Citation Nr: 20026558 Decision Date: 04/17/20 Archive Date: 04/17/20 DOCKET NO. 18-00 602 DATE: April 17, 2020 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to a left ankle fracture, is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a left ankle fracture and/or secondary to a right knee disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1987 to November 1991. He testified before the undersigned Veterans Law Judge in March 2020. His representative waived Regional Office review of new evidence during the hearing. The Veteran was afforded a VA knee examination in October 2014. The Veteran was diagnosed with a contusion, chondromalacia patella, and a quadricep tendon repair of the right knee. Degenerative arthritis was also found in the right knee. The Board notes test were not conducted on the left knee. The examiner provided a negative nexus for the Veteran’s right knee disabilities, but did not address any left knee disabilities; however, July 2014 MRI results in the VA treatment notes show the Veteran was diagnosed with a meniscal tear and degenerative changes of the left knee. Accordingly, the Veteran finds the examination inadequate because it did not address all of the Veteran’s bilateral knee disabilities. During the hearing, the Veteran asserted that his right knee disability was secondary to his service-connected left ankle fracture, and his left knee disability was secondary to his right knee disability and his service-connected left ankle fracture. The Board notes that the October 2014 nexus opinion only addressed direct service-connection for the Veteran’s right knee. Therefore, the Veteran should be afforded a new VA examination which addressed both of the Veteran’s knees; and the examiner should provide nexus opinions based on applicable direct and secondary theories of entitlement. The matters are REMANDED for the following action: 1. Contact the Veteran and request authorization to obtain any outstanding records pertinent to the claim, including any private treatment records following proper VA procedures (38 C.F.R. § 3.159(c)). 2. After obtaining any outstanding records, forward the Veteran’s claims file to a qualified medical professional to obtain a VA knee examination to determine the nature and etiology of the Veteran’s bilateral knee disabilities. The Veteran’s entire record (including this remand) must be reviewed by the examiners. If necessary, an examination may be conducted, bearing in mind the complications of the COVID-19 epidemic. The examiner must provide opinions, with a full rationale, that respond to the following: (a.) Identify all right and left knee disabilities demonstrated during the appeal period or in proximity to the claim, even if currently resolved; (b.) For any diagnosed right knee disability, provide an opinion as to 1.) whether it is at least as likely as not (a 50 percent or greater probability) that such diagnosis was caused or incurred by active service, or 2.) was caused or aggravated (increased in severity beyond the natural progress of the disorder) by the Veteran’s left ankle fracture; and (c.) For any diagnosed left knee disability, provide an opinion as to 1.) whether it is at least as likely as not that such diagnosis was caused or incurred by active service, 2.) was caused or aggravated by the Veteran’s left ankle fracture, or 3.)was caused or aggravated by the right knee disability. Any opinions offered should be accompanied by a clear rationale consistent with the evidence of record. The Board notes that causation and aggravation are independent concepts and should have separate findings and rationales. See Atencio v. O’Rourke, 30 Vet. App. 74 (2018). As such, the VA examiner must provide separate findings and rationales relating to causation and aggravation. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. N. Quarles, 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.