Citation Nr: 20042828 Decision Date: 06/24/20 Archive Date: 06/24/20 DOCKET NO. 15-06 297A DATE: June 24, 2020 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. INTRODUCTION The Veteran had active service from September 1978 to July 1988. In February 2017, the Veteran attended a hearing before the undersigned Veterans Law Judge. A transcript of that proceeding is of record. When this case was most recently before the Board in June 2018, the above-noted issues were remanded for further development. The case has since been returned for additional appellate review. REASONS FOR REMAND Although further delay is unfortunate, the Board finds additional development is necessary prior to final adjudication of this matter. A remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the course of the June 2018 remand, the Board found an April 2014 medical opinion to be insufficient, because the VA examiner fatally cited to a lack of ongoing treatment to support his negative medical nexus opinion. The Board specifically indicated a medical examiner cannot solely rely on the absence of medical records corroborating the incurrence or continuity of a disorder, and moreover, is simply not free to ignore a veteran’s statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). The Board also noted that during her February 2017 Board hearing the Veteran reported experiencing knee injuries in service, with ongoing manifestations of pain. Following the June 2018 remand, the Veteran underwent a second VA examination in November 2019. In the course of her examination the Veteran was diagnosed with a right knee meniscal tear, left knee patellofemoral pain syndrome, and bilateral knee osteo and degenerative arthritis. The examiner concluded the Veteran’s knee disabilities were less likely than not incurred in service. In support of her conclusion the examiner, like the April 2014 VA examiner, principally relied upon a lack of “chronicity of care.” The examiner again ignored the Veteran’s competent reports of ongoing knee pain since service. With respect to the Veteran’s right knee disabilities, the examiner also indicated the disabilities were less likely than not proximately due to or aggravated by her left knee disabilities. Unfortunately, the examiner only addressed the Veteran’s right knee arthritis disabilities, but failed to explain how or why her meniscal tear could not have been consequentially related to her left knee disabilities. Based on the foregoing insufficiencies, the Board finds substantial compliance with the Board’s June 2018 remand has not been achieved. As such, a remand is required. Accordingly, the case is REMANDED for the following actions: 1. Afford the Veteran a VA examination by an examiner with sufficient expertise, who has not previously examined this Veteran, to address the etiology of the Veteran’s claimed left and right knee disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner(s). Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion with respect to whether any diagnosed left or right knee disability at least as likely as not (a 50 percent probability or greater): a) originated during her period of active service or is otherwise etiologically related to her active service. The examiner should also state whether any presently diagnosed left knee disability at least as likely as not (a 50 percent probability or greater): b) was caused by her right knee disability; or c) was worsened by her right knee disability. Further, the examiner should also state whether any presently diagnosed right knee disability at least as likely as not (a 50 percent probability or greater): d) was caused by her left knee disability; or e) was worsened by her left knee disability. (Continued on the next page)   The examiner(s) must specifically address the Veteran’s reports relative to the etiology of the claimed disabilities. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. Fraser, 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.