Citation Nr: 21003635 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 09-01 651 DATE: January 22, 2021 REMANDED Entitlement to service connection for a right knee condition is remanded. REASONS FOR REMAND The Veteran served honorably with the United States Army from March 1991 to June 1997. This matter was previously before Board of Veterans’ Appeals (Board) in June 2020, at which time the issue of service connection for a right knee condition was remanded for further development. Entitlement to service connection for a right knee condition is remanded. Although the Board regrets the additional delay, the Veteran’s representative asks for, and the Board agrees, that remand is once again warranted. In particular, remand is required to obtain a medical opinion that complies with the prior Board remand instructions, and to consider lay statements of record. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998) (requiring substantial compliance with remand directives). The Board previously remanded this matter in June 2020 for further development including a VA examination and a request for records. The examiner was directed to identify all right knee disabilities diagnosed since November 2005 and for each diagnosed right knee disability opine whether it was at least as likely as not related to an injury, event or disease to include his June 1991 in-service diagnosis of cryoglobulinemic vasculitis. The resulting examination did not comply with the remand directives. See June 2020 Board Decision. Following the Board remand, VA secured an addendum opinion in September 2020. The examiner noted first that the Veteran’s in-service diagnosis of cryoglobulinemic vasculitis is an inflammatory vascular condition, and that it does not affect the joints including the knees. The examiner concluded it was less likely than not that the Veteran’s chrondryl lesion leading to chondroplasty was due to or incurred in the Veteran’s IT band syndrome/tendinitis in service. The examiner found the Veteran’s right IT band tendinitis was a lateral tendinous condition of the knee and did not involve the joint surface. He noted there was no evidence of a chondryl articular surfaces. He also noted the pathophysiology of tendinitis was different and separate from the lesions of the artticular surfaces. In sum, he found it was less likely than not that the Veteran’s chondral lesion with chondroplasty has its nexus in service or was due to the Veteran’s vasculitis diagnosis. See September 2020 Addendum Opinion. For multiple reasons, the Board concludes that the September 2020 addendum opinion does not substantially comply with the June 2020 Board remand directive. First, although the examiner provided an opinion for the Veteran’s diagnosis of chrondyl lesion, the examiner did not explain whether the other right knee diagnoses present in the file since 2005, including right knee degenerative joint disease, right knee iliotibial band syndrome, and right knee chondroplasty medical femoral condyle, were made in error or had resolved. See February 2007 VA examination; April 2012 VA examination; July 2015 VA examination. Additionally, the examiner did not opine whether any of diagnosed right knee disabilities were at least as likely as not related to an injury, event or disease in service; instead, the examiner concluded that the Veteran’s diagnosis of chrondryl lesion leading to chondroplasty was not related to his diagnosis of IT band syndrome, tendinitis or his vasculitis. Moreover, the remand directives noted the addendum opinion should be completed by the December 2019 VA examiner or from another appropriate provider if the examiner was unavailable. However, it is not clear why the RO obtained an opinion from a general practice, obstetrics and gynecology physician. Therefore, remand is required. See Stegall, supra; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). Lastly, the Board is aware that this claim has been remanded multiple times. The Board reminds the Veteran that he is free to obtain and submit a medical opinion(s) from any competent medical provider that provided a thorough rationale for the opinions requested below (i.e., the Veteran’s current right-knee diagnoses and a) whether any diagnosis is related to service; or b) is caused or aggravated by the Veteran’s service-connected left-knee condition). The matter is REMANDED for the following action: Obtain a medical opinion for the nature and etiology of the Veteran’s right knee disabilities. Based on the review of the record (and examination if needed) the examiner should answer the following: (a.) Identify all the Veteran’s current right knee disabilities. *The examiner should note that the Veteran has been previously diagnosed with right knee degenerative joint disease, right knee iliotibial band syndrome, right knee chondroplasty medical femoral condyle. See February 2007 VA examination; April 2012 VA examination; July 2015 VA examination. IF THE EXAMINER DETERMINES THAT THE VETERAN DOES NOT CURRENTLY SUFFER FROM THESE CONDITIONS, THE EXAMINER MUST OPINE AS TO WHETHER THE DIAGNOSES WERE MADE IN ERROR OR RESOLVED. (b.) For each diagnosed right knee disability, is it at least as likely as not related to an injury, event or disease to include the Veteran’s report of an injury occurring while running on active duty? The examiner should address the Veteran’s contention that he injured his knee while on a company run during active service. See June 2006 Medical Treatment Record; see also May 4, 2008 Buddy Lay Statement, May 15, 2008 Buddy Lay Statement. (c.) For every diagnosed disability, the examiner must determine whether it is at least as likely as not that any of the Veteran’s right knee disabilities is cause or aggravated (defined as any increase in disability) by his service-connected left knee disability. An opinion as to BOTH causation AND aggravation is requested. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Emily A. Kotroco 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.