Citation Nr: 21000892 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 18-00 928 DATE: January 6, 2021 REMANDED Entitlement to service connection for right knee injury is remanded. Entitlement to service connection for chronic obstructive pulmonary disease is remanded. REASONS FOR REMAND The Veteran has active service from March 1986 to March 1990. This case is before the Board of Veterans’ Appeals (Board) from the January 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans’ Law Judge at a January 2020 hearing. In an April 2020 decision the Board found new and material evidence had been received and reopened the claims. These matters were then remanded to the RO for additional development. Unfortunately, there has not been substantial compliance with the Board’s prior remand directives in accordance with Stegall v. West, 11 Vet. App. 268, 271 (1998), and additional remand is required. 1. Service connection for right knee injury. The April 2020 remand included a directive that the examiner should reconcile any conflicting medical evidence of record to the extent possible, specifically including the February 2020 private medical opinion of record. The August 2020 examiner provided a rationale for the negative nexus opinion but did not address the February 2020 private opinion of record. In the February 2020 opinion, the physician provided that ankylosis is a stiffness of a joint due to abnormal adhesions, which are the result of previous injury. The February 2020 private opinion references June suture removal on June 2, 1987 and the June 23, 1987 injury. The February 2020 opinion provided it is a reasonable medical conclusion to assert that the two separate injuries both occurring while the Veteran was in service, are at least as likely as not the cause of his current right knee pain (2/06/2020 Medical Treatment Record - Non-Government Facility, pgs. 7-8). Remand is required for an addendum opinion that addresses the February 2020 private opinion of record in compliance with prior remand directives. Additionally, the Veteran has argued that the December 2011 notation of chronic right knee pain, prior to the September 2014 notation denying any problems with right knee supports the finding that the current condition was not the direct result of a 2014 on the-job injury (10/27/2020 Third Party Correspondence). The examiner appears to cite to this finding but does not explain why this fails to demonstrate continuity of symptomatology. Accordingly, the Board finds that the medical opinion is also inadequate because the conclusion was not supported with sufficient analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson 21 Vet. App. at 124. 2. Service connection for chronic obstructive pulmonary. The April 2020 remand directives provided the Veteran was to be afforded a VA examination for COPD. If a current respiratory disorder, to include COPD, was found, the examiner was to provide a nexus opinion. The Veteran was afforded a VA examination in August 2020 (8/05/2020 C&P Exam). However, no opinion is associated with that examination. Remand is required to obtain an addendum opinion that substantially complies with the Board’s prior remand directives for a nexus opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are remanded for the following action: 1. With regard to right knee injury, forward the claims file to the August 2020 knee examiner if available (if not available, to a comparably qualified and appropriate clinician) for an addendum opinion consistent with this remand. If the following cannot be addressed without an examination, an examination should be scheduled. The examiner should reconcile the conflicting medical evidence of record to the extent possible, specifically including the February 2020 private medical opinion of record. Additionally, the examiner should address whether the December 2011 notation of chronic right knee pain, prior to the September 2014 notation denying any problems with right knee supports the assertion Veteran’s current condition was not the direct result of a 2014 on the-job injury, and if not, why. A comprehensive rationale for all opinions expressed must be provided. The copy of the examination report and all completed test reports should be associated with the claims folder. If an opinion cannot be rendered without resorting to speculation, the examiner must explain in detail why an opinion cannot be offered. 2. With regard to COPD, forward the claims file to the August 2020 respiratory condition examiner if available (if not available, to a comparably qualified and appropriate clinician) for an addendum opinion consistent with this remand. If the following cannot be addressed without an examination, an examination should be scheduled. The examiner must provide an opinion whether any existing respiratory disorder is at least as likely as not (50 percent probability or more) related to an in-service injury, event, or disease, including specifically the Veteran’s described asbestos exposure while chipping a bulkhead wearing a respirator aboard the USS INDEPENDENCE (CV 62). The examiner should also opine as to whether the Veteran’s current respiratory diagnosis is an extension of or related to in-service complaints of respiratory illness, to include bronchitis and sinus issues as contended by the Veteran and noted on his entrance physical. Noting that another PFT was not obtained, the examiner should explain why this was not feasible. The examiner should reconcile any conflicting medical evidence of record to the extent possible, specifically including the February 2020 private medical opinion of record. The examiner is reminded to consider the Veteran’s lay reports, and a reason must be provided if the Veteran’s lay reports are rejected. Lay statements cannot be rejected solely due to a lack of medical documentation. A comprehensive rationale for all opinions expressed must be provided. The copy of the examination report and all completed test reports should be associated with the claims folder. If an opinion cannot be rendered without resorting to speculation, the examiner must explain in detail why an opinion cannot be offered. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. A. Myers 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.