Citation Nr: 21076043 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 16-22 679 DATE: December 22, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1988 to May 1988. He has additional service in the Army Reserves, the Army National Guard, the Air Force National Guard, and the Air Force Reserves. This matter is before the Board of Veterans' Appeals (Board) on appeal of a March 2015 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). In July 2019, the Veteran testified at a hearing before the undersigned. In February 2020 and March 2021, the Board remanded the claim for additional development. Regrettably, the Board finds a remand is required to ensure a complete record upon which to decide the Veteran's appeal. 1. Right knee disability The Veteran seeks service connection for a right knee disability. Specifically, the Veteran testified that he injured his right knee in March 2000 while participating in a training run during a period of weekend reserve service. Service treatment records include a document labeled "DD Form 1380" and "U.S. Field Medical Card." This card reflects a right knee injury on Sunday, March 5, 2000, and documents confirming the Veteran's participation in Inactive Duty Training (INACDUTRA) on March 5, 2000 are also included in the claims file. As noted in the Board's March 2021 remand, the findings of the September 2020 VA examination were deemed inadequate due to the fact the examiner dismissed the Veteran's reports of a March 2000 fall, with continuing knee pain, based on the lack of contemporaneous medical records. The Board noted that file included a March 2000 "U.S. Field Medical Card," indicating a March 5, 2000 right knee injury. In the March 2021 remand, the Board requested additional private treatment records and Social Security Administration (SSA) records be obtained and associated with the claims file. These records indicate on-going treatment pertaining to the right knee during the appeals period, to include a meniscectomy of the right knee in 2013, and a total right knee replacement in 2021. The Board also directed a new VA examination and opinion be proffered to ascertain the etiology of the right knee disability. Following the August 2021 VA examination, an October 2021 opinion found that it was less likely than not the claimed condition was incurred in or caused by the claimed in-service event. As rationale, the VA examiner stated that the March 2000 in-service injury is not the cause of the current right knee arthritis. The examiner also concluded that the total right knee replacement was completed in 2021, more than 20 years after the right knee injury and, therefore, "it is less likely than not." The Board finds this opinion is inadequate for rating purposes as the examiner failed to provide sufficient rationale for his conclusory statements. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Specifically, while finding that the March 2000 in-service injury was not the cause of his current disability, an alternate injury or disease was not identified. Further, the Board finds that only citing to the passage of time between an injury and a surgical procedure on the same body part without identifying an intervening injury is not sufficient to break the chain of causation. Consequently, on remand, the RO must obtain an addendum opinion to determine whether the March 2000 in-service injury to the right knee is the type of injury that could lead to arthritis and, eventually, require surgical intervention. The matters are REMANDED for the following action: 1. Obtain any additional VA or private treatment records relevant to the current appeal not presently associated with the claims file. Document all requests for information as well as all responses in the claims file. 2. Then, obtain an addendum opinion from a different VA examiner than the author of the October 2021 medical opinion. The Board is not directing an in-person examination of the Veteran and the need for one is left up to the discretion of the RO. The examiner must review the claims file. The examiner is asked to provide a response to the following: (a.) Is any right knee disability at least as likely as not related to service, including a March 5, 2000 fall while running? Meaning, is any currently diagnosed right knee disability the type of disease that may be expected to occur given the in-service injury? The examiner must specifically discuss the March 2000 U.S. Field Medical Card included in the service treatment records in providing this opinion. (b.) Is it at least as likely as not that the any right knee arthritis (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiner must provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If the examiner rejects any report from the Veteran, a rationale for doing so must be provided. The absence of contemporaneous medical records, without additional explanation, is not a sufficient reason to dismiss these reports. M.N. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Berry, 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.