Citation Nr: 21000652 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 16-40 525 DATE: January 5, 2021 REMANDED Entitlement to service connection for left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2008 to June 2008 and from April 2010 to May 2011. These matters come before the Board of Veterans’ Appeals (Board) from a December 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Guaynabo, Puerto Rico. In December 2015, the Veteran timely filed a notice of disagreement (NOD), and in June 2016, the RO issued a statement of the case (SOC). In July 2016, the Veteran perfected a substantive appeal, and in a June 2018 decision, the Board remanded the claim for additional development. Unfortunately, as discussed below, the Board’s directives have not been substantially completed, and a remand is required. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran’s appeal has been advanced on the docket. 38 U.S.C. § 7107(a)(2) (2012); 38 C.F.R. § 20.900(c) (2019). 1. Entitlement to service connection for left knee disability is remanded. The Veteran is seeking service connection for a left knee disability. Specifically, he contends that his current knee condition and pain is related to his inservice military occupational specialty (MOS) which required him to spend eight hours a day driving and during which he would start to feel discomfort in his knees. The Veteran also asserts that his disability is secondary to his service-connected back difficulty because when his back disability worsened during service, his knees were aggravated as he would rely on them more when lifting or carrying heavy equipment in an attempt to alleviate his back pain. See July 2019 VA Form 9. As noted above, in a June 2018 decision, the Board remanded this issue for additional development. Specifically, the AOJ was instructed to obtain a medical opinion regarding secondary service connection. Pursuant to the remand instructions, in September 2020, the Veteran was afforded a VA examination and a medical opinion was issued. The VA examiner opined that the Veteran’s left knee disability was less likely than not related to the Veteran’s service connected back disability. He explained that the Veteran’s MRI showed mild edema suprapatellar (quadriceps) fat pad which is also known as Quadriceps (Anterior Suprapatellar) Fat Pad Impingement Syndrome. He noted that irritation and inflammation of the fat pad in the knee may be acute or chronic in nature. In chronic presentation, it’s secondary to abnormal biomechanics causing pain and discomfort. The causes of abnormal biomechanics can be due to activities that cause repeated extension, such as kicking, jumping, running and cycling. Furthermore, the list of potential causes of fat pad syndrome does not include degenerative changes at L4-L5 and L5-S1 by MRI, right ankle lateral collateral ligament sprain (chronic/recurrent), right knee medial bursitis/condition or gait abnormalities/antalgic gait. Here, the September 2020 VA examiner reviewed the Veteran’s claims file, but did not discuss the Veteran’s medical history, left knee bursitis diagnosed in his October 2015 VA examination, or the Veteran’s competent lay statements concerning his inservice MOS. Accordingly, the September 2020 VA opinion is inadequate for adjudicative purposes and a remand for another VA opinion is warranted. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008); Barr v. Nicholson, 21 Vet. App. 303 (2007). The matter is REMANDED for the following action: 1. The AOJ should obtain all outstanding VA treatment records and any private treatment records identified by the Veteran, to include the Veteran’s military personnel records. All obtained records should be associated with the evidentiary record. 2. After all outstanding treatment records have been associated with the claims file, obtain an addendum opinion from an appropriate clinician, regarding the nature and etiology of the Veteran’s left knee disability. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. If an opinion cannot be obtained without an examination, then a VA examination should be afforded to the Veteran. The VA examiner/clinician should address the following: (A) Whether it is at least as likely as not (50 percent probability or more) that the Veteran’s left knee disability, to include left knee bursitis and/or fat impingement syndrome, began during or is due to her military service? In doing so, the examiner should address the Veteran’s competent lay assertions in his July 2019 VA Form 9 regarding his inservice MOS and knee discomfort during service. (B) Whether it is at least as likely as not (i.e. a 50 percent probability or greater) that the Veteran’s left knee disability, to include left knee bursitis and/or fat impingement syndrome, is due to or aggravated by the Veteran’s service-connected back disability. In doing so, the examiner should address the Veteran’s competent lay assertions in his July 2019 VA Form 9 regarding his inservice MOS and increased use of his knees to accommodate his back pain. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). (Continued on the next page)   3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claims should be readjudicated based on the entirety of the evidence. If the benefits sought remain denied, furnish the Veteran and her representative a supplemental statement of the case (SSOC) and return the case to the Board. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kaufer, 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.