Citation Nr: 21064324 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 18-24 873 DATE: October 19, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 2001 to May 2006. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In July 2021, the Veteran testified before the undersigned Veterans Law Judge (VLJ). A hearing transcript is associated with the record. The VLJ held the record open for 60 days for the Veteran to submit a medical opinion. See Hearing Transcript (July 2021). No opinion was received. Entitlement to service connection for a right knee disability is remanded. The Veteran contends that she injured her right knee during service when she stepped off an aircraft ladder wrong. She stated that she did not report the knee problems at that time, but began seeking treatment in 2004. See NOD (October 2016); Hearing Transcript (July 2021). She reported that after an in-service motor vehicle accident (MVA), her symptoms worsened. See Hearing Transcript (July 2021). The Veteran also stated that although she did not seek treatment until well after service, she continued to have right knee symptoms. See Form 9 (May 2018); Hearing Transcript (July 2021). The Board finds that remand is warranted to obtain an adequate VA examination. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Service connection may be granted for any disease initially diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). A medical opinion must also be supported by an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). "[T]the VA examiner's failure to consider [a veteran's] testimony when formulating her opinion renders that opinion inadequate." McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016); Dalton v. Nicholson, 21 Vet. App. 23 (2007) (An opinion based on the absence of treatment records without consideration of a veteran's competent reports is inadequate). Here, an October 2016 VA examination was provided. As noted by the VA examiner, the Veteran's service treatment records (STRs) contained evidence of right knee complaints. See Military Personnel Record (June 2016). A February 2004 STR noted right knee locking and pain for 1.5 years, and the Veteran reported that the knee symptoms had increased since her 2003 MVA. See Military Personnel Record (June 2016). The VA examiner diagnosed patellofemoral syndrome and opined that the disability was less likely as not due to the knee pain in service. See C&P Exam (October 2016). The examiner reasoned that the Veteran had not sought treatment for 12 years after service and had not mentioned knee pain in her new patient visit at a VA medical center in 2007. See C&P Exam (October 2016). The examiner's explanation is inadequate as it did not fully address the Veteran's statements of continuous symptoms since service. Additionally, continuous symptoms and/or treatment are not required; service connection may be granted where a disability is otherwise related to an in-service event. Accordingly, remand is required to obtain an adequate opinion. In remanding these matters, the Board makes no finding, implicit or otherwise, as to the credibility of the Veteran's assertions. Neither the Veteran's credibility nor any lack thereof should be presumed in this remand. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from 2018 to the Present. 2. Obtain an addendum opinion regarding the Veteran's right knee disability. The entire claims file, to include a copy of this REMAND, should be made available to and reviewed by the clinician. Based on review of the record, detail the Veteran's reported symptoms, including the nature, onset, progression and severity of any symptoms consistent with the diagnosed right knee patellofemoral syndrome. The opinion should, among other things, include a discussion of the Veteran's documented history and assertions. The opinion should also identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). The clinician should provide an opinion, with supporting rationale, as to: Whether the Veteran's right knee patellofemoral syndrome at least as likely as not (1) had its onset in service, or (2) is otherwise related to an in-service injury, event, or disease. Consider whether in-service symptoms as noted in the STRs, and post-service statements by the Veteran that she had continuous symptoms since service discharge, at least as likely as not represent the onset of a right knee disability in service and indicate whether such symptoms are more likely than not due to other causesexplain. NOTE (1): An adequate medical opinion may not be predicated solely on the absence of an in-service diagnosis or documented complaints. NOTE (2): If any medical history is rejected, a complete explanation is required. 3. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.