efforts to obtain additional evidence must be documented in the claims folder. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed left knee disability. The examiner must review the claims file and must note that review in the report. The rationale for all opinions expressed must be provided. Based on the examination and a review of the record, the examiner is asked to respond to complete the following: (a.) Please identify any left knee disability diagnosed during the current examination or found at any point during the period on appeal (i.e. since August 2012). (b.) Is it at least as likely as not (50 percent or greater probability) that any such disability was caused or aggravated by any aspect of active service? (c.) If not, is it at least as likely as not (50 percent or greater probability) that the disability was caused or aggravated (permanently worsened) by the service-connected right knee disability? (d.) If no clinical disability is identified, does the Veteran’s reported left knee pain cause functional impairment of earning capacity? If so, is it at least as likely as not (a 50 percent or greater probability) that such functional impairment was caused or aggravated by active service? If not, is it at least as likely as not (50 percent or greater probability) that the functional impairment was caused or aggravated by the service-connected right knee disability? The term “aggravation” means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. In all conclusions, the examiner must identify and explain the medical basis or bases, with identification of the evidence of record. The examiner should assume that the Veteran is a credible historian and should consider his lay testimony concerning onset, history of treatment, and symptomatology. If the examiner is unable to offer the requested opinions, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to 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. 3. Then, readjudicate the Veteran’s claim. If the claim remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case (SSOC) and an opportunity to respond. The case should then be returned to the Board for further appellate consideration. L. CHU Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. T. Raftery, Associate Counsel