Citation Nr: 21004527 Decision Date: 01/27/21 Archive Date: 01/27/21 DOCKET NO. 17-04 788 DATE: January 27, 2021 REMANDED Entitlement to service connection for right knee pain is remanded. Entitlement to service connection for left knee muscle pain is remanded. Entitlement to service connection for residuals of a shrapnel wound to right knee is remanded. Entitlement to service connection for residuals of a shrapnel wound to left knee is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1964 to July 1968. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision. These issues were previously remanded by the Board in January 2019. The Veteran’s claims of service connection for back pain and a total disability rating based on individual unemployability (TDIU) for the entire period on appeal were granted by the AOJ in an October 2019 rating decision. Thus, they are no longer on appeal. Pending STR’s The previous remand requested the agency of original jurisdiction to undertake appropriate development to obtain outstanding service treatment records that were relevant to the remanded claims. The claims file, as it stands, indicates the development for outstanding service treatment records is still pending. Accordingly, a remand is needed to allow the AOJ to complete this pending records request. VA Examination As noted, these claims were remanded by the Board in January 2019. The Veteran underwent a VA examination in July 2019 for his knee conditions. The diagnosis section reported a healed shrapnel wound with residual pain in the Veteran’s left knee. A diagnosis for the right knee was not reported, but “current symptoms” reported the Veteran endured bilateral knee pain. Yet, the examination, also, later reported the pain was not observed on the examination. As to the opinion, in pertinent part, the examiner reported that the she could not find sufficient medical evidence such as diagnostic imaging or testing that demonstrates shrapnel in the knee. It was also stated that it was hard to say without mere speculation that the knee pain is directly and completely related to military service. In conclusion, the examiner reported that based on the examination, review of medical records, lack of medical evidence, and the healed shrapnel wound with residual pain, the left knee was less likely than not incurred in or caused by the claimed-in-service injury, event, or illness. The examiner reported that there was no objective evidence to support a diagnosis of the right knee. An addendum opinion is needed. The examiner stated that there was no evidence showing shrapnel in the knee; but later concluded that the Veteran had a healed shrapnel wound in his knee with residual pain. It is not clear what the examiner concluded whether a diagnosis regarding shrapnel in his left knee. The examination also stated it was hard to say without mere speculation that the knee pain was directly and completely related to military service. Yet, the appropriate standard is not that stringent. Instead it is whether it is “at least as likely as not” that the Veteran’s knee pain is related to his reported inservice event of shrapnel to his knee causing knee pain and his diagnosis. Accordingly, a remand is needed for an opinion with the appropriate standard. The matters are REMANDED for the following action: 1. Complete the pending records request for the Veteran’s service treatment records. 2. Obtain updated medical records, private and VA, and associate them with the record. 3. Obtain an addendum opinion from a VA examiner that is not the July 2019 VA examiner to determine the nature and etiology of the Veteran’s bilateral knee condition. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The addendum opinion must include a notation that this record review took place. It is up to the discretion of the examiner as to whether a new examination of the Veteran is necessary to provide an adequate opinion. After the record review and examination of the Veteran, if deemed necessary by the examiner, the VA examiner is asked to respond to the following inquiries: (a.) Confirm the diagnosis for each knee. (b.) Is at least as likely as not (a 50 percent probability or greater) that any current knee condition for VA purposes is related to an in-service injury, event, or disease? For each requested opinion above, a comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be provided without resorting to speculation, the examiner must explain why this is so and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required). M. Miller Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wade 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.