Citation Nr: 21064439 Decision Date: 10/20/21 Archive Date: 10/20/21 DOCKET NO. 17-57 938 DATE: October 20, 2021 REMANDED Entitlement to service connection for a left knee condition, to include degenerative arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1965 to December 1966. He appeals a May 2015 rating decision by the Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) denying reopening a prior claim for entitlement to service connection for a lumbar spine condition and left and right knee conditions. A Board of Veterans' Appeals (Board) hearing was held in January 2020. A transcript is of record. In March 2020, the Board reopened the claims and remanded the issues for development. Again, in May 2021, the Board remanded these issues for further development. Subsequent to this development, the AOJ granted entitlement to service connection for lumbar spine and right knee degenerative arthritis. See July 2021 rating decision. This is considered a full grant of the issues and, therefore, these issues are no longer before the Board. The AOJ denied entitlement to service connection for left knee degenerative arthritis; thus, this sole issue is back before the Board. The Veteran received a VA examination in June 2021; however, no opinion was proffered. A second VA examination was conducted in July 2021, where the VA examiner noted a diagnosis of left knee degenerative arthritis. Again, the VA examiner did not provide any medical opinion regarding the etiology of a left knee condition. Instead, a different clinician reviewed the evidence of record and opined that the Veteran's left knee condition was less likely than not caused by service, to include his in-service parachute jumps and physical training. See July 2021 VA medical opinion. As rationale, the reviewing clinician noted "the claims file is quiet for complaints/treatment of the left knee other than the DBQ examinations." Id. This is inaccurate. See, e.g., July 2006 VA treatment records ("chronic knee and back pain"); August 2007 Veteran statement (knees "continue to be extremely painful"); October 2017 VA examination report ("both knees swell frequently" chronic pain that "comes and goes" daily); January 2020 Board Hr. Tr. at 15 (knee issues progressed over time). The Veteran is competent to report the history and symptoms of his left knee condition, to include progressive pain, and on remand, this pertinent lay and medical evidence should be considered. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). The Veteran further contends his left knee condition was secondary to his now service-connected back and/or right knee condition. For this, another clinician reviewed the record and opined the left knee degenerative arthritis was not caused by the Veteran's service-connected lumbar spine or right knee arthritis. See August 2021 medical opinion. As rationale, the reviewing clinician noted no orthopedic literature "suggests that an injury to one joint would have any significant impact on another or opposite uninjured joint or limb, unless the injury resulted in major muscle or nerve damage...or shortening of the injured limb resulted in length discrepancy...so that the individual's gait pattern has been altered...." Id. The October 2020 VA lumbar spine examination report noted the Veteran had an abnormal, or altered, gait due to muscle spasms. The reviewing clinician also noted "avoiding use of a painful or limited [body part] is a natural compensation [and] whether the contralateral body part is capable of the increased load is a property of the contralateral body party." This statement suggests the Veteran can naturally avoid any limitations and pain resulting from his service-connected lumbar spine and right knee conditions by compensating with his left knee, which may or may not be able to handle this compensation. However, if the Veteran's left knee cannot handle the natural compensation, because he has developed left knee arthritic pain, this opinion suggests his pain may increase or be aggravated by its inability to handle the natural compensation of the right knee or lumbar spine. Unfortunately, the VA examiner did not actually provide an opinion regarding whether the Veteran's left knee condition was aggravated by his spine and/or right knee condition. See El-Amin v. Shinseki, 26 Vet. App. 136, 140-41 (2013). Thus, as the July and August 2021 medical opinions were all inadequate, a remand is required. The matters are REMANDED for the following action: 1. Obtain any outstanding and updated relevant VA and/or private treatment records and associate the same with the claims file. 2. Thereafter, obtain an opinion from an appropriately qualified clinician, preferably other than any clinician who proffered an opinion in 2021, to determine the nature and etiology of the Veteran's left knee condition, to include as secondary to his service-connected lumbar spine and right knee degenerative arthritis. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. It is up to the discretion of the reviewing clinician as to whether a new examination is necessary to provide an adequate opinion. If so, a complete history should be elicited directly from the Veteran and the opinion should include a notation that this record review took place. After a thorough review of the record to include all in-service and post-service treatment records, the reviewing clinician should answer the following: (a). Is it at least as likely as not (a 50 percent probability or more) the Veteran's left knee condition, to include degenerative arthritis, began in service or is related to his in-service parachute jumps and physical training? The reviewing clinician is directed to consider the following pertinent evidence: (1) DD Form 214 notes the Veteran's MOS was a parachute rigger, and he received the Parachutist Badge; (2) July 2006 VA treatment records noting "chronic knee and back pain;" (3) August 2007 Veteran statement that his knees "continue to be extremely painful;"(4) October 2017 VA examination report noting the Veteran's knees swell frequently and he has daily chronic pain; (5) January 2020 Board Hr. Tr. at 15 noting the impact of in-service parachute jumps on his knees; and (6) February 2021 Veteran letter noting an in-service injury at graduation from rigger school. (b). Is it at least as likely as not (a 50 percent probability or more) that the Veteran's left knee condition, was (1) caused or (2) aggravated by his service-connected lumbar spine and/or right knee degenerative arthritis, to include altering his gait to alleviate his back and right knee pain throughout the years since service? The reviewing clinician is directed to consider the following pertinent evidence: (1) January 2020 Board Hr. Tr. at 14-15 noting the Veteran's knee pain progressed over time, and he changed his gait to alleviate his lumbar spine pain; (2) October 2020 VA lumbar examination report noting the Veteran suffers from muscle spasms resulting in an abnormal gait; and (3) August 2021 medical opinion citing to medical literature explaining that a contralateral body part [i.e. left knee] may not be capable of the increased load caused by avoiding use of a painful or limited component [i.e. a right knee or lumbar spine]. A full and complete rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the reviewing clinician cannot provide a requested opinion without resorting to mere speculation, it must be stated, and the reviewing clinician must provide the reasons why an opinion would require speculation. 3. After the above has been completed to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran with an SSOC and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Bona, Associate 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.