Citation Nr: 20003364 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 16-06 266 DATE: January 14, 2020 REMANDED Entitlement to service connection for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1988 to April 2001. In an August 2013 decision, the Department of Veterans Affairs (VA) determined that his period of service from May 14, 1988, to April 17, 2001, was dishonorable and was a bar to VA benefits under 38 C.F.R. § 3.12(d)(4). This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. The Veteran testified at a hearing before the undersigned Veterans Law Judge in April 2019. A transcript of that hearing has been associated with the claims file. Upon review, the Board finds that additional development is needed prior to adjudication of the claim. The Veteran was afforded a VA examination in August 2014 in connection with his claim. The examiner listed the diagnosed as a left knee strain, small posterior left knee meniscal tear, and chondromalacia, but opined that a current left knee disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. He acknowledged that the Veteran’s service treatment records showed that an arthroscopy was performed in May 1992 and that both patellofemoral syndrome and a small (2 mm.) medial meniscus tear of the posterior horn were noted at that time. The examiner also observed that no operative treatment was performed on the date of the arthroscopic procedure. Instead, the meniscus ear was treated conservatively, and the Veteran returned to full duty without limitations until his separation from service in 2001, which was approximately eight years later. A February 2001 separation examination had found the lower extremities to be normal. The examiner further noted that post-service private medical records dated in 2014 reported a diagnosis of "Runner's Knee" and patellofemoral syndrome, which were not documented at the time of the separation examination. Therefore, he concluded that the Veteran’s chondromalacia/patellofemoral syndrome and small medial meniscus tear noted in 1992 had resolved by his separation examination. He found that the current left knee findings are more consistent with normal wear and tear changes that developed during the thirteen years since service. Nevertheless, the Board notes that the Veteran did report having some chronic left knee pain with laxity (not considered disabling) at the time of his February 2001 separation examination, which the August 2014 VA examiner did not address. Similarly, the Veteran noted the Veteran’s report that he had received treatment at a VA facility near the end of his military service, but stated that there were no VA treatment records in the claims file. However, the claims file does contain VA treatment records dated in December 1999 and August 2000 that pertain to his left knee. As such, it appears that the August 2014 VA examiner relied on an incomplete or inaccurate factual premise. The record also contains June 2014 private treatment records from Dr. K.W. (initials used to protect privacy), an orthopedist, noting the Veteran’s history of a left knee injury and arthroscopy in May 1992 and his report of continuing left knee pain since that time. Dr. K.W. stated that his pain is now primarily patellofemoral, and given the mechanism of injury, he suspected that the Veteran sustained an injury to the chondral tissue of the patellofemoral joint. The August 2014 VA examiner did not address these findings. For these reasons, the Board finds that an additional VA examination and medical opinion are needed to determine the nature and etiology of any left knee disorder that may be present. The Board also notes that there may be outstanding service treatment records. In this regard, the Veteran testified at the April 2019 hearing that he received ongoing treatment for the left knee in service after his May 1992 arthroscopy, including at the Naval hospital in Norfolk, Virginia, and at Cannon Air Force Base in Clovis, New Mexico. He also reported receiving treatment at the Naval hospital in Yokosuka, Japan, prior to the surgery. Thus, on remand, the agency of original jurisdiction (AOJ) should attempt to obtain any outstanding records. The matter is REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for a left knee disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also obtain any outstanding VA medical records. 2. The AOJ should request the complete service treatment records for the Veteran for all periods of service. A specific request should be made for clinical records from the Naval hospital in Yokosuka, Japan; the Naval hospital in Norfolk, Virginia; and at Cannon Air Force Base in Clovis, New Mexico. If any requested service records are not available, the AOJ should clearly document the claims file to that effect and notify the Veteran of any inability to obtain the records. 3. After completing the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any left knee disorder that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. 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, hearing testimony, and lay statements. It should be noted that the Veteran is competent to attest to matters of which he has 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 examiner should opine as to whether it is at least as likely as not that the Veteran has a current left knee disorder that manifested in service or that is otherwise causally or etiologically related to his military service, to include any injury or symptomatology therein. In rendering this opinion, the examiner should address the arthroplasty in May 1992 and the Veteran’s report of left knee pain at laxity during his February 2001 separation examination. It should be noted that the Veteran’s period of service from May 14, 1988, to April 17, 2001, was dishonorable and is a bar to VA benefits. Thus, service connection cannot be granted for any disease, injury, or event during that time period. However, the examiner may consider any documented complaints in determining whether any injury or symptoms prior to that time were continuous or chronic. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. The AOJ should review the VA examination report to ensure that it is in compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. 5. After completing these actions, the AOJ should conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.S. Chilcote, 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.