Citation Nr: 18161331 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 14-44 060 DATE: December 31, 2018 REMANDED Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1988 to November 1994. This matter is on appeal of a March 2014 rating decision. VA is obligated to provide an examination and/or opinion where the record contains evidence that the claimant has a current disability, the record indicates that a disability or signs of symptoms of disability may be associated with active service or service-connected disability, and the record does not contain sufficient information to make a decision on the claim. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. A medical opinion is inadequate if it relies on an inaccurate fact. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A medical opinion is further inadequate if it does not take into account the Veteran’s reports of symptoms and history, even if recorded in the course of the examination. Dalton v. Nicholson, 21 Vet. App. 23 (2007); see also Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The Veteran contends that his current bilateral knee disability, diagnosed as a bilateral knee strain, is the result of an injury in service. He alleges that he has experienced continued pain in both knees since his initial injury in service. The Veteran’s service treatment records (STRs) show that he was treated for complaints of bilateral tibia/fibula pain in January 1989 and was assessed with bilateral shin splints. In March 1990, the Veteran gave a history of having left knee pain 2 months before and complained of worsening pain after playing basketball. September 1990 and October 1990 treatment records show ongoing complaints of left knee pain with tenderness under the knee cap and occasional giving out of the joint. There was objective evidence of crepitus and testing was positive for apprehension. The assessment was chondromalacia patellae (CMP) and tendonitis of the inferior patellar ligament. An undated STR shows the Veteran had point tenderness to the medial collateral ligament (MCL) area and the assessment was MCL strain. The Veteran’s August 1994 separation examination shows clinical evaluation of the lower extremities was abnormal with testing positive for patellar apprehension. The diagnosis was patellofemoral pain syndrome (PFPS) and the examiner noted that it had developed while the Veteran was in service. Although the January 2014 VA examiner opined that the Veteran’s diagnosed bilateral knee strain was less likely as not incurred in or caused by his service, the opinion appears to be based on the lack of objective clinical evidence of a bilateral knee disability at the time of discharge and on the lack of objective clinical evidence of treatment for knee complaints immediately after service until 2014. The opinion also appears to have dismissed the Veteran’s report of experiencing bilateral knee pain since his injury in service. Further, the examiner incorrectly states that the Veteran was treated for left knee pain on only 2 occasions in September and October 1990 and that no records were found from the Veteran’s retirement from service. As noted above, the Veteran’s August 1994 separation examination shows that clinical evaluation of the knees was abnormal and that the Veteran’s diagnosed PFPS developed in service. The January 2014 opinion is based on inaccurate facts and does not address the Veteran’s credible history of bilateral knee pain since service. On remand, after any outstanding treatment records have been obtained, an addendum medical opinion should be obtained that considers the Veteran’s allegations of continuity of symptomatology since his service, as well as the August 1994 separation examination showing a diagnosis of PFPS that developed during service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336 (Fed. Cir. 2006) (stating that the absence of documented treatment cannot, alone, serve as a basis for finding that lay evidence lacks credibility). The matter is REMANDED for the following action: 1. Contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claim, including any private treatment records for his bilateral knee disability since service. Based on his response, attempt to procure copies of all records which have not previously been obtained from identified treatment sources. 2. After obtaining any additional records, an addendum medical opinion must be obtained from the physician who conducted the January 2014 VA examination for the Veteran’s bilateral knee disability, or if the examiner is unavailable, another clinician with sufficient experience and expertise. Another examination of the Veteran need only be performed if deemed necessary by the clinician providing the opinion. The electronic claims file must be made available to the examiner. Based on review of the pertinent evidence of record, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s current bilateral knee disability (50 percent or better probability) had its onset in service or is related to his active duty service or any incident therein, to include any injury he sustained during service. A complete rationale for all opinions must be provided that addresses the Veteran’s report of continuous bilateral knee pain since his injury in service and the August 1994 separation examination report showing a diagnosis of PFPS that was noted to have developed during the Veteran’s service. 3. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Wells-Green