Citation Nr: 21066323 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 12-19 463 DATE: October 29, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served in the New Jersey Army National Guard and had a period of active duty for training (ACDUTRA) from January 9, 2004, to February 17, 2004. She has been granted service connection for bipolar disorder based on her period of ACDUTRA, thereby establishing veteran status. This matter comes before the Board of Veterans' Appeals (Board) on appeal from November 2009, and June 2010 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge in May 2013. A transcript is of record. The Board remanded the case for further development in March 2018 and April 2020. The case has since been returned to the Board for appellate review. Upon review, the Board finds that additional development is necessary prior to adjudication of the claim. Following the most recent remand, a December 2020 VA examiner opined that the Veteran's right knee disorder was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. He acknowledged the Veteran's report that she had twisted her right knee while running in basic training and that she was seen for right knee pain in January 2004; however, he stated that there was no diagnosis rendered at that time. The examiner also noted that MRIs did not reveal a meniscal tear in May 2005 and October 2006, but that she later had a right knee arthroscopy with a partial lateral meniscectomy in 2007, which was long after her military service. He stated that, given that the Veteran had a short period of service from January 2004 to February 2004, it is unclear if a right knee injury became chronic. Therefore, the examiner indicated that any further injury to her knee cannot be contributed to her military service and likely happened after her discharge. In addition, he found that there was no objective evidence to render a diagnosis of right knee patellofemoral chondromalacia. Nevertheless, as noted in the prior remand, the January 2004 service treatment record appears to note an assessment of retropatellar pain syndrome (RPPS). As the January 2020 examiner stated that there was no diagnosis rendered at the time, it appears that his opinion is based on an inaccurate or incomplete. Therefore, the Board finds that an additional medical opinion is needed. The matters are REMANDED for the following action: 1. The agency of original jurisdiction (AOJ) should refer the Veteran's claims file to a VA examiner for a clarifying opinion as to the nature and etiology of the Veteran's right knee disorder. An additional physical examination should be performed only if deemed necessary by the VA examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. It should be noted that the Veteran is competent to attest to factual matters of which she has first-hand knowledge. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should state this with a fully reasoned explanation. The examiner should identify all current right knee disorders, to include any right knee meniscal tears, patellofemoral chondromalacia, and/or degenerative joint disease. If any previously diagnosed right knee disorders are not found, the examiner should address whether they were misdiagnosed or have resolved. For each diagnosis identified, the examiner should provide an opinion as to whether it is at least as likely as not that the disorder manifested in or is otherwise causally or etiologically related to the Veteran's period of ACDUTRA from January 9, 204 to February 17, 2004, to include any injury or symptomatology therein. The examiner should specifically consider the January 2004 service treatment record that appears to note an assessment of retropatellar pain syndrome. (The term "at least as likely as not" does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. The AOJ should ensure compliance with the prior directive and conduct any other development as may be indicated. J.W. ZISSIMOS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. DeVerter, 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.