Citation Nr: 21069187 Decision Date: 11/17/21 Archive Date: 11/17/21 DOCKET NO. 10-19 260 DATE: November 17, 2021 REMANDED Entitlement to service-connection for right knee condition is remanded. Entitlement to service-connection for left knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from August 1993 to June 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2008 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in December 2013. This case was previously before the Board most recently in May 2021, when it was remanded to the Agency of Original Jurisdiction (AOJ) for development. The case has been returned to the Board for further appellate review. An August 2021 rating decision granted entitlement to service connection for a tension headache disability, secondary to the Veteran's service-connected cervical strain disability. This action represents a total grant of the benefit sought on appeal with respect to the issue, and it is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). 1. Entitlement to service-connection for right knee condition is remanded. 2. Entitlement to service-connection for left knee condition is remanded. Unfortunately, the Board finds that another remand is necessary in this case. In the Board's May 2021 remand, the AOJ was directed to obtain a new VA medical opinion regarding the etiology of the Veteran's claimed bilateral knee condition. In particular, the selected examiner was to address the Veteran's diagnoses of bilateral knee strain in September 2016, and of bilateral lateral patellar subluxation in December 2020. The subsequent June 2021 VA medical opinion, authored by the same examiner who had done the October 2020 VA examination and opinion, was inadequate. The examiner did not address the September 2016 knee strain diagnosis at any point in their opinion. As to the December 2020 patellar subluxation diagnosis, the examiner instead relied on his own October 2020 finding of an absence of a knee condition to dismiss the December 2020 diagnosis, despite that the finding of patellar subluxation were made after the examiner had last seen the Veteran. The examiner stated that the December 2020 findings were not "clinically reproducible" and "can be divergent," but did not offer a rationale explaining why the December 2020 diagnosis was affirmatively less probative, accurate, or significant than his own October 2020 findings of an absence of a condition. Because the June 2021 VA medical opinion did not address the September 2016 diagnosis and dismissed the December 2020 patellar subluxation diagnosis without sufficient rationale, the Board concludes that the opinion did not substantially comply with the Board's May 2021 remand directives. Therefore, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician, preferably one who has not previously examined the Veteran, to determine whether any current right and/or left knee disability is related to the Veteran's military service. Schedule the Veteran for a new VA examination if deemed necessary by the examiner. 2. Following review of the claims file and/or examination, the examiner should identify all current knee disabilities found during the pendency of this claim since approximately February 2008. For EACH disability identified during the appeal, to include knee symptoms that result in functional impairment, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise related to the Veteran's active service. The examiner's opinion must specifically address the September 2016 diagnosis of right and left knee strain and the December 2020 diagnosis of lateral subluxation of the right and left patella. If the examiner determines that these are not current disabilities, the examiner must provide a thorough explanation for this finding, such as whether such a diagnosis was made in error or whether the condition does not constitute a disability, etc. Reliance on previous findings of an absence of a knee condition, without more, will be deemed inadequate. The examiner should specifically address the Veteran's lay statements regarding injuries during service and the onset of knee symptoms, including claims of incurrence from parachuting and/or a vehicle rollover. The examiner may not dismiss the Veteran's report of symptoms capable of lay observation solely on the basis that they are not documented in contemporaneous treatment records. If the examiner finds that there are no current disabilities of the right or left knee, the examiner should opine whether the knee symptoms the Veteran has reported in the record cause any functional impairment. If the examiner determines that functional impairment is caused by the Veteran's knee symptoms, the examiner should offer an etiology opinion as to whether the symptoms causing functional impairment are at least as likely as not related to the Veteran's military service. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Narnor, Harriyah 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.