Citation Nr: 21075592 Decision Date: 12/21/21 Archive Date: 12/20/21 DOCKET NO. 16-42 548 DATE: December 21, 2021 REMANDED 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 on active duty in the Army from March 1985 to March 1989 and in the Army National Guard from November 1990 to July 1991 and from December 1991 to June 1992. This matter comes before the Board of Veteran's Appeal (Board) on appeal from an April 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran selected a hearing with a Veterans Law Judge on his December 2017 VA Form 9. In March 2019, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. By way of background, the Board previously remanded this claim in August 2019, February 2021, and July 2021, for further development. Entitlement to service connection for the Veteran's right and left disabilities. As stated above, this matter was previously remanded in July 2021 for further development to include a VA addendum opinion. The case has now returned to the Board for appellate review and, although it again regrets further delay, the Board finds that additional remand is required. After reviewing the evidence of record, the Board that there has not been substantial compliance with the Board's prior remand directives. Accordingly, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). When VA undertakes to provide an examination for a claim for service connection, even if not statutorily obliged to do so, it must provide an adequate one or, at minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303 (2007). In order to be adequate, medical opinions must support their conclusions with an analysis or rationale the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran was most recently afforded an addendum opinion in support of his claim for service connection for joint pain, to include leg pain, in October 2021. In the Board's July 2021 remand, the examiner was asked to opine as to whether the Veteran's current disabilities either (1) had their clinical onset in service, to include consideration of his in-service complaints of joint pain and body aches, (2) represented a progression of an earlier (in-service) condition, or (3) were noted in service under a different diagnosis or assessment. Here, the October 2021 examiner opined that the Veteran's bilateral knee disabilities were not related to service because there was no objective evidence that any complaints of generalized joint pains included bilateral knee pain. In support of this finding, the examiner stated that these non-specific joint pains cannot be interpreted as being related to his current knee pain without resorting to mere speculation. However, the Board notes that this opinion conflicts with the December 2019 VA examiner's finding that the Veteran's reports of migratory pain were associated with arthritic pain and his joint pain included right leg pain. See December 2019 VA Medical Opinion. Based on this examiner's finding, the Board finds that the October 2021 VA medical opinion is inadequate because the examiner did not consider all relevant evidence of record. See, Dalton v. Nicholson, 21 Vet. App. 23 (2007). As the Board has previously noted, the fact that the Veteran's knee disabilities were not noted as such in service is the premise of the questions put to the examiner. As the case currently stands and in light of the December 2019 VA examiner's finding regarding the Veteran's complaints of joint pain and migratory pain, the Board requires a medical opinion to attempt to estimate the approximate onset date of the Veteran's right knee osteoarthritis. Accordingly, the Board finds that an addendum opinion is warranted. The VA examiner should address whether the Veteran's knee disabilities had their clinical onset in service. Barr v. Nicholson, 21 Vet. App. 303 (2007). In ordering a remand in the instant case, the Board is not making a preliminary formal finding as to the credibility of the Veteran's lay reports. Rather, the Board is merely requesting that the examiner on remand consider the Veteran's own descriptions of the history of his knee disabilities. See Smith v. Wilkie, 32 Vet. App. 332, 338-39 (2020). The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. After completing the development outlined in Item 1., the RO should send the claims file to an appropriate VA examiner, who has not previously participated in this case, for a medical opinion for a medical nexus opinion in support of his claims for service connection for right and left knee disabilities. Upon thorough review of the claims file and physical 3. Is it at least as likely as not that the Veteran's right and left knee disabilities had their onset in or are otherwise related to his active-duty service? 4. Please to attempt to estimate the approximate date of onset of the Veteran's right knee osteoarthritis. In providing the requested response in Parts (a) and (b), please consider the December 2019 VA examiner's findings that Veteran's report of migrating pain is arthritis pain and his joint pain, included right knee pain. See STRs dated December 1988 (body aches), February 1988 (body aches); February 1989 (leg cramps and joint pain); December 2019 VA Medical Opinion. 5. In particular, please state whether: (1) any current knee condition may represent a progression of the Veteran's in-service joint complaints; (2) any current knee condition may have been noted under a different assessment or diagnosis in service or earlier in the record; or (3) the Veteran's complaints of joint pain and body aches were manifestations of his current knee disabilities. PLEASE NOTE: the mere fact that knee complaints, diagnoses, or treatment were not noted in service does not show that a knee disability did not have its onset in service. A general complaint of "joint pain" is to be treated as right leg pain based on the December 2019 VA medical opinion. The Board's queries aim to discover whether that may be the case here. An opinion concluding that the Veteran's disabilities are not related to service on the grounds that the record is silent for in-service knee complaints, diagnoses, or treatment will be deemed inadequate. The examiner must provide a fully articulated medical rationale for each opinion, citing to peer-reviewed medical literature referenced in formulating it, if any. If the examiner finds that an opinion cannot be provided, this conclusion should also be clearly explained (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large and not the insufficient knowledge of the individual examiner). S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Foster, 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.