Citation Nr: 21001267 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 17-53 935 DATE: January 7, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from June to July 1964 and from January to June 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2017 rating decision issued by a regional office (hereinafter agency of original jurisdiction or AOJ) of the Department of Veterans Affairs (VA). The Veteran filed an October 2017 appeal to the Board under the legacy system, which was certified to the Board in November 2017. In June 2018, the Veteran attempted to opt into the Rapid Appeals Modernization Program. However, as the Veteran has not withdrawn his Board appeal under the legacy system, it remains the valid appeal. See 38 C.F.R. § 3.2500(e). Finally, due to the Veteran’s age, the Board has advanced this case on the docket pursuant to 38 U.S.C. § 7107(b)(3). 38 C.F.R. § 20.900(c). Entitlement to service connection for a right knee condition is remanded. The Veteran asserts that his right knee disorder, which he admits preexisted his active service, was aggravated beyond its natural progression by this service. A preexisting injury or disease will be considered to have been aggravated by active service where there is an increase in disability during such service, unless there is a specific finding that the increase in disability is due to the natural progress of the disease. 38 U.S.C. § 1153; 38 C.F.R. § 3.306(a). In his May 2017 notice of disagreement, the Veteran indicated he injured his right knee before his initial enlistment. He stated that basic training exacerbated his knee condition and he was medically discharged in order to return home and undergo surgery. The Veteran stated that after recovering from surgery he reenlisted in the Army but further exacerbated his knee during service, which he asserted turned into osteoarthritis as he aged. The Veteran was afforded a VA knee examination in December 2016. After observing functional impairment in the Veteran’s right knee, the examiner noted that both the Veteran and his service treatment records confirm the Veteran’s right knee condition preexisted his active service. The examiner opined that the Veteran’s right knee condition was clearly and unmistakably not aggravated beyond its natural progression by his active service, stating the records indicate the Veteran’s “right knee would have resulted in a state requiring surgery given his recurrent pain and usage whether he entered service or not, to say otherwise would be purely speculative.” The Board observes that the Veteran claimed his right knee disorder was aggravated by both his periods of active service, while the December 2016 VA examiner only addressed the Veteran’s 1964 active service, failing to discuss his later period of active service in 1967. Therefore, the opinion is inadequate, and remand is required in order to obtain an addendum opinion. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The matters are REMANDED for the following action: 1. Obtain any updated VA and private treatment records and associate them with the claims file. 2. Forward the claims file to a qualified VA examiner for an addendum opinion regarding the nature and etiology of the Veteran’s right knee disorder. The need for an additional examination is left to the discretion of the examiner. The examiner is to accept that the Veteran’s right knee disorder clearly and unmistakably preexisted his periods of active service in 1964 and 1967. The examiner is asked to provide the following opinions: (a) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s preexisting right knee disorder was aggravated (underwent an increase in severity) during his period of active service from June 9, 1964 to July 4, 1964; and if so, (b) Whether there is clear and unmistakable (obvious or manifest) evidence that the increase in severity during this period of active service was due to the natural progress of the disease. (c) Whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s preexisting right knee disorder was aggravated (underwent an increase in severity) during his period of active service from January 31, 1967 to June 4, 1967; and if so (d) Whether there is clear and unmistakable (obvious or manifest) evidence that the increase in severity during this period of active service was due to the natural progress of the disease. (e) In answering these questions, the examiner is requested to specifically discuss the significance of an October 1965 physical examination noting an old knee injury which was not considered disabling (NCD) and a February 6, 1967 induction examination noting history of surgery in 1965 with no sequelae with a February 21, 1967 orthopedic consultation noting that some of the Veteran’s symptoms increased during basic training when determining whether an increased severity of underlying disability is shown during the 2nd period of active service. The examiner is informed that temporary or intermittent flareups of a preexisting injury or disease are not sufficient to be considered “aggravation in service” unless the underlying condition, as contrasted with symptoms, has worsened. In formulating the requested opinion(s), the examiner is asked to discuss: •An October 1965 surgeon’s note stating “Surgery right knee 2/18/65. Good recovery. Knee stable at present.” •February 1967 STRs in which the Veteran reported his right knee coming “frequently out of joint” and as well as an increase of symptoms during basic training. •June and July 2012 private treatment records including imaging revealing osteoarthritis in the right knee and in which the Veteran complains of right knee stiffness for the past two years. •A May 2017 buddy statement from a fellow soldier indicating that during active service “it was obvious” that [the Veteran] had a problem with his right knee that was exacerbated by marches and physical activities.” •The Veteran’s September 2016 statement in support of his claim indicating his right knee condition was exacerbated by basic training during his first term of active service as well as by training exercises during his second period of active service, to include his knee buckling on multiple occasions and being drained at least once. A complete rational must be provided for any opinion offered. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. C. Schumacher, 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.