Citation Nr: 21001797 Decision Date: 01/11/21 Archive Date: 01/11/21 DOCKET NO. 16-60 404 DATE: January 11, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Navy from June 1960 to January 1973. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in January 2019. This case was previously before the Board in May 2019 and May 2020, when it was remanded for development. The case has been returned to the Board for further appellate review. 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. The prior Board remand directed the RO to obtain new examinations for the right and left knee disabilities. After the RO scheduled them, the Veteran cancelled the examinations, and the record does not reflect any request from the Veteran to reschedule the examinations. The supplemental statement of the case indicated that perhaps the Veteran cancelled the examinations in an effort to withdraw the claims, but there is no other indication in the record that this is so. The medical record in this case is such that opinions without an in-person examination most likely would correct the inadequacies of the November 2019 examination. Accordingly, another remand is necessary to obtain adequate opinions regarding the Veteran’s claims. If the Veteran desires to withdraw the service connection claims for right and left knee disabilities, he should do so in writing; otherwise, VA will continue to adjudicate the claims. The matters are REMANDED for the following action: Forward the claims file to an appropriate clinician to provide an opinion regarding whether any current right and left knee disabilities are related to the Veteran’s military service. The examiner should be instructed that, because no left knee disability was clinically noted on the Veteran’s military entrance examination, the Veteran is presumed sound at entrance into the military as to his left knee, and the examiner must disregard any evidence suggesting the Veteran had any preexisting left knee disability prior to military service. Following review of the claims file, the examiner should identify all right and left knee disabilities found during the pendency of these claims. For each knee disability identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the knee disability began in or is otherwise caused by the Veteran’s active service, to include his duties as a Navy diver. The examiner should address the literature submitted by the Veteran in January 2019 regarding the possible effects of diving on the joints. The examiner should also opine whether it is at least as likely as not (50 percent or greater probability) that each knee disability is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran’s service-connected tremors. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the knee disability prior to aggravation by the tremors. Causation and aggravation are separate concepts and must be addressed independently. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Josey, 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.