Citation Nr: 21071234 Decision Date: 11/30/21 Archive Date: 11/30/21 DOCKET NO. 16-30 213 DATE: November 30, 2021 REMANDED Entitlement to service connection for a right knee disorder, to include as secondary to a service-connected disability is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1968 to February 1970. His service personnel records confirm his service in the Republic of Vietnam, as well as his participation in combat operations therein. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran and his wife testified before in a travel board hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed In October 2019, the Board remanded the case for further development to include obtaining a VA compensation examination and medical opinions regarding the etiology of the Veteran's right knee disorder, to include on a direct and secondary basis. In August 2020, the RO awarded service connection for the Veteran's bilateral hip disorder. In July 2021, the Board remanded the case again. Pursuant to the Board's remand directives, the Veteran was to be scheduled for a VA examination to help determine the nature and etiology of his right knee disorder. The examiner was asked to address whether the Veteran's right knee disorder was directly related to service, to include jumping off helicopter, or secondary to the service-connected disabilities of the left knee, spine, and newly service-connected bilateral hip disorder. Right Knee Disorder A VA examination was conducted in September 2021. The examiner diagnosed the Veteran with a meniscal tear of the right knee from 2006. In a corresponding medical opinion, the examiner opined that the Veteran's right knee disorder was less likely than not incurred in or caused by service. In support of the opinion, the examiner listed all medical records to date, to include the Veteran's reports of jumping from a helicopter in service and the prior VA examiner's opinions. The examiner also opined that the Veteran's right knee disorder was not aggravated beyond natural progression by the Veteran's service-connected disabilities. In support of the opinion, the examiner stated, "Veteran had rt knee meniscus tear surgery in 2006 and no other complain[t's] but rt knee burning pain and pain with flexion and extension noted." The Board finds the July 2021 medical opinions inadequate for several reasons. First, the examiner's opinions were conclusory in nature and do not provide sufficient rationale. In general, an adequate medical opinion must support its conclusion with an analysis that can be weighed against contrary opinions and be based upon prior medical history and examinations. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence . . . is essential for a proper appellate decision"). Here, with respect to direct service connection, the examiner made no attempt to explain why the medical evidence did not support a relationship to service but merely provided a list of medical treatment. With respect to aggravation, the examiner stated the Veteran's complaints regarding his right knee disorder but did not address the service-connected disabilities and explain how they may or may not have aggravated his right knee disorder. It is also noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124-25. A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Additionally, the examiner did not address whether the Veteran's jumping from helicopters in service was a factor in the development of his right knee disorder. Finally, the examiner in 2021, referred to and relied upon a diagnosis of right knee meniscal tear in 2006; however, the operative report shows that the Veteran's right medial meniscus was intact, and the post-operative diagnosis was chondromalacia grade 3 of patella, lateral trochlea, and medial femoral condyle. As such, to the extent that the examiner misstated the Veteran's medical history, the opinion is of no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). Given the deficiencies discussed above, a new opinion is necessary prior to making a decision on the merits. The matter is REMANDED for the following action: 1. Obtain another medical opinion from a VA examiner regarding the nature and likely etiology of the Veteran's right knee disorder. The claims file and a copy of this remand should be made available to the examiner, who will acknowledge receipt and review of these materials. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. 2. After review of the record, the examiner is asked to respond to the following: (a.) For each right knee diagnosis, opine whether it was, at least as likely as not (50 percent or greater probability) incurred in service or otherwise related to it. **Specifically, address the Veteran's lay statements and duties while serving in combat in Vietnam, including jumping off helicopters. The examiner should note that the Veteran is competent to attest to factual matters of which he 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 not rely on the absence of evidence in the Veteran's service treatment records to provide a negative opinion (b.) If the Veteran's right knee disorder is not found to be directly related to service, opine whether it, at least as likely as not (50 percent or greater probability), was either caused or aggravated by his service-connected left knee, spine, and/or bilateral hip disabilities. ** Please note that for secondary service connection, "aggravation" need not be permanent in nature. See Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). A complete rationale should be provided for all opinions and a discussion of the fact and medical principles involved would be of considerable assistance to the Board. 2. Thereafter, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Beach, Julia M. 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.