Citation Nr: 21071660 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 16-40 989 DATE: December 1, 2021 REMANDED Entitlement to service connection for left knee osteoarthritis, to include as secondary to residuals of a left ankle osteochondral fracture, is remanded. REASONS FOR REMAND The Veteran had active service from July 1972 to April 1980. In March 2019, the Veteran testified before the undersigned Veterans Law Judge at a Board videoconference hearing. A transcript is of record. This claim was previously before the Board in October 2019, at which time the Board remanded it for additional development. In a December 2020 decision, the Board denied entitlement to service connection for left knee osteoarthritis, to include as secondary to residuals of a left ankle osteochondral fracture. The Veteran subsequently appealed the decision to the United States Court of Appeals for Veterans Claims (Court). While that case was pending at the Court, the Veteran's attorney and the VA Office of the General Counsel filed a joint motion to vacate the Board's decision as it pertained to this issue and remand the Veteran's claim for readjudication. In a July 2021 Order, the Court granted the motion, vacated the Board's December 2020 decision as it pertained to this issue, and remanded this case to the Board for readjudication. Entitlement to service connection for left knee osteoarthritis, to include as secondary to residuals of a left ankle osteochondral fracture, is remanded. The service treatment records (STRs) do not show complaints, treatment, or diagnoses related to the left knee. The Veteran reported on April 1976 and February 1980 medical history reports that he had never had a "trick" or locked knee. He reported in February 1980 of having had arthritis, rheumatism, or bursitis, and it was noted that the Veteran had been diagnosed with rheumatoid arthritis in October 1979. The medical history report does not indicate that the rheumatoid arthritis was related to the left knee. The STRs show that the Veteran was diagnosed with degenerative arthritis of the left ankle. At the February 1980 discharge examination, the lower extremities were normal. The Veteran had a VA examination in March 1981 at which it was noted that he had crepitation of the knees. He reported on a September 1986 medical history report for National Guard service that he had never had a "trick" or locked knee. There were no abnormalities of the left knee on examination. VA treatment records beginning in June 2010 include osteoarthritis of the knee, and a knee brace was ordered. The treatment records do not specify which knee was being referred to. The Veteran complained of left knee pain at June 2014 VA treatment that had been constant since the prior fall. It was also noted that there was swelling and pain in the right knee. The Veteran said at December 2015 VA treatment that his left knee had constantly ached for months. At March 2016 VA treatment the Veteran reported left knee spasms and giving way for two years. The impression was minimal degenerative changes. The Veteran reported knee spasms and giving way for two years at March 2016 VA treatment. The Veteran had a VA examination in January 2017 at which he was diagnosed with left knee osteoarthritis. He reported starting to have knee pain about 15 years before and that it had gotten worse in the past two years. The examiner opined that the left knee condition was less likely than not proximately due to or the result of the left ankle disability. It was noted that imaging showed mild bilateral knee osteoarthritis, and that there was also bilateral osteoarthritis in the hips, lumbar spine, cervical spine, shoulder, and wrist. The Veteran had widespread osteoarthritis, and the left knee osteoarthritis was due to a progression of aging and post-military activities, not the service-connected left ankle disability. Imaging studies supported that the left ankle condition had not aggravated the left knee osteoarthritis beyond its natural progression. At August 2017 treatment, the Veteran reported that his left ankle pain was affecting his knee and hip. Once VA undertakes the effort to provide an examination, it must obtain a fully adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The January 2017 VA examiner did not provide an opinion as to whether the left knee osteoarthritis is related to service on a direct basis. Furthermore, consideration was not given to notations of crepitation of the knee joints, and although not fully legible, "arthralgias" of the knee joints from the March 1981 examination. A new medical opinion must be obtained before the claim can be decided on the merits. VA treatment records to October 2021 have been associated with the claims file. The RO should attempt to obtain all relevant VA treatment records dated from October 2021 to the present, while the claim is in remand status. Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain VA treatment records from October 2021 to the present. 2. Thereafter, obtain an addendum to the January 2017 examiner's opinions regarding left knee osteoarthritis. The Veteran's claims folder should be provided to the reviewer prior to completion of the opinion. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left knee osteoarthritis was incurred in service or within a year of service, or is otherwise related to service. The examiner must also opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left knee osteoarthritis is proximately due to and/or aggravated beyond its natural progression by the service-connected left ankle osteochondral fracture. The examiner's opinion must include discussion of the crepitation of the knee joints, and although not fully legible, "arthralgias" of the knee joints found at the March 1981 examination. The examiner is advised that 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 certain conclusion as it is to find against it. The examiner must discuss the medical rationale for all opinions expressed, whether favorable or unfavorable, if necessary, citing to specific evidence in the file. If the examiner cannot provide his or her requested opinion without resorting to speculation, he or she should state why that is the case. Michael J. Skaltsounis Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Scott Shoreman, 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.