Citation Nr: 19174703 Decision Date: 09/25/19 Archive Date: 09/25/19 DOCKET NO. 17-27 986 DATE: September 25, 2019 REMANDED Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a left knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1974 to June 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The Veteran had initially appealed several other issues to include service connection for a right hip condition, left hip condition, migraine headaches, and irritable bowel syndrome (IBS). She also appealed decisions for increased evaluations for a mental health condition, cervical spine condition, lumbar spine condition, and a right shoulder condition. On the Form 9 submitted in May 2017, the Veteran limited the appeal to the right knee condition and left knee condition. Therefore, the Board does not have jurisdiction over the matters of right hip condition, left hip condition, migraine headaches, IBS, mental health condition, cervical spine condition, lumbar spine condition, and a right shoulder condition. Although the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and there is a complete record upon which to decide the Veteran’s claim so that she is afforded every possible consideration. See U.S.C. § 5103A; 38 C.F.R. § 3.159. 1. Service Connection for a Right Knee Condition 2. Service Connection for a Left Knee Condition The Veteran contends that her bilateral knee conditions are due to an accident while in service, or in the alternative, due to her service-connected right ankle condition. Upon review of the service treatment records (STRs), a left knee disability was noted on her enlistment medical examination but was asymptomatic, and therefore, she was found fit for active duty. The STRs are otherwise silent as to any complaints or treatment for any knee conditions. The Veteran’s STRs and military personnel records do not document an in-service automobile accident. However, the Veteran has stated that the automobile accident occurred in 1978. See December 2015 Statement in Support of Claim. The Board notes that the Veteran is competent to attest to this event in service and finds her statements to be credible. See Layno v. Brown, 6 Vet. App. 465 (1994). A VA podiatry treatment record from May 2016 notes that it is more likely than not that the Veteran’s right knee plain is related to the service-connected right ankle injury. The Veteran’s primary care physician, Dr. F.C., stated that the Veteran’s knee pain is more likely than not related to her service-connected right ankle injury. See May 2017 VA treatment record. His rationale was that although the symptoms developed over time, the surgery of July 2014 exacerbated her fault gait mechanics, stressing both knees. Although there are positive opinions made by physicians, there is no indication that the physicians reviewed the Veteran’s claim file and there is no rationale that supports the opinions. Thus, while favorable to the Veteran, these medical opinions do not provide high probative value. The Veteran was afforded a VA examination in August 2017. The VA examiner found that the Veteran’s right knee condition was less likely than not (less than 50 percent probability) proximately due to the service-connected right ankle condition. He stated that in 2014, the Veteran stated that she has had knee problems for two and a half years. He further stated that this is consistent with her development of early arthritis of the knee. Regarding the right knee, the VA examiner opined that the right knee is less likely than not (less than 50 percent probability) proximately due to or the result of the service-connected right ankle condition as the Veteran began showing signs of early arthritis of her knees in 2011 and x-rays in 2014 showed mild degenerative changes involving her patellae. He concluded that this is unlikely to be a result of her service-connected right ankle condition. The Board finds that the August 2017 VA opinion is inadequate as the VA examiner failed to address the Veteran’s assertions that her altered gait from the right ankle disability caused her knee problems. In this regard, the VA examination is not adequate for rating purposes and a remand is necessary to obtain another VA examination and opinion that adequately addresses the claim of entitlement to service connection for the right and left knee conditions. Furthermore, there is no medical opinion that addresses service connection on a direct basis. A remand is required to obtain a medical opinion that addresses the Veteran’s assertions that her knee conditions are related to her in-service automobile accident. The matters are REMANDED for the following action: 1. Obtain VA treatment records from October 2018 to present. All reasonable attempts should be made to obtain any identified records. 2. After completing the above development, arrange for a VA examination with a medical opinion to address the claim for service connection for left and right knee conditions. The decision for an in-person examination of the Veteran is left to the discretion of the examiner. The Veteran’s record, to include a copy of this remand, should be made available to and reviewed by the examiner, and an opinion as follows is requested: Is it at least as likely as not (a 50 percent or greater probability) that the Veteran has a right knee condition and left knee condition that a) had an onset in service; b) is otherwise related to service; to include as related to injuries sustained from an automobile accident in 1978; or c) was caused or aggravated by, or a result of the service-connected right ankle condition, including whether there is any incremental increased in disability or aggravation as a result of service. State whether there was an increase in disability regardless of permanence, but medically ascertainable. Any increase in disability should be described in terms of diagnosis, severity, and duration. d) The examiner should also opine whether it is at least as likely as not (50 percent probability or greater) that arthritis of the left and right knees manifested to at least a compensable degree within one year of her discharge from active duty service. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner is specifically requested to address the Veteran’s assertions that her knee conditions are a result of her in-service automobile accident and in the alternative, whether her altered gait has caused her knee conditions. In considering any lay statements of record, the examiner should note that the Veteran is competent to attest to matters of which she had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Kim, 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.