Citation Nr: 21062904 Decision Date: 10/12/21 Archive Date: 10/12/21 DOCKET NO. 17-39 861 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. Entitlement to service connection for a lumbar spine disability is remanded. REASONS FOR REMAND The Veteran had active duty service from December 1986 to September 1988 and November 1990 to April 1991, including service in Southwest Asia from January 1991 to March 1991. The Board most recently remanded this case in February 2020. 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. The August 2020 medical opinion provided regarding the etiology of the Veteran's bilateral knee disabilities is inadequate because there is no supporting rationale based on the evidence of record. The examiner essentially found that the current knee disabilities were not related to service because they were related to injuries that occurred prior to service. The record shows that the Veteran had surgeries to his knees prior to service in the early to mid-1980s for chondromalacia patella of the left knee and severe patellofemoral arthritis with poor tracking of the patella in the right knee. At entry into service in July 1986, it was noted that the Veteran had bilateral chondromalacia patella and had scarring on the knees from the surgeries. However, the physician who performed the left knee surgeries in July 1984 and March 1985 for chondromalacia patella of the left knee submitted a letter in June 1986 that the Veteran had done quite well since surgery and he had advised the Veteran that he may participate in any and all activities without restriction. During service, the Veteran was seen in the emergency room for his left knee and was given crutches and a brace in December 1990. After service a May 1995 VA examination report shows the Veteran stated that he was in good health when he entered service and had no difficulties until exercising in 1990 when associated with the 365th Evacuation Hospital at Albuquerque Proving Ground. He reported that his left knee popped out laterally and then went back into position. He also submitted a statement in January 2020 that his left knee popped out of joint in service during Desert Storm (from January 1991 to March 1991). Within four years after service, he was found to have degenerative joint disease of the knees in November 1995. The examiner who provided the medical opinion in August 2020 did not appear to have considered any of this relevant information in making the etiology opinion regarding the knees. Thus, the Board cannot rely on the opinion provided. 3. Entitlement to service connection for a lumbar spine disability is remanded. The Veteran asserted that after he returned from Desert Storm, he had intermittent back pain that became severe. See August 2007 statement. He stated that he wondered if the pain was from Gulf War Syndrome. Id. The Veteran was found to have degenerative joint disease of the lumbar spine in November 1995, approximately four years after his separation from service. A May 1995 VA treatment record also notes tenderness to palpation at T-5, T-6. It was noted that he had a history of a back lifting injury. The August 2020 medical opinion provided did not consider this, nor any of the Veteran's statements regarding back pain since returning from Desert Storm. A supplemental medical opinion is warranted to address the Veteran's claim. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's right and left knee disabilities. The examiner must review the claims file, including, but not limited to, the following: (a.) The Veteran had surgeries on his knees prior to service in the early to mid-1980s for chondromalacia patella of the left knee and severe patellofemoral arthritis with poor tracking of the patella in the right knee. (b.) At entry into service, other than scarring on the knees, the Veteran was found able to participate in all activities without restriction from the physician who performed the left knee surgeries. (c.) During service, the Veteran was seen in the emergency room in December 1990 for his left knee and was given crutches and a brace. He also stated in January 2020 that his left knee popped out of joint during his service in Desert Storm (from January 1991 to March 1991). (d.) A May 1995 VA examination report shows the Veteran stated that he was in good health when he entered service and had no difficulties until exercising in 1990 when associated with the 365th Evacuation Hospital at Albuquerque Proving Ground. He reported that his left knee popped out laterally and then went back into position. (e.) Within four years after service, he was found to have degenerative joint disease of both knees in November 1995. (f.) The Veteran has stated that since service his knees would dislocate at times (see, e.g., VA-Form 21-526 dated in February 1995). Did the Veteran's right and left knee disabilities, which existed prior to service, at least as likely as not increase in severity during service? If so, was the increase in severity clearly and unmistakably (undebatable) due to the natural progress of the disease? 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's lumbar spine disability is at least as likely as not related to service, including his complaints of back pain since his service in Southwest Asia during the Persian Gulf War. The examiner must review the claims file, including, but not limited to, the following: (a.) The Veteran asserted that after he returned from Desert Storm, he had intermittent back pain that became severe. See August 2007 statement. (b.) The Veteran was found to have degenerative joint disease of the lumbar spine in November 1995, approximately four years after his separation from service. (Continued on the next page) (c.) A May 1995 VA treatment record also notes tenderness to palpation at T-5, T-6. It was noted that he had a history of a back lifting injury. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sarah B. Richmond, 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.