Citation Nr: 21003311 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 18-15 185 DATE: January 21, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1983 to October 1986. By way of background, in a May 2019 decision, the Board denied the Veteran’s service-connection claim for left knee strain. The Veteran appealed the decision to the Court of Appeals for Veterans Claims (Court). The parties signed a Joint Motion for Remand (JMR) that was granted by the Court, vacating the Board’s May 2019 decision, and remanding the issue to the Board for readjudication. In October 2020, the Board remanded the matter for further development consistent with the JMR. Entitlement to service connection for a left knee disability is remanded. The Veteran has alleged that he has a left knee disability that is related to service. See February 2017 VA Form 21-526EZ; November 2017 VA Form 21-0958; and March 2018 VA Form 9. A review of the Veteran’s service treatment records indicates that the Veteran injured his left knee and received treatment while on active duty. See November 1983 Service Treatment Records. During the Veteran’s separation examination in October 1986, he noted that his knees hurt, and the examiner noted there was slight swelling of his left knee. See October 1986 Separation Examination. The record does not contain any private treatment records or post-service VA treatment records. The Board regrets having to again delay adjudication of the Veteran’s claim. However, another remand is necessary to ensure substantial compliance with the Board’s prior remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Specifically, in the October 2020 remand, consistent with the terms of the JMR, the Board determined that an addendum opinion was warranted in which the examiner discusses the Veteran’s claims of experiencing knee symptoms since his discharge from service. VA medical opinions were obtained in October 2020 and November 2020 indicating the Veteran’s left knee strain was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the opinions fail to adequately address the Veteran’s statements regarding his continuing symptoms. Indeed, while the November 2020 opinion references the Veteran’s descriptions of ongoing knee problems, the opinion is was again based exclusively on a lack of documented care for decades after service. Additionally, the VA examiner noted that the Veteran reported that he has discussed “this issue” with his private primary care physician. Despite the Veteran’s identification of private treatment during this most recent assessment, there is no indication in the Veteran’s file that efforts were taken to obtain these identified treatment records. Given the assertions of the Veteran and his description of symptoms, the Board believes an updated opinion should be ordered to assess the nature and severity of the Veteran’s claimed left knee disability. The appeal is REMANDED for the following action: 1. Obtain and associate with the file any outstanding VA treatment records. 2. Give the Veteran an additional opportunity to submit, or authorize VA to obtain on his behalf, any records of private treatment for the left knee that are not already associated with the claims file. All efforts to obtain these records should be fully documented. 3. After any outstanding records have been associated with the claims file, furnish the Veteran’s claims file to an examiner other than the examiners who authored the April 2017, October 2020, and November 2020 opinions. The record must be made available for the reviewing clinician’s review. The need for an additional examination is left to the discretion of the medical professional selected to write the addendum opinion. Following a review of the entire record, the examiner is requested to provide an opinion as to the following: It is at least as likely as not (50 percent or greater probability) that the Veteran’s current knee disability had onset in or is otherwise related to the Veterans’ in-service knee injury. The examiner should specifically discuss whether the nature of the Veteran’s current disability, from a medical perspective, is consistent with the Veteran’s in-service injury and his lay reports of ongoing symptoms after service. The mere fact that he did not receive treatment following service cannot be the exclusive basis upon which a negative determination is made without further discussion as to why, medically, such observation is dispositive. (Continued on Next Page) 4. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Fulmer, 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.