Citation Nr: 21067806 Decision Date: 11/05/21 Archive Date: 11/05/21 DOCKET NO. 16-63 901 DATE: November 5, 2021 REMANDED Service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1997 to March 2003 in the U.S. Air Force. This matter comes before the Board of Veterans' Appeals (Board) from a December 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. In August 2019, the Board remanded this claim so that the RO could review evidence added to the claims file since the October 2016 statement of the case (SOC) in the first instance. Although further delay is regrettable, upon review of the evidence, the Board finds that additional remand is required. The Veteran contends that his right knee disability is related to an in-service motor vehicle accident or playing basketball during service. Alternatively, he contends that his right knee disability is related to his service-connected left knee disability or back disability. The Veteran was afforded a VA examination in August 2013. In September 2013, a VA physician opined that after review of the previous orthopedic VA examination, it is less likely than not that the Veteran's right knee condition is due to or secondary to his left knee condition because they are two entirely different and separate conditions, and one does not cause the other. The Board finds this opinion is inadequate for adjudication purposes because it is conclusory and does not address aggravation. In October 2013, a VA physician assistant opined that the Veteran's right knee meniscus injury is not related to his left knee strain because a meniscus tear would not affect or result in a contralateral left knee condition or strain. The Board finds this opinion is inadequate for adjudication purposes because the examiner did not address the affect, if any, of the Veteran's left knee condition on his right knee condition. In July 2016, a VA physician opined that the Veteran's right knee meniscus injury is less likely than not caused by the June 2001 motor vehicle accident. However, the Board finds this opinion inadequate for adjudication purposes because the rationale focuses on the lack of documentation of a right knee injury during service. See Dalton v. Nicholson, 21 Vet. App. 23, 40 (2007) (noting that an examiner cannot rely on the absence of medical records corroborating an injury to conclude that there is no relationship between the veteran's current disability and his military service). Moreover, the VA physician did not address whether the Veteran's right knee disability was caused by playing basketball during service. In August 2019, a VA examiner opined that the Veteran's right knee disability is less likely than not proximately due to or the result of his service-connected back disability. The rational stated that the Veteran was diagnosed with a right knee disability after service and there is no evidence in the Veteran's medical records to establish a nexus. The Board finds that this opinion is inadequate for adjudication purposes because it is conclusory. Based on the foregoing, the Board finds that remand is warranted to obtain a new VA opinion. Additionally, the record shows that there may be outstanding private treatment records. See VA Treatment Records received September 2013.As such, remand is warranted to request these records. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Ask the Veteran to identify any private treatment records relating to his right knee disability. Request that he submit or authorize for release any outstanding private treatment records and associate any identified medical records with the file. 3. Obtain an addendum opinion from an appropriate clinician regarding the etiology of the Veteran's claimed right knee disability. If an examination is deemed necessary by the clinician, then one should be scheduled, and all necessary tests and studies should be completed. The clinician should identify all diagnoses related to the Veteran's right knee. Upon review of the claims file, the clinician is asked to opine as to the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right knee disability had its onset in service. The clinician must address the Veteran's statements that his knee pain started in 2001 and has progressively worsened. (b.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right knee disability is related to any in-service injury, event, or disease, to include a January 1998 notation of shin splints, playing basketball throughout service, and a June 2001 motor vehicle accident. The clinician must address the medical evidence cited by the Veteran that "performing activities that involve aggressive twisting and pivoting of the knee puts you at risk of a torn meniscus" and "overuse injuries develop over time. These injuries result from repetitively using the same parts of the body. An overuse injury may start as a small tear and larger the longer it's left untreated." See August 2021 Appellate Brief. (c.) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran's right knee disability was (1) proximately due to or (2) aggravated by his service-connected left knee disability or back disability. The clinician must address the Veteran's contention that his right knee disability is a result of normal wear and tear from everyday activities on his right knee due to his service-connected left knee disability and his gait was altered significantly subjecting his right knee to abnormal and unusual stress which has had an accumulative effect over the years resulting in his right knee disability. See July 2019 Appellate Brief. Additionally, the clinician must consider the Veteran's contention that he had to make adjustments, adaptations, and modifications to his gait in situations related to walking over the years because of his service-connected left knee disability, which produced serious injury to his right knee. Id. The clinician should consider the Veteran's medical history and lay statements of record. A complete rationale must be provided for all opinions offered. If the clinician cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case. Further, the clinician must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community. The clinician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. The clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kernen, 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.