Citation Nr: 21073881 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 19-23 286 DATE: December 13, 2021 REMANDED Entitlement to service connection for bilateral (left and right) knee disability, including chondromalacia and/or ostearthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1978 to April 1985. In support of his claim, the Veteran testified at a "virtual" teleconference hearing in September 2021 before the undersigned Veterans Law Judge of the Board. A transcript of the proceeding is of record. Unfortunately, however, this claim must be further developed before being decided on appeal. The Veteran underwent a VA examination in July 2018 to determine the nature and etiology of his claimed bilateral knee disability, but the Board finds that examination inadequate for adjudication purposes. Thus, more medical comment is needed before deciding the appeal of this claim. See Barr v. Nicholson, 21 Vet. App. 303 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007); 38 C.F.R. § 3.159(c)(4). Specifically, the evaluating VA clinician failed to review the Veteran's claims file and, consequently, did not consider relevant VA treatment records showing a diagnosis of osteoarthritis in 2009. And, while review of the claims file is not necessarily required or determinative of the probative value of a medical opinion since, as an example, the Veteran may be a credible historian, it has significance when, as here, the examiner neglected to consider potentially relevant evidence that may affect the basis of the opinion or tend to undermine it. See Kowalski v. Nicholson, 19 Vet. App. 171 (2005); Coburn v. Nicholson, 19 Vet. App. 427 (2006). Furthermore, a different VA physician rendered the medical opinion, finding that the Veteran's condition is less likely than not related to his military service because there is no competent medical evidence of the claimed disability in his service treatment records (STRs). However, the mere absence of evidence of treatment for a bilateral knee disability in the Veteran's STRs cannot, alone, be sufficient rationale for providing an unfavorable opinion. Dalton v. Nicholson, 12 Vet. App. 23 (2007); Fountain v. McDonald, 27 Vet. App. 258, 272-75 (2015) (indicating that a VA examiner may not generally rely on the absence of evidence as negative evidence). In addition, in making a determination, the opining clinician disputed the examining physician's diagnosis of chondromalacia but also failed to address the Veteran's confirmed diagnosis of osteoarthritis. As such, the Board finds that supplemental medical comment (an addendum opinion) is needed. Accordingly, this claim is REMANDED for the following action: 1. Contact the Veteran and request authorization to obtain any outstanding records pertinent to his claim, including any private treatment records, following proper VA procedures (38 C.F.R. § 3.159(c)). Notify him if unable to obtain records that have been sufficiently identified (38 C.F.R. § 3.159(e)). 2. After receiving all additional records, obtain a supplemental medical opinion from a qualified clinician concerning the nature and etiology of the Veteran's bilateral knee disability. To assist in making this important determination, a copy of this remand and all relevant medical and other records must be made available to the examiner for review. The examiner must consider the pertinent evidence, including the Veteran's lay assertions. Based on review of the claims file and the Veteran's statements regarding the development and treatment of this claimed disability, the examiner is asked to answer the following question: Is it at least as likely as not (a 50 percent or greater probability) the Veteran's bilateral knee disability began during his service, or within a year of his discharge, or is otherwise related or attributable to his service? The Veteran is competent to report his symptoms and history, and his reports must be specifically acknowledged and considered in formulating the opinion regarding the origins of his bilateral knee disability and posited relationship or correlation with his service. If the examiner rejects the Veteran's reports of symptoms, the reason for doing so must be discussed. It is essential that the examiner provide rationale for the opinion and address the deficiencies in the prior July 2018 VA medical examination report. To this end, the examiner must consider the Veteran's diagnosis of osteoarthritis in 2009. It is essential the examiner provide reasoning for the opinion, regardless of whether responding favorably or unfavorably, preferably citing to specific evidence in the file supporting conclusions and/or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mukherjee, Cameron B. 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.