Citation Nr: 21074052 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 17-05 646 DATE: December 14, 2021 ORDER Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1983 to July 1996. This matter comes before the Board of Veterans Appeals (Board) on appeal from a November 2012 decision by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded in February 2019 and July 2021, to obtain an examination and adequate opinion for the Veteran's knees. 1. Entitlement to service connection for a right knee disability 2. Entitlement to service connection for a left knee disability The Veteran contends that her bilateral knee disabilities are due to service. The record contains statements from the Veteran, as well as friends and family, testifying that she has had continuous knee pain since service. On remand, the September 2021 VA examiner found that the Veteran's knee disabilities were less likely than not due to service. By way of rationale, the examiner conceded the 1996 bilateral knee strain diagnosis by the December 2019 examiner and lay testimony of the Veteran and her family. He found that the Veteran was diagnosed with degenerative joint disease (DJD), bilaterally, and opined that DJD "is considered a naturally occurring, age-related condition that was age-appropriate at the time of diagnosis", noting a gap of 21 years between service and diagnosis. Finally, he found that "in the absence of evidence of internal derangement or direct trauma to the knee, there is no condition in service or at separation that would predispose the veteran to develop naturally occurring, age-related DJD of the knees." Unfortunately, despite the otherwise thorough and detailed opinion on the nature and cause of the Veteran's knee disabilities, the Board finds the opinion inadequate. The examiner partially based his opinion on an inaccurate factual premise when he found that the first evidence of a bilateral knee disability, other than the credible and conceded complaint of trick or locked knee and swollen or painful joints on her separation examination, was documented in or around October 2017. In fact, the examiner found no continuity, emphasizing that "it is unlikely an individual could have endured such a span without seeking care for a condition arising in service". However, the record documents the Veteran complained of knee pain as early as August 2012, more than five years prior to the examiner's assertion. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion is only as good and credible as the history on which it was based, and if based on an inaccurate factual premise it has no probative value.); see also Monzingo v. Shinseki, 26 Vet. App. 97, 107 (2012) ("If the opinion is based on an inaccurate factual premise, then it is correct to discount it entirely") (citing Reonal). As the opinion is inadequate, the Board remands this matter for the issuance of a new addendum VA medical opinion. The matters are REMANDED for the following actions: 1. Obtain an opinion from an appropriate clinician regarding the nature and cause of the Veteran's bilateral knee condition. If the clinician believes an in-person or telehealth examination is necessary, one should be scheduled. After reviewing the entire claims file, the examiner should answer the following: (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral knee condition had its onset during service, or was caused or aggravated by an in-service event, injury, or disease? The opinion must give full consideration to the Veteran's lay testimony, as well as buddy statements submitted in December 2013 and August 2015 which state that the Veteran began complaining and showing signs of knee pain during active service. The examiner's attention is also invited to the Veteran's complaints of knee pain as early as August 2012. The examination report must include a complete rationale for any opinion provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. A. MARSH II Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Kelsey Love, 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.