Citation Nr: 21000299 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-40 433 DATE: January 5, 2021 REMANDED Entitlement to service connection for a bilateral knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1976 to July 1980. This matter comes before the Board of Veteran Appeals (Board) on appeal from a July 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. In December 2019, the Board remanded the case for further development and i now returns for further appellate review. Entitlement to service connection for a bilateral knee disorder. As noted in the December 2019 Remand, the Veteran contends that he has a bilateral knee disorder as a result of in-service injuries related to playing the aggressor during Special Forces training where he hit an M60 with his knees and due to hard parachute landings, and reports that he has experienced ongoing knee pain since service, to include in 2006 when his left knee gave out. The Board also observed that, while the Veteran’s complete service treatment records were unavailable for review, his DD 214 reflects that his military occupational specialty was infantryman and he was awarded the Parachute Badge, and his post-service treatment record reflected diagnoses of patellofemoral syndrome and degenerative joint disease (DJD) bilaterally. Finally, while couched in speculative terms, a September 2019 opinion from a private nurse practitioner, S.M., suggested that the Veteran’s bilateral knee disorder was at least as likely as not directly related to his military service. Thus, in light of the foregoing, the Board remanded the case in order to afford the Veteran a VA examination so as to determine the nature and etiology of his bilateral knee disorder. Thereafter, in January 2020, following a review of the record, interview with the Veteran, and physical examination, a VA examiner opined that his bilateral knee disorder, which she diagnosed as patellofemoral arthritis, was less likely than not incurred in or caused by any instance of his military service, to include hitting an M60 with his knees and/or hard parachute landings. As rationale for her opinion, the examiner noted that patellofemoral arthritis is a condition noted to be related to intrinsic mechanical defects (poor patellar tracking, patellar tilt, and others) and the Veteran had a patellar tilt bilaterally with poor tracking of the patella in flexion and extension of the knee. She further stated such is likely part of the cause of the Veteran’s patellofemoral arthritis and further noted he had been morbidly obese since 2014, which also contributed to his patellofemoral arthritis. Additionally, she found that patellofemoral arthritis is not a condition usually associated with trauma, such as hitting his knees on an M60, and/or due to hard parachute landings, and/or due to repetitive microtrauma due to multiple parachute landings. However, the Board finds the January 2020 opinion to be inadequate to decide the claim. In this regard, the examiner only addressed the diagnosis of patellofemoral arthritis, and did not offer an opinion as to the etiology of the Veteran’s diagnosed patellofemoral syndrome and DJD. Additionally, while she found the Veteran’s patellofemoral arthritis to be related, in part, to a patellar tilt, she did not address the etiology of such condition, to include whether such may be related to his reported in-service trauma. Finally, while the examiner indicated that the Veteran’s morbid obesity, which has been present since 2014, contributed to his bilateral knee disorder, he has reported experiencing knee pain since service, which resulted in a fall in 2006 and documented complaints as early as 2008, prior to his obesity. Thus, the Board finds a remand necessary to obtain an addendum opinion that addresses such matters. The matter is REMANDED for the following action: Forward the record, to include a copy of this Remand, to an appropriate VA examiner so as to obtain an addendum opinion addressing the nature and etiology of the Veteran’s bilateral knee disorder. Following a review of the record, the examiner should address the following inquiries: (A) For each bilateral knee disorder, to include patellofemoral syndrome, DJD, and patellofemoral arthritis, the examiner shoulder offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such disorder had its onset in, or is otherwise related to the Veteran’s military service, to include in-service injuries related to playing the aggressor during Special Forces training where he hit an M60 with his knees and/or due to hard parachute landings. If the examiner finds that any diagnosed bilateral knee disorder, to specifically include patellofemoral arthritis, is related to patellar tilt, he or she should offer an opinion as to whether such tile is related to the Veteran’s reported in-service trauma to the bilateral knees. (B) If arthritis is diagnosed, the examiner should offer an opinion as to whether manifested within one year of the Veteran’s separation from service in July 1980, i.e., by July 1981. If so, he or she should describe the manifestations. The examiner is advised that the sole basis for a negative opinion may not be the fact that the Veteran’s service treatment records (which are largely unavailable) are silent for any complaints, treatment, or diagnosis of a bilateral knee disorder. The examiner must consider the Veteran’s reports as to the onset of bilateral knee pain during service and continuity of related symptomatology thereafter, which is prior to the onset of morbid obesity in 2014, and S.M.’s September 2019 opinion suggesting that the nature of the force of the Veteran’s numerous parachute jumps on the knees could have caused deterioration of the cartilage. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. M. Kelly, 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.