Citation Nr: 21009563 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 20-14 380 DATE: February 22, 2021 REMANDED The issue of service connection for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1977 to March 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2020, the Board remanded the issue on appeal for further development. As will be discussed below, a review of the record reflects that the Agency of Original Jurisdiction (AOJ) failed to substantially comply with the August 2020 Board’s Remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The issue of service connection for a left knee disorder. The Veteran contends that left knee pain began during service in 1984 and has consistently worsened since discharge from service. He also alleges that left knee pain is secondary to service-connected hypertension in that in-service hypertension prescriptions of HCTZ and Dyazide caused joint pain in his left knee. See VA examinations dated February 2018 and December 2020. Service treatment records (STRs) indicate the Veteran was prescribed 50 mg of HCTZ in 1982 to manage hypertension. In May 1988, the Veteran’s prescription changed from HCTZ to Dyazide. In March 1989, the Veteran’s complained of knee pain for over two weeks, was placed on limited duty for two months, and chondromalacia was assumed. The February 1989 separation examination indicated the Veteran was still taking prescribed Dyazide for hypertension. See STRs dated October 1982, February 1983, May 1988, February 1989, and March 1989. Post-service treatment records indicate complaints of joint pain in the knees, knee injections to address knee pain, and the continuation of prescribed HCTZ even though it caused a reaction of muscle/joint pain. On August 23, 2011, the Veteran’s private physician discontinued HCTZ noting an allergic side effect of muscle/joint pain. See Private treatment records dated February 2010, August 2011, September 2014, and September 2020. In the August 2020 Board decision, the Board requested that the VA examiner specifically address the Veteran’s contentions of continuity of left knee pain and the in-service diagnosis of chondromalacia. The December 2020 VA examiner failed to specifically address any of the aforementioned issues. The Board, accordingly, finds that an addendum opinion is necessary. See December 2020, VA examination; see also Stegall, 11 Vet App. at 217; Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (a medical opinion is inadequate if it does not take into account the Veteran’s reports of symptoms and history). The Board notes that the Veteran receives private treatment for his knees from Sentara Norfolk General Hospital, Sentara Internal Medicine Physicians, and Hampton Roads Orthopedic Sports Medicine. On remand, any previously unobtained ongoing relevant medical records should be procured and associated with the Veteran’s claims file. The matter is REMANDED for the following action: 1. With any assistance required from the Veteran, request updated treatment records from Sentara Norfolk General Hospital (since September 2020), Sentara Internal Medicine Physicians (from 2009 to present), and Hampton Roads Orthopedic Sports Medicine (since September 2019), and associate them with the claims file. 2. After completing directives #1, obtain an addendum opinion for the December 2020 VA examination from the original VA examiner to determine the nature and etiology of a left knee disorder. If the original VA examiner is unavailable, a new examiner may be assigned. Examination of the Veteran is not necessary unless it is necessary to provide a reliable opinion. The examiner should review the virtual file and address the following: (a.) Whether it is at least as likely as not (50 percent or greater probability) that a left knee disorder manifested during or is otherwise related to the Veteran’s period of active service, to include ongoing symptoms of left knee pain since discharge from service, an in-service diagnosis of chondromalacia, in-service complaints of knee pain for two weeks, and in-service prescription of Dyazide and HCTZ since 1982. See December 2020, VA examination; STRs dated STRs dated October 1982, February 1983, May 1988, February 1989, and March 1989. (b.) Whether it is at least as likely as not (50 percent or greater probability) that a current left knee disorder, to include left knee pain, is proximately due to or the result of a service-connected disability, to include service-connected hypertension. (c.) Whether it is at least as likely as not (50 percent or greater probability) that a current left knee disorder was aggravated by (i.e., worsened beyond the normal progression of that disease) a service-connected disability, to include service-connected hypertension. In responding to (b) and (c), the VA examiner should consider and address the following: (i) the Veteran started taking HCTZ in 1982 and switched to Dyazide in 1988 to treat hypertension during service; (ii) the Veteran reported onset of left knee pain in 1984 that has continued to worsen since discharge from service; (iii) the Veteran continued taking HCTZ until August 23, 2011, when the Veteran’s private treating physician discontinued the prescription because it caused an adverse reaction of joint/muscle pain. See VA examinations dated February 2018 and December 2020; Private treatment records dated February 2010, August 2011, September 2014, and September 2020; STR dated October 1982, February 1983, May 1988, February 1989, and March 1989. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinions. If the examiner rejects the Veteran’s reports of symptomatology, he or she must provide a reason for doing so. A comprehensive rationale for all opinions must be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner (does not have the knowledge or training). JAMES L. MARCH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Straughn, 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.