Citation Nr: 21001870 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 17-41 529 DATE: January 12, 2021 REMANDED Entitlement to service connection for right knee joint osteoarthritis (right knee condition) as secondary to service-connected left knee condition is remanded. REASONS FOR REMAND The Veteran served active duty service from August 1995 to August 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision by the Department of Veteran Affairs (VA) Regional Office (RO). Entitlement to service connection for a right knee condition as secondary to service-connected left knee condition is remanded. In the January 2020 VA medical opinion, the VA examiner opined that the Veteran’s right knee condition is less likely than not proximately due to or the result of the Veteran’s service-connected left knee condition. The VA examiner reasoned there is no medical evidence that indicate the Veteran’s right knee condition is due to his left knee. The VA examiner acknowledged the January 2016 statement where the Veteran stated he favors his right leg because of his left knee injury; however, the VA examiner determined there is no evidence to support that the Veteran was consistently seen or treated for a right knee condition. Also, the VA examiner referenced that the October 2001 report did not indicate right knee complaints, and the October 2015 VA examination indicated his right knee was normal. Similarly, in the January 2020 VA medical opinion, the VA examiner opined that the Veteran’s right knee condition was less likely than not aggravated beyond its natural progression by his service-connected left knee condition. The VA examiner reasoned that there is no medical evidence in records that indicate the Veteran’s right knee condition is due to his left knee. Also, the VA examiner referenced that the October 2001 report did not indicate right knee complaints, and the October 2015 VA examination indicated his right knee was normal. The Veteran is entitled to substantial compliance with the Board’s remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). Here, the January 2020 VA medical opinion inaccurately determined there is no evidence to support that the Veteran was consistently seen or treated for a right knee condition. There is sufficient, contrasting medical evidence indicating complaints and/or treatment for a right knee condition. See Reonal v. Brown, 5 Vet. App. 458, 460 (1993). Also, the January 2020 aggravation opinion lacks a rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Because there has not been substantial compliance with the September 2019 Board remand directives, another remand is necessary. The Board stresses the importance of carefully following the directives of this remand in order to allow for a final resolution of this issue. The matters are REMANDED for the following action: 1. Provide the Veteran’s claims file to a qualified examiner to determine the etiology of the Veteran’s right knee condition. The entire claims file and a copy of this remand must be made available to the examiner for review. A new physical or telehealth examination is only required if deemed necessary by the examiner. Although an independent review of the claims file is required, the Board calls the examiner’s attention to the following: a. December 2015 VA treatment record where it notes joint pain in knees. b. March 2016 and January 2020 VA examinations where it indicates a right knee condition and medical history of right knee pain. c. November 2018 VA treatment record for right knee pain study, and a noted history of knee pain. The examiner must provide opinions as to the following: a. Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right knee condition is proximately due to or the result of his service-connected left knee condition. b. Whether it is at least as likely as not that the Veteran’s right knee condition was aggravated beyond its natural progression by his service-connected left knee condition. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. 2. Ensure that the directives specified in this remand have not been implemented. If they have not, appropriate corrective action must be undertaken before readjudication. Stegall v. West, 11 Vet. App. 268 (1998). (Continued on the next page)   3. If the claim remains denied, the RO should issue an appropriate supplemental statement of the case and afford the Veteran an opportunity to respond. The case should then be returned to the Board, if in order, for further review. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Willoughby, 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.