Citation Nr: 20026068 Decision Date: 04/15/20 Archive Date: 04/15/20 DOCKET NO. 14-17 738 DATE: April 15, 2020 REMANDED Entitlement to service connection for a left knee condition, to include as due to a service-connected right knee disability, is remanded. REASONS FOR REMAND The Veteran had active duty service from November 1973 to November 1977. This matter comes before the Board of Veterans’ Appeals (Board) from an August 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for a left knee condition, to include as due to a service-connected right knee disability is remanded. The Veteran’s claim was remanded by the Board in March 2018 to obtain outstanding VA/private treatment records, as well as an addendum medical opinion addressing the Veteran’s secondary service connection theory of entitlement; the Veteran claims that his left knee condition is either proximately due to, or aggravated by, his service-connected right knee disability. See September 2012 Notice of Disagreement (NOD). Now associated with the Veteran’s claims file is an October 2019 VA examination and addendum medical opinion, as well as an August 1995 private treatment record. The August 1995 private treatment record by Dr. F.R.M. reveals that the Veteran’s currently diagnosed left knee condition dates back further than previously shown by the objective medical evidence of record. On this point, the Board notes that the October 2019 VA examiner did not note, or even address, the Veteran’s August 1995 diagnosis for the left knee. As such, the Board finds the October 2019 VA examination to be of no probative value and inadequate for purposes of adjudicating the present appeal, as it is based upon an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Furthermore, regarding the October 2019 VA medical examination and addendum medical opinion, the Board finds that its remand instructions were not substantially complied with as the provided medical opinion, rather than addressing secondary service connection, addressed aggravation of a condition that existed prior to service. Here, the Board finds no objective medical evidence of record to suggest that the Veteran’s left knee condition pre-existed service; rather, the evidence shows that the Veteran suffered an injury to his right knee prior to service. See October 1973 Enlistment Examination; October 19, 1973 private treatment record by Dr. E.F.S.; May 17, 1977 Service Treatment Record (STR). As previously stated, upon remand, the Board sought an addendum medical opinion addressing whether the Veteran’s currently diagnosed left knee condition is proximately due to, or aggravated by, the Veteran’s service-connected right knee disability. See 38 C.F.R. § 3.310(a)-(b); March 2018 Board remand instructions. Therefore, as the Board’s March 2018 remand instructions were not substantially complied with, unfortunately, another remand is necessary to obtain an adequate medical opinion addressing the Veteran’s secondary service connection theory of entitlement. Stegall v. West, 11 Vet. App. 268, 271 (1998); Barr v. Nicholson, 21 Vet. App. 303 (Fed. Cir. 2007). The matters are REMANDED for the following action: 1. Associate with the Veteran’s claims file any outstanding VA treatment records since September 2019. 2. Obtain an addendum medical opinion addressing the Veteran’s direct, as well as secondary service connection, theories of entitlement with regard to the left knee disability. If the VA examiner deems that a new examination is necessary for purposes of providing the herein requested addendum medical opinion(s), then one should be scheduled. The VA examiner should review the Veteran’s entire claims file, to include this remand, and then opine as to all of the following: a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s currently diagnosed left knee condition is related to the injury he sustained during service, specifically a lateral dislocation of the left knee cap? See May 24, 1976 STR; September 23, 1976 STR; see also September 2012 NOD. (Continued on the next page)   b.) Is it as least as likely as not (50 percent probability or greater) that the Veteran's currently diagnosed left knee condition is proximately due to, or aggravated by, his service-connected right knee disability? If aggravation is found, the VA examiner should address the following, to the extent possible: i. the baseline manifestations of the Veteran's left knee condition found prior to aggravation; and ii. the increased manifestations which, in the examiner's opinion, are proximately due to the Veteran’s service-connected right knee disability. A complete rationale must be provided for all opinions. A full medical history regarding the claimed for left knee condition should be elicited from the Veteran. Additionally, the VA examiner should address the newly associated August 1995 private treatment record by Dr. F.R.M. revealing “degenerative osteoarthritic changes in the [left] knee joint proper and in the patellofemoral joint. K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S.R. Fey, 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.