Citation Nr: 21062825 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-43 830 DATE: October 12, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded REASONS FOR REMAND The Veteran served on active duty from August 1985 to August 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In May 2019, the Board remanded these issues in order to afford the Veteran with a VA examination that would assess his current right and left knee disorders and to obtain an opinion on whether they were related to service, or were caused or aggravated by his service-connected bilateral pes planus. The Board Remand specifically noted that the Veteran had been diagnosed with left knee arthritis and that he had right knee pain which caused functional loss, including an inability to run, inability to walk or stand for long periods, and abnormal range of motion measurements. The Veteran attended a VA examination in December 2019. The examiner noted that the Veteran had been found to have mild osteoarthritis in the left knee in 2015, but wrote that a December 2019 X-ray was normal. The examiner also acknowledged that the Veteran had pain in both knees, and that it hurt to bend the knee or run. The examiner found that the Veteran did not have a current diagnosis associated with his knees. He wrote that there was no disability in either knee, and no evidence of a functional impairment. Regarding the Board's nexus questions, he wrote that the Veteran's complaints of knee pain in 2015 had too long a time lag from the knee pain noted in service, and therefore they were not connected. He did not answer the Board's question regarding secondary service connection related to pes planus. The Board finds that this medical opinion is not adequate, and the issues are again remanded. The VA examiner did not find that the Veteran had a current knee disability, and he stated that the Veteran had no functional impairment in his knees, despite the Veteran's reports of having difficulty running, bending down, or standing/walking for long periods of time. The Board finds that this should be reevaluated in light of Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), which held that where pain alone result in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. Furthermore, the Board points out that X-rays taken in November 2015, which is within the appeal period, showed that the Veteran had left knee osteoarthritis. The Veteran has also been found by his VA treatment provider to have patellofemoral syndrome symptoms. The examiner also failed to provide an opinion regarding whether the Veteran's right or left knee disabilities have been caused or aggravated by his service-connected pes planus, which was specifically asked by the Board in its prior remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (Board remand confers a right on a claimant to compliance with the remand order). These issues are therefore remanded so that a new, adequate VA examination and opinion can be obtained prior to further adjudication. The matters are REMANDED for the following action: 1. Obtain all VA treatment records since September 2020. 2. Schedule the Veteran for an examination with an examiner, other than the examiner who performed the December 2019 examination, in order to address the nature and etiology of his bilateral knee disorders. If feasible, the examination may be held via telehealth during social distancing restrictions, and an opinion can be provided based on other medical evidence of record. The examiner must be provided access to the Veteran's entire claims file and must specify in the report that the claims file has been reviewed. The examiner should then address: a) What are the Veteran's current diagnoses of the right and left knee, including any diagnoses that he has received since November 2015? The Board notes that a November 2015 X-ray found mild arthritis in the left knee, and in January 2019, his VA physician found that he had patellofemoral syndrome symptoms. b) If no specific, current diagnosis is found for either knee, please discuss the functional impact of the appellant's reported pain, impaired mobility, and/or lack of stamina. Discuss the impact, or lack thereof, from pain, focusing on the evidence of functional limitation caused by pain, and if it limits the ability to perform normal working movements of the body with normal excursion, strength, speed, coordination, or endurance. See Saunders, 886 F.3d 1356. c) For all diagnoses which are currently present or which the Veteran has had since November 2015, or for any symptoms causing functional impairment that are found, is it as likely as not that the disorder had its onset during service or is related to any injury or incident in service? Please consider the Veteran's treatment in June 1987 for bilateral knee pain and his December 1988 report of having bilateral knee pain for the past 6 months. d) For all diagnoses which are currently present or which the Veteran has had since November 2015, or for any symptoms causing functional impairment that are found, is it as likely as not that the disorder was either i) caused or ii) aggravated by his service-connected pes planus, including due to an altered gait? The examiner is reminded that the Veteran is competent to report on symptoms as he has observed them. A complete and fully explanatory rationale must be provided. If any opinion cannot be rendered without resorting to speculation, the examiner must explain why. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mary E. Rude, 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.