Citation Nr: 21075367 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 16-27 496A DATE: December 20, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran had active service from August 1965 to September 1968. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision of the VA Regional Office (RO). In June 2017, the Veteran testified at a hearing before a VA Decision Review Officer. A transcript of the hearing has been reviewed and associated with the record. This case was previously remanded in February 2019, August 2020, and March 2021. 1. Entitlement to service connection for a right knee disability is remanded. The Veteran contends that he sustained a knee injury in service. In March 2012 correspondence, the Veteran stated that he fell down a ladder while going to general quarter and fell to the deck, injuring the knee cap. The Veteran's August 1965 enlistment examination shows that he reported a history of a car accident. He reported that he did not break anything but had bruising on the knees. The examination noted "instability both knees." In an October 1968 claim, the Veteran stated that he had swollen knees in the spring of 1962. He asserted that his condition was aggravated in service. Private records dated in January 2007 reflect that the Veteran underwent arthroscopic surgery with debridement, chondroplasty, and partial medial meniscectomy. At a June 2017 RO hearing, the Veteran testified that he was a boatswain's mate, which involved a lot of grinding decks and painting decks. He testified that he slipped on a ladder and hit his knee. The Veteran testified that he continued to have problems with his knee after service. The Veteran had a VA examination in November 2020. The examiner opined that the claimed condition was less likely than not related to service. The examiner's rationale was that the right knee injury during service was acute only. The examiner explained that there was no evidence of chronicity of care, and the symptoms are subjective only. The Board found the November 2020 opinion to be inadequate because the examiner relied on the absence of medical evidence and did not discuss whether the Veteran had degenerative arthritis. The Board remanded the claim for a new medical examination. The Veteran had a VA examination in April 2021. The examiner opined that it is less likely than not that a right knee disability is related to service. However, the examiner concluded that it was possible that the Veteran's knee disability was related to falling off a ladder in service, and it would be mere speculation. Because the examiner did not explain why an opinion could not be provided without speculation, the April 2021 medical opinion is inadequate. In October 2021, an addendum opinion was completed. The examiner diagnosed s/p meniscal repair, right knee strain, and degenerative arthritis. The VA examiner opined that the right knee disability is less likely than not related to service. The examiner's rationale was that there was no chronicity of care on active duty, the exit examination was silent for right knee complaints, and there was no x-ray evidence of disruption of the joint during active duty. The examiner concluded that the DJD was most likely due to the aging process. The examiner stated that the lay statements of chronicity were not supported by objective evidence. The VA medical opinions of record did not address whether the pre-existing right knee instability, which was noted at enlistment, was aggravated during service. A remand is necessary to obtain an addendum opinion. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate examiner for an addendum opinion regarding the Veteran's right knee disability. It is left to the examiner's discretion whether to reexamine the Veteran. The examiner must address the following: (a) Is it clear and unmistakable that the Veteran's pre-existing right knee instability WAS NOT aggravated beyond the natural progress of the disorder by his active military service? In other words, please determine whether it is clear and unmistakable that there was no increase in the right knee disability during service or that it is clear and unmistakable that any increase in disability was due to the natural progress of the pre-existing condition. (b) The examiner must opine as to whether his current diagnoses of right knee status post meniscal repair, degenerative arthritis, and right knee strain are at least as likely as not related to service, including slipping and falling from a ladder and working on the deck as a boatswain's mate. The examiner must consider the Veteran's lay statements about his service duties and his problems with his knee since service. In providing the requested opinions, the examiner cannot rely exclusively on the absence of treatment in the Veteran's medical history (c) Provide a detailed rationale for the opinions. K. R. Laffitte Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Catherine Cykowski 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.