Citation Nr: 20054036 Decision Date: 08/14/20 Archive Date: 08/14/20 DOCKET NO. 15-25 730 DATE: August 14, 2020 REMANDED Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a bilateral foot condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1988 to December 1991. This matter was initially before the Board in December 2018, where it was remanded for additional development. Specifically, VA examinations were warranted for his left knee, right knee, and bilateral foot disabilities. 1. Entitlement to service connection for a right knee condition is remanded. 2. Entitlement to service connection for a bilateral foot condition is remanded. While the Board regrets further delay, an addendum opinion must be sought to clarify the conflicting medical evidence of record. The Veteran was afforded a VA examination in October 2019 for his service connection claims for his right knee, left knee, and bilateral foot conditions. The examiner opined that the Veteran’s left knee condition is at least as likely as not caused by active service. The examiner reasoned the following: The Veteran claims that his initial knee problems stem from military training, especially Special Forces and Airborne training. I find that to be a very plausible claim given the known rigors of the Special Forces training and the frequency of lower extremity injury during airborne operations. As such, in a May 2020 rating decision, the Veteran was granted service connection for his left knee disability and the claim for service connection for the left knee is no longer in appellate status. Conversely, the examiner opined that the Veteran’s right knee condition is less than not likely related to service. The examiner reasoned that there was “strong evidence that his right knee injury was caused by or incurred by the Veteran’s post-military occupation in 1997.” However, according to the Veteran’s September 1999 private treatment records, the physician stated that “disability in both knees would be related to the patient’s employment and work injuries.” Despite this treatment note, the Veteran was granted service connection for his left knee condition, and not the right knee and bilateral foot conditions. Since the Veteran’s occupational injury did not deter the examiner from rendering a positive nexus opinion for his left knee disability, it should not be the sole basis for concluding that the Veteran’s right knee condition is not related to service, especially given the fact that the examiner explicitly stated that it is plausible that his training during service can cause injuries to the lower extremities. Similarly, the examiner provided a negative nexus opinion for the Veteran’s bilateral foot condition. The examiner stated that while the Veteran’s bilateral foot condition is less likely than not related to service, “according to [the] Army Public Health Center, repetitive overuse of joints with heavy equipment can cause pain in the limbs,” and “microtrauma that occurs during services can lead to life-long musculoskeletal disabilities such as sprains, arthritis, pain in bones… and/or associated damage that may be functioning beyond it’s normal degree of function.” Additionally, the examiner provided no etiology as to the Veteran’s bilateral foot condition. Based on the conflicting opinions, the Board finds that it is necessary to seek an addendum opinion for clarification purposes, in order to adjudicate the Veteran’s claims. The matters are REMANDED for the following action: 1. Update VA treatment records. 2. Thereafter, obtain an addendum opinion from the examiner who conducted the October 2019 VA examiner, or an appropriate clinician, if the examiner is not available. It is in the discretion of the examiner if another physical examination is required to answer these questions. The examiner must opine whether it is at least as likely as not (50 percent probability or more) that the Veteran’s right knee condition and bilateral foot condition had its onset during service or is otherwise related to the Veteran’s active service. The examiner is requested to discuss whether there is any medical reason to accept or reject the contention that the Veteran’s right knee and bilateral foot condition was caused by “the known rigors of the Special Forces training and the frequency of lower extremity injury airborne operations.”   The examiner must provide all findings, along with a complete rationale for his or her opinions in the examination reports. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adeleke, 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.