Citation Nr: 21066987 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 16-54 158 DATE: November 3, 2021 REMANDED Service connection for a right knee condition. Service connection for a left knee condition. REASONS FOR REMAND The Veteran served on active duty from September 1974 to January 1996. The case is on appeal from a September 2014 rating decision. In October 2018 the Veteran testified at a Board hearing. Most recently, in an August 2020 decision, the Board denied the claims of service connection for a left and a right knee condition. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claim (Court). Pursuant to a May 2021 joint motion for remand (JMR), the Court vacated the Board's August 2020 decision by a June 2021 order, and remanded the case to the Board. 1. Service connection for a right knee condition. 2. Service connection for a left knee condition. Upon appeal to the Court, the parties to the JMR agreed that the Board did not provide an adequate statement of reasons and bases for its decision to deny service connection for a right and a left knee condition. In this regard, the Board relied on a January 2020 VA opinion to deny the claim. The January 2020 examiner concluded that it is less likely than not that the Veteran's left and right knee degenerative arthritis was incurred in or caused by the claimed in-service injury, event, or illness. She explained the Veteran's degenerative arthritis was first shown in 2004 at age 50, many years after his release from active duty. She noted further there is no single cause for osteoarthritis, instead there is a host of biologic and mechanical factors that culminate in the development of osteoarthritis and studies show advancing age, obesity, nicotine, and job-related physical work result in wear and tear which contribute to knee arthritis. Applying these factors to the Veteran, the examiner explained the Veteran developed arthritis at age 50; he has long standing smoking history; he previously worked on his feet at a juvenile detention center after service; and he has a gradually progressing elevated body mass index, which is presently 35.5, indicating obesity. As such, the examiner noted, the Veteran has multiple risk factors, aside from his physical training during service, that contributed to his current left and right knee arthritis. Thus, she concluded the Veteran's left and right knee arthritis are less likely than not incurred in or caused by any event during service. The January 2020 examiner also acknowledged an opinion provided by the Veteran's physician in December 2018, which stated the Veteran's left and right knee degenerative arthritis was aggravated due to traumatic joint injury or repetitive joint use during service. However, the examiner found significant that there was no definitive arthritis diagnosis during service. The parties to the JMR raised the issue of the adequacy of the January 2020 VA opinion as the January 2020 examiner did not specifically address the Veteran's reports of repetitive use of his knees during his 21 years in the U.S. Army or provide an opinion as to the Veteran's risk for developing osteoarthritis given any "history or repetitive use" during service. In addition, the parties to the JMR raised the issue of the adequacy of the January 2020 VA opinion as the examiner provided a negative nexus opinion based in part on the fact that there was no definitive diagnosis or treatment for a knee condition during active service. However, the JMR notes that in the decision on appeal, the Board found that it was at least as likely as not that the Veteran experienced some knee pain during service as the Veteran's statements regarding his knee pain during service were competent, credible, and consistent with his service and his service records show that he reported a "tricked or locked knee" in service. Therefore, the Board finds an additional VA opinion is warranted to determine if the Veteran's right and left knee condition is related to service. The opinion requires a discussion of the clinical significance of the Veteran's history of repetitive use during service and the Veteran's experience of knee pain during service. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain VA treatment records since July 2019. 2. Schedule the Veteran for a VA examination (or telehealth interview, record review, etc., if an in-person examination is not feasible) by a qualified medical professional for an opinion to determine the nature and etiology of the Veteran's right and left knee condition. The need for an examination is left to the discretion of the examiner. The entire claims file should be reviewed by the examiner. Any necessary testing should be conducted. The examiner should then provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's right and left knee shoulder had its onset during service, within one year of service, or is otherwise related to the Veteran's service. (Continued on the next page) In providing an opinion, the examiner should consider the December 2018 private opinion and the January 2020 VA opinion, and address the Veteran's risk for developing osteoarthritis given his reports of repetitive use of his knees during his 21 years in the U.S. Army. The examiner should also address the clinical significance that the Veteran experienced knee pain during service, although there was now definitive treatment or diagnosis for a knee condition during service. A complete rationale for all opinions expressed should be provided. If an opinion cannot be offered without resorting to speculation, the reason for this should be fully explained in the opinion. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.