Citation Nr: 21072487 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 17-49 536 DATE: December 3, 2021 REMANDED Entitlement to service connection for right knee disability (to include degenerative arthritis, anterior cruciate ligament, medial meniscal tear, parameniscal cyst, and shin splints) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1990 to January 1997, to include additional service in the Air National Guard. This claim comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2016 by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2017, the Veteran submitted a notice of disagreement (NOD) indicating that he disagreed with the evaluation of his right knee disability. To date, the Veteran has not been granted service connection for his right knee disability, and therefore cannot disagree with a disability rating he has not received. However, in a July 2017 Report of General Information, the VA clarified that the Veteran intended to disagree with the issue of service connection for his right knee disability. The Veteran initially requested a live videoconference hearing in his September 2017 VA Form 9. The Veteran's April 2020 and September 2020 hearings were postponed; however, the Veteran was a no-show for his September 2021 hearing. See October 2021 Appellate Brief. He has not offered good cause for his failure to appear at the hearing or request that such be rescheduled. Therefore, the Board considers his request for a hearing to be withdrawn. See 38 C.F.R. §§ 20.702 (d); 20.704 (d). Entitlement to service connection for right knee disability. The Veteran contends that his right knee disability had its onset, or is otherwise related to, his active-duty service. The Veteran underwent VA medical examinations regarding the nature and etiology of his right knee disability in March 2016 and November 2017. The claim must be remanded again because both medical examinations are inadequate. Both examiners improperly relied on the lack of records documenting continuity of symptoms to form their negative opinions. Furthermore, the examiners did not discuss or consider the Veteran's April 2016 examination completed by Dr. P.A.L, a private medical provider. Specifically, Dr. P.A.L.'s statement that the Veteran's in-service injury in 1991 "could have contributed" to the development of his right knee arthritis. As such, an addendum opinion must be obtained on remand. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate those documents with the Veteran's claims file. 2. Subsequently, obtain an addendum opinion from an appropriate VA examiner for the Veteran's service connection claim for right knee disability (to include right knee degenerative arthritis, anterior cruciate ligament, medial meniscal tear, parameniscal cyst, and shin splints). If the examiner determines that an opinion cannot be provided without an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) then one should be scheduled. Copies of all pertinent records must be made available to the examiner. After reviewing the record, the examiner is asked to answer the following question: Is it at least as likely as not (50 percent probability) that any currently diagnosed right knee disability was incurred in or is otherwise related to service? The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. The examiner must consider and discuss as necessary: the April 2016 examination in which Dr. P.A.L notes that the Veteran's in-service injury in 1991 "could have contributed" to his current right knee arthritis. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. E. Bresler 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.