Citation Nr: 19152467 Decision Date: 07/09/19 Archive Date: 07/08/19 DOCKET NO. 18-44 973 DATE: July 9, 2019 REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2005 to April 2010. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision dated in November 2017 issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that while the RO adjudicated additional issues in the November 2017 rating decision, the Veteran limited his notice of disagreement, and subsequent appeal, solely to the issues of entitlement to service connection for a left and right knee disorder. The Veteran contends that he has a bilateral knee disorder as a result of his military service. Specifically, he reported that, due to his military occupation, he was constantly required to crawl on top of helicopters to perform regular maintenance duties for hours with no personal protective equipment for his knees, and run on asphalt; and that such led to multiple occasions of severe right knee pains and large knots forming below both of his knees. The Veteran further reported that he brought up these issues several times while in service to flight surgeons with no resolution or explanation; and that such issues continued to the present day. He noted that prior to his military service, he was extremely healthy. In this regard, the Veteran’s DD Form 214 shows that his primary military occupational specialty was helicopter airframe mechanic. Furthermore, the Veteran has a current diagnosis for a left and right knee disorder, to include bilateral osteoarthritis, as evidenced by an October 2017 VA examination. Nevertheless, the Board finds that further development is required to determine if the Veteran’s bilateral knee disorder is related to his military service. Here, the October 2017 VA examiner found that it was less likely that the Veteran’s bilateral knee osteoarthritis was incurred in or caused by his knee issues during service. As rationale for the opinion, she reported that evidence-based literature indicated that the most common cause of knee osteoarthritis was age; and that almost everyone would eventually develop some degree of such. The examiner further reported that on the Veteran’s separation health assessment, it was noted that he reported bilateral knee swelling; however, there was no documentation of these occurrences. Additionally, the examiner noted that, following the Veteran’s report to the physician performing his separation health examination, he was diagnosed with “possible patellar tendonitis,” which was a common overuse injury, caused by repeated stress on an individual’s patellar tendon. Here, the examiner explained that the Veteran did not have a current diagnosis of patellar tendonitis; and that his knee osteoarthritis was mainly related to aging. She further explained that a 2016 X-ray demonstrated findings consistent with prior Osgood-Schlatter disease; and that evidence-based literature indicated that such disease was a common cause of knee pain in growing adolescents. The examiner noted that Osgood-Schlatter disease was an inflammation of the area just below the knee where the tendon from the kneecap attached to the shinbone; and that such most often occurred during growth spurts. However, the October 2017 VA examiner appears to indicate that the Veteran may have had a bilateral knee disorder that pre-existed service. Specifically, as noted above, she stated that findings from X-ray evidence in 2016 were consistent with prior Osgood-Schlatter disease. Here, under pertinent law and regulations, a veteran will be considered to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at entrance into service, or where clear and unmistakable (obvious or manifest) evidence demonstrates that an injury or disease existed prior thereto. 38 U.S.C. § 1111; 38 C.F.R. § 3.304(b). When no pre-existing condition is noted upon entry, the veteran is presumed to have been sound upon entry and the presumption of soundness arises. In this regard, the Veteran’s September 2004 Report of Medical Examination reveals that clinical evaluation of his lower extremities was normal; and his corresponding Report of Medical History reflects that he denied knee trouble. Accordingly, the Veteran is presumed sound at entry; and an opinion as to whether the Veteran clearly and unmistakably had a bilateral knee disorder prior to service that was not aggravated by service is required to rebut the presumption of soundness. Therefore, the Board finds that a remand is necessary to obtain an addendum opinion addressing such matter. Moreover, in a June 2018 telephone correspondence, the Veteran reported that he had recently received treatment through the Tuscaloosa, Alabama, VA Medical Center (VAMC). Here, he indicated that he had underwent tests, to include an X-ray of his knees. However, records from such facility are only dated through October 2017. Therefore, while on remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated treatment records dated from October 2017 to the present from the Tuscaloosa, Alabama VAMC. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5104A(b)(2) and 38 C.F.R. § 3.159(e). 2. Return the record to the VA examiner who conducted the Veteran’s October 2017 examinations. The record, to include a copy of this Remand, should be made available to, and be reviewed by, the examiner. If the October 2017 VA examiner is not available, the record should be provided to an appropriate medical professional so as to render the requested opinions. The need for additional examinations of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Following a review of the record, the examiner should address the following inquiries: Is there clear and unmistakable evidence that the Veteran’s current bilateral knee disorder pre-existed his entry to active duty in April 2005? (i) If there is clear and unmistakable evidence that the Veteran’s current bilateral knee disorder pre-existed his military service, the examiner is asked to opine as to whether there is clear and unmistakable evidence that such did not undergo an increase in the underlying pathology during service, i.e., was not aggravated during service. If there was an increase in the severity of the Veteran’s current bilateral knee disorder, the examiner should offer an opinion as to whether such increase was clearly and unmistakably due to the natural progress of the disease. (ii) If there is no clear and unmistakable evidence that the Veteran’s current bilateral knee disorder pre-existed service, then the examiner is asked whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder is directly related to service, to include his in-service duties as a helicopter airframe mechanic? A rationale for any opinion offered should be provided. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Koria B. Stanton, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.