Citation Nr: 21074511 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 18-29 676 DATE: December 15, 2021 REMANDED Entitlement to service connection for right knee disability is remanded. Entitlement to service connection for left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1994 to August 1998. The Veteran testified at a hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing has been associated with the record. 1. Entitlement to service connection for right knee disability. 2. Entitlement to service connection for left knee disability. The Veteran contends that his right knee disability had its onset, or is otherwise related to, his service. He claims that his left knee disability is either directly related to service, or secondary to his right knee disability. The claims are remanded to obtain a medical opinion. The September 2016 VA examination includes a negative nexus opinion, but the rationale for that opinion is inadequate. The examiner related the Veteran's currently diagnosed right knee disability to a post-service injury but did not explain why the complaints noted in service are not a likely cause. The premise of the negative opinion is also inaccurate as the examiner said there was no evidence the Veteran suffered a right leg laceration in service; that injury is documented in the service treatment records. The negative opinion for the left knee is also inadequate because the examiner concluded that the Veteran's left knee disability is "subjective" only. The examination on remand must address whether the Veteran's reported pain alone may constitute disability, even without an identifiable underlying pathology. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The opinion is further inadequate because the examiner improperly based it on a lack of documented treatment for the left knee; the examiner did not consider the Veteran's competent report of ongoing symptoms and did not address whether the left knee was aggravated by the right knee. The matters are REMANDED for the following action: 1. Take all appropriate action to obtain any outstanding VA treatment records and associate with the record. 2. After completion of the above, schedule the Veteran for an examination with an appropriate clinician to determine the nature and likely etiology of any left and right knee disability. Copies of all pertinent records must be made available to the examiner. The examiner is asked to answer the following: (a) Identify all diagnosed disabilities affecting either knee. (b) For each diagnosed knee disability, it is at least as likely as not related to an in-service injury, event, or disease? The examiner must specifically consider (i) the documented right knee injury in service that included a leg laceration and (ii) the March 4, 1998 service treatment record for the left knee. (c) If no specific knee disability is diagnosed, the examiner must consider whether any pain in either knee results in functional impairment of earning capacity. For any identified functional impairment of either knee, the examiner must opinion whether it is at least as likely as not related to an in-service injury event, or disease. (d) Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed left knee disability, or identified functional impairment, has been (i) caused by or (ii) aggravated by the Veteran's right knee disability? Aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. The examiner must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. If an opinion cannot be provided, the examiner should indicate why. 3. Confirm that the VA medical opinion provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin 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.