Citation Nr: 21007534 Decision Date: 02/09/21 Archive Date: 02/09/21 DOCKET NO. 15-08 937 DATE: February 9, 2021 REMANDED Entitlement to a rating in excess of 10 percent for Osgood-Schlatter’s disease of the right knee is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 2002 to September 2003. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. The Board issued remands in June 2018 and February 2020. The RO issued a September 2020 supplemental statement of case (SSOC) and returned the case to the Board for adjudication. 1. Entitlement to a rating in excess of 10 percent for Osgood-Schlatter’s disease of the right knee is remanded. Although the Board is aware this case has been on appeal since February 2015 and additional delay is regrettable, an additional remand is necessary to allow the Board to make a fully informed decision regarding the Veteran’s claim. In the February 2020 remand, the Board indicated that the Veteran had recently undergone a right knee arthroscopy and partial medial and lateral meniscectomies since his last examination in June 2019. The Board stated that these procedures suggested that the Veteran’s right knee disability has worsened, and a new examination is needed to properly evaluate his disability. In a September 2020 VA examination, the examiner concluded that there was no change in the Veteran’s established diagnosis of Osgood-Schlatter’s disease and there were no additional diagnoses. However, in the sections regarding meniscal conditions and surgical procedures, the examiner indicated the Veteran did not have any history of a meniscus condition or a history of surgical procedures despite the reason for the remand was due to the Veteran’s recent meniscus tear and subsequent arthroscopic meniscotomy surgery. Therefore, as the medical examination does not substantially comply with the February 2020 remand directives, the Board finds the opinion inadequate. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding veterans are entitled to compliance with Board remand instructions). Further, in a November 2019 rating decision, the Veteran was service-connected for right knee instability as an additional disability. Moreover, a June 2019 VA examination report indicates that the meniscus disorder for which the Veteran had surgery was not related to or a manifestation of his service-connected disability. In rating disabilities, VA is precluded from differentiating between symptomatology attributed to a nonservice-connected disability and a service-connected disability in the absence of medical evidence that does so. See Mittleider v. West, 11 Vet. App. 181, 182 (1998). The September 2020 VA examination report does not clearly distinguish symptoms associated with each of his right knee disabilities. Accordingly, the Board finds remand for an additional medical examination to determine the current severity of the Veteran’s Osgood-Schlatter’s disease is required. In addition, the examination should clarify, to the extent possible, his disabilities associated with service-connected Osgood-Schlatter’s disease and his right knee instability, as opposed to his other knee disorders. The matter is REMANDED for the following action: 1. Schedule the Veteran for a new VA examination with an appropriate medical professional to determine the current severity of his right knee Osgood-Schlatter’s disease. Any indicated evaluations, studies, and tests deemed necessary by the examiner should be completed. The examiner must also review the entire claims file, including the Veteran’s VA medical treatment records, specifically regarding the Veteran’s right knee arthroscopy and partial medial and lateral meniscectomies. The examiner should distinguish between manifestations related to the Veteran’s service-connected Osgood-Schlatter’s disease and right knee instability from manifestations related to his nonservice-connected knee disabilities. If the symptoms cannot be distinguished, the examiner should so state. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. A rationale for all opinions expressed should be provided as the Board is precluded from making medical findings. A discussion of the facts and the medical principles (Continued on the next page)   involved will be of considerable assistance to the Board, including citation to any supporting medical treatises. J. B. FREEMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Aubee, 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.