Citation Nr: 21073947 Decision Date: 12/13/21 Archive Date: 12/13/21 DOCKET NO. 16-19 654 DATE: December 13, 2021 REMAND Entitlement to service connection for a left knee disability, to include degenerative joint disease (DJD) and patella subluxation, is remanded. REASONS FOR REMAND The Veteran had active naval service from May 1966 to December 1969. This case comes before the Board of Veterans' Appeals (Board) on appeal of an October 2015 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This case was previously before the Board in September 2019, January 2020, and July 2021, at which times the issue on appeal was remanded for additional development. This case has been returned to the Board for further appellate action. The Board initially notes that in the September 2019 Board decision, the issue of entitlement to service connection for a left lower leg disability was stayed, and the issue of entitlement to service connection for a left knee disability was remanded. Since that time, RO has failed to issue a supplemental statement of the case (SSOC) addressing the claim of entitlement to service connection for a left lower leg disability. Therefore, that issue is not yet ripe for the Board's appellate review and is referred to the RO for any necessary action and issuance of an SSOC. 1. Entitlement to service connection for a left knee disability The Board regrets additional delay but finds that another remand is warranted to obtain an adequate medical opinion that complies with the July 2021 Board remand directives. The Board emphasizes that compliance with a remand is not discretionary, and failure to comply with the terms of a remand necessitates a remand for corrective action. Stegall v. West, 11 Vet. App. 268 (1998). The Veteran asserts that his left knee disability is the result of a severe left knee injury that he sustained during active service. The Board initially notes that the Veteran's service treatment records (STRs) reveal that the Veteran reported that he "he twisted his left knee" in September 1966. As a result of that left knee injury, the Veteran was restricted to light duty with no extensive walking or standing. Additionally, an April 1969 treatment note documented the Veteran's complaints that his knee hurt him when he stood on it for a long time, and that he had a history of knee problems. Further, the Veteran's separation examination notes a left knee injury. The Veteran's post-service treatment records reveal complaints of left knee pain as early as 2007, and a June 2007 diagnosis of DJD in the left knee. In a July 2016 statement, the Veteran noted that he re-injured his knee three months after his separation from service while lifting equipment out of the trunk of a car. Additionally, a June 2017 treatment note documented that the Veteran hurt his left knee while carrying 70-pound weights. In November 2020, the Veteran was afforded a VA examination for knee and lower leg conditions. At that time, the Veteran reported that he injured his left kneecap in service which resulted in swelling. The Veteran also reported that his kneecap was adjusted back into position at sick call, that he was wrapped up and given crutches to ambulate, and that his left knee pain never resolved. Additionally, the Veteran reported that he only had left knee pain when he turned the wrong way and that his knee felt like it was loose in the socket. The VA examiner assessed that the Veteran's left knee was normal. The VA examiner also noted that there was no pain on examination and that the Veteran's left knee was not productive of subluxation. In an August 2021 addendum opinion, a VA examiner opined that the Veteran's claimed left knee disability was less likely than not incurred in, or caused by, his active service. The VA examiner reasoned that the Veteran's in-service left knee injury was acute only and that there was no evidence of chronicity of care. The VA examiner also noted that the record was silent for a chronic left knee condition in service, and that his knee was noted as normal on the November 2020 VA examination. Recently, a September 2021 radiology report documented the Veteran's history of left knee patella subluxation. The Board finds that the November 2020 VA examination and August 2021 VA medical opinion are inadequate for adjudication purposes. In this regard, the VA examiners failed to adequately consider the Veteran's lay statements of continued pain and recurrent left knee injuries since his separation from service. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). Additionally, the examination and opinion also fail to annotate or address the Veteran's June 2007 diagnosis of DJD of the left knee. See Reonal v. Brown, 5 Vet. App. 458, 461(1993). As the November 2020 examination and August 2021 opinion are inadequate, they cannot serve as the basis for denial of entitlement to service connection. The Board notes that the Veteran is competent to report the observable symptoms of his left knee disability, to include pain and dislocation. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). However, the Veteran is not competent to diagnose or provide a nexus opinion pertaining to his DJD, as that requires medical expertise and is outside the common knowledge of a layperson. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Based on the foregoing, the Board finds that a remand is warranted to obtain an adequate addendum opinion pertaining to the nature and etiology of any currently present left knee disability. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). This matter is REMANDED for the following action: 1. The Veterans Benefits Administration (VBA) must forward the Veteran's claim file, to include a copy of the herein remand, to an orthopedist who has not previously examined the Veteran or provided a medical opinion in this case. The examiner must review the claims file, to include a copy of the herein remand, and note that review in the report. Based on a thorough review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any identified left knee disability, to include DJD and patella subluxation, were caused or otherwise related to the Veteran's active service. In forming this opinion, the VA examiner must specifically address the Veteran's lay statements regarding the onset and continuity of his left knee disability. The examiner must also specifically address the Veteran's documented post-service left knee injuries, and annotation of a history of left knee patella subluxation. A complete and detailed rationale must be provided for all opinions expressed. Another VA examination of the Veteran should only be conducted if deemed necessary by the examiner providing the requested medical opinion. 2. Thereafter, the VBA must confirm that all medical opinions comport with this remand, and undertake any other development determined to be warranted. 3. Thereafter, the VBA must readjudicate the appeal. If the decision is adverse to the Veteran, issue a copy of the readjudication to the Veteran and his representative and afford them an appropriate opportunity to respond. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Byrd, Associate 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.