Citation Nr: 21005135 Decision Date: 01/29/21 Archive Date: 01/29/21 DOCKET NO. 14-32 815 DATE: January 29, 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 honorably on active duty in the U.S. Army from November 1965 to November 1968. This case comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously before the Board. After determining that the Veteran’s October 2019 VA examination was inadequate because the examiner failed to discuss the Veteran’s contention that he had experienced knee pain since his time in service, in June 2020, the Board remanded the issues of entitlement to service connection for a right knee and left knee disability for further development, to include a new VA examination. This development is now complete, and these matters are now before the Board for appellate review. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability The Veteran contends that his right and left knee conditions are related to his active service. Specifically, he asserts these conditions resulted from physical training in military boots, including road marches, as well as from lifting heavy equipment. See July 2012 Statement in Support of Claim; Jan. 2014 Statement in Support of Claim; 2019 Sept. 2014 VA Form 9. The Veteran most recently appeared for a VA examination in September 2020. The examiner determined that the Veteran had a bilateral knee strain. See Sept. 2020 VA Examination at 2. However, he stated that the Veteran’s knee strain was less likely than not related to his active service because the record showed no complaints of, treatment for, or diagnosis of knee pain in service. See Sept. 2020 VA Examination Opinion at 3. Additionally, though noting that the Veteran reported experiencing knee pain in service, the examiner opined that the Veteran had not sought treatment for knee pain since his 1968 separation from service. See id. Unfortunately, the Board finds the September 2020 examination inadequate for adjudication purposes. In this regard, though the examiner determined the Veteran had a bilateral knee strain, he did not address that the Veteran had been previously diagnosed with bilateral osteoarthritis of the knees. See id. He also failed to address service treatment records indicating the Veteran had leg cramps in service. See Sept. 1968 Service Treatment Records at 92. Further, the Board finds that this opinion appears to be based, at least in part, on the lack of contemporaneous treatment records without adequate consideration of the Veteran’s lay statements asserting that his current knee disabilities began in service as the result of in-service training. See Miller v. Wilkie, 32 Vet. App. 249, 258 (2020); Dalton v. Nicholson, 21 Vet. App. 23 (2007) (lack of documented findings is not an adequate basis for a negative opinion). The Board acknowledges that once VA undertakes the effort to provide an examination or opinion when developing a service connection claim, an adequate examination must be provided. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Accordingly, although the Board regrets further delay, remand is necessary to provide the Veteran with a new VA opinion that addresses the nature and etiology of the Veteran’s right and left knee disabilities. See id.; Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (explaining that “a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two”). The matters are REMANDED for the following action: 1. Obtain any updated VA treatment records pertaining to the Veteran and associate them with the file. 2. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed right knee and left knee disabilities. The examiner must review pertinent documents in the clams file in conjunction with the examination. This must be noted in the examination report. All tests and studies deemed necessary by the examiner should be performed. a. The examiner is asked to provide a diagnosis for any bilateral knee conditions that have existed during the pendency of the claim. In providing this opinion, the examiner must consider: (1) the October 2019 VA examination showing a diagnosis of bilateral osteoarthritis of the knee; (2) the September 2020 VA examination showing a diagnosis of bilateral knee strain. b. The examiner should then opine as to whether it is at least as likely as not (a 50 percent probability or greater) that the Veteran’s current bilateral knee condition had its onset in service or is otherwise etiologically related to active service. In providing this opinion, the examiner must address: (1) the Veteran’s assertion that his knee condition may be due to training, marching, and lifting heavy objects in service; (2) the Veteran’s lay statements asserting that he experienced knee pain in service; and (3) service treatment records showing a complaint of leg cramps upon separation from service. See Sept. 1968 Service Treatment Records at 92. The examiner is advised the Veteran is competent ot report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. Rationale for all requested opinions must be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board O. Gomez, Law Clerk 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.