Citation Nr: 21072180 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 17-00 010 DATE: December 2, 2021 REMANDED Entitlement to service connection for a right knee condition, to include as secondary as service-connected left knee condition, is remanded. REASONS FOR REMAND The Veteran service on active duty in the Air Force from July 1974 to August 1977. This case comes before the Board of Veterans' Appeals (Board) on appeal from a June 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran was scheduled for a Board hearing, in which he failed to appear. Therefore, the hearing request is deemed withdrawn due to his failure to report for the scheduled hearing and no request for postponement was received. See 38C.F.R. §§20.703, 20.704. In July 2021, the Board remanded the Veteran's claims for additional development. The Board notes that there was substantial compliance with its July 2021 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998); D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Regrettably, the Board finds that another remand is necessary prior to readjudication of the claim. The Veteran contends that he currently has a right knee condition that is directly related to his active duty service, to include an injury during a softball game with a collision at home plate, or otherwise proximately caused or aggravated by his service-connected left knee disability. In the July 2021 remand, the Board noted that the prior 2017 VA medical opinion in this case solely focused on whether the claimed right knee condition was caused by the Veteran's service-connected left knee disability, and did not adequately address the possibility of aggravation. The Board requested an addendum opinion that addressed both questions of aggravation and causation as the Veteran's claim of secondary service connection. In September 2021, a VA examiner determined that it is less likely than not that the Veteran's right knee condition was caused or aggravated by his service-connected left knee disability. The examiner identified the Veteran's right knee condition as a right knee strain, noting the lack of imaging of the right knee showing any ligamentous, cartilaginous, tendinous or arthritic changes. The Board notes, however, that the recent medical evidence only reflects the findings from 2016 and 2017 imaging studies of the left knee; it is unclear whether the Veteran has ever undergone imaging studies for the right knee and the subsequent medical evidence does not reflect any assessment of the joint. Thus, the Board is not confident that the September 2021 VA opinion is based on the most accurate or complete assessment of the Veteran's claimed right knee condition, to contemplation of any functional impairment. Moreover, the September 2021 examiner provided the exact same rationale when addressing both the causation and aggravation questions, rationale that was essentially identical that provided and found to be inadequate for the 2017 VA opinion. The examiner noted a review of a summary paper provided by an orthopedic surgeon, specifically stating: According to a summary paper,.... 'The evidence available indicates than an injury in one extremity rarely causes a major problem in the opposite or uninjured extremity, except when damage to one leg results in a major displacement of the center of gravity while walking, significant shortening of the injured limb and the abnormal gait pattern has been present for an extended period of time.' Review of records of [the] Veteran do [sic] not show any indication of major displacement of the center of gravity of the body while walking, history of significant shortening of the injured limb or abnormal gait pattern of a chronic basis due to the left knee in order to attribute the right knee to the contralateral knee. Again, the Board highlights that the September 2021 examiner did not identify clinical findings of record specific to the right knee in providing this rationale. Moreover, the examiner's rationale does not adequately address the Veteran's contentions that he favors his right knee due to his service-connected left knee disability. Thus, the opinion is inadequate with which to decide the Veteran's claim. Given the deficiencies with the medical opinions regarding secondary service connection, and the lack of a medical opinion that addresses the Veteran's claim of an in-service right knee injury, a remand is needed to provide the Veteran with an adequate VA medical examination and opinions. Accordingly, a remand is necessary to address the matters discussed above. The matter is REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his right knee condition and obtain any outstanding records and associate them with the Veteran's claims file. 2. After associating all newly acquired records with the claims file, schedule the Veteran a VA examination by an appropriate physician, such as an orthopedic surgeon, to determine the nature and etiology of the Veteran's right knee condition. The entire claims file, including a copy of this remand, must be made available to the examiner, and note review of the record in the examination report. Any indicated tests or studies should be performed, and all relevant evidence should be discussed. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. Following complete review of the record, the examiner must address the following: (a) Identify and clearly describe all diagnoses related to the Veteran's right knee condition, to include pain that causes functional impairment. In so doing, the examiner must consider and discuss the September 2021 diagnosis of right knee strain. (b) Identify any functional impairment(s) caused by any right knee condition, to include pain. (c) For all identified diagnoses or functional impairment, the examiner must opine as to each whether it is at least as likely as not (50 percent or greater probability) that the disability had its onset during any period of active duty service, or is otherwise etiologically related to his active duty service, to include from an injury during a softball game with a collision at home plate. (d) For all identified diagnoses or functional impairment, the examiner must opine as to each whether it is at least as likely as not (50 percent or greater probability) that the disability is caused or aggravated by a service-connected disability, to include the service-connected left knee disability. Any opinion should include a detailed rationale. The examiner should consider the entire claims file, and discuss the Veteran's lay statements regarding the nature, onset, and chronicity of symptoms. The examiner is advised that the Veteran is competent to report symptoms, and that his reports must be considered in formulating the requested opinion, to include his lay statements regarding favoring his right knee. (e) If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rational for the conclusion that an opinion could not be provided without resorting to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Carter, 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.