Citation Nr: 21075657 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 17-19 148 DATE: December 21, 2021 REMANDED Entitlement to service connection for left knee degenerative joint disease is remanded. REFERRED The issues of entitlement to service connection for right thumb and index finger numbness, swollen right foot, muscle and joint pain in back and knees, chronic fatigue, asthma, and swollen ankles were raised in a November 2021 VA Form 21-526EZ, and are referred to the Agency of Original Jurisdiction (AOJ) for adjudication. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1980 to September 1992. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision letter issued by the Department of Veterans Affairs (VA) Regional Office (RO). The matter last appeared before the Board in January 2019, at which time the issue was remanded to the RO to obtain an adequate addendum opinion. The Board also remanded the issue of entitlement to service connection for a respiratory disorder, which the Veteran had described as upper airway resistance syndrome and sleep apnea. Entitlement to service connection for obstructive sleep apnea was granted in a July 2020 rating decision. The Board finds this to be a full grant of the benefit requested, and the issue is no longer part of the current appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Regarding the claim for service connection for a left knee disability, the Board finds such addendum opinion is also inadequate and remands the issue to the RO to obtain an adequate opinion. The Board further notes that as updated VA medical center (VAMC) records have been associated with the claims file since the July 2020 supplemental statement of the case (SSOC), remand will also afford the RO the opportunity to review the updated records. Entitlement to service connection for left knee degenerative joint disease is remanded. In the January 2019 Board remand, the Board found the April 2013 knee examination opinion inadequate as the examiner's rationale appeared, without further clarification, to be contradictory, noting multiple in-service treatment for the condition but the condition to be not chronic. An addendum opinion was obtained in October 2019. The examiner did not provide a diagnosis of the condition but opined that the Veteran's claimed left knee degenerative joint disease condition less likely as not (50% or greater probability) had its onset or is otherwise etiologically related to active-duty service. The examiner rationalized that on October 21, 2019, the radiologist read the Veteran's left knee X-ray as joint spaces left knee are maintained, i.e., no radiographic evidence of the breakdown or loss of the cartilage of the left knee joint. The examiner cited medical literature and indicated that degenerative joint disease is caused used by breakdown and loss of cartilage of the joints. Then in July 2020, a separate examiner provided a diagnosis of left knee diagnosis of left meniscal degeneration/tibiofemoral and patellofemoral cartilage, loss but failed to provide an opinion as to this diagnosis. Hence, the Board finds the addendums are inadequate. Specifically, the April 2013 VA knee examination reported that imaging studies were performed, and degenerative or traumatic arthritis was present in both knees and moreover, a diagnosis of degenerative joint disease of the knees was provided. It is unclear as to whether the October 2019 examiner found no diagnosis of degenerative joint disease of the left knee. The October 2019 examiner's addendum opinion is in conflict with the April 2013 examination diagnosis. Furthermore, even absent the April 2013 examination report, the October 2019 addendum appears to opine as to evidence of whether degenerative joint disease is present but does not opine as to any otherwise diagnosed left knee condition while the July 2020 addendum provides no opinion as to the left meniscal degeneration/ tibiofemoral and patellofemoral cartilage loss diagnosis. Additionally, after such opinion was obtained, in November 2021, private treatment records associated with the claims file were translated. Notably, records associated with the claims file in February 2003 detail that the Veteran visited an orthopedic physician's office in October and November 1998 and was diagnosed with suspected ligament instability with hyperextension of both knee joint and chondropathia genu, more pronounced on the left than the right. The doctor further noted the Veteran's medical history of being a basketball player since 1985 and his left knee joint causing short lasting pain in the morning and when getting up after sitting for longer periods of time. The doctor also noted that the Veteran cannot remember having suffered a trauma. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran's claimed left knee degenerative joint disease. The claims file and a copy of this remand must be made available to the examiner and the examiner should note in the examination report that the claims older and the remand have been reviewed. The need for an additional examination of the Veteran is left to the discretion of the clinician selected to write the addendum opinion. Based on prior VA examination results and opinions, and a review of the record, the examiner should provide an opinion as to the following: a) What are the Veteran's current left knee diagnoses? If no current diagnosis is found, please discuss his past diagnoses of arthritis, meniscal degeneration, and cartilage loss. b) Is it as least as likely as not (50 percent probability or greater) that the Veteran's claimed left knee degenerative joint disease had its onset during service or within one year of service, or is it otherwise etiologically related to active duty service? Please explain why or why not, including consideration of the Veteran's lay statements. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must fully explain why. Mary E. Rude Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Alli, 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.