Citation Nr: 21009913 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-24 373A DATE: February 23, 2021 REMANDED Entitlement to service connection for bilateral knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1978 to August 1978. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision. In June 2018 and February 2020, the Board remanded this matter for further development. 1. Entitlement to service connection for bilateral knee disability is remanded. In February 2020, the Board remanded this matter to obtain a VA medical opinion regarding whether the Veteran’s current bilateral knee disability began in service or is related to service. In August 2020, a VA medical opinion provider opined that it is not at least as likely as not that the Veteran’s bilateral knee disability began in service or is otherwise related to service. The opinion provider explained that no objective evidence of diagnosis or treatment for bilateral knee degenerative joint disease was documented on the Veteran’s service treatment records. However, the opinion provider failed to address the Veteran’s July 1978 knee complaints in his report of medical history at the time of separation from service. In September 2020, a VA medical opinion provider opined that the Veteran’s bilateral knee disability is less likely as not related to service. The opinion provider explained that degenerative arthritis is a condition of the aging process. The opinion provider further explained that the Veteran’s knee pain in service can be attributed to many other factors and that it was self-resolving since there was no continuity or residuals until years later. However, the opinion provider did not adequately address the Veteran’s reports that he has had knee pain since service which became progressively worse and that he self-treated with aspirin and massage until eventually seeking treatment. The opinion is also incomplete as it states that the Veteran’s in-service knee pain can be attributed to other factors but does not list or discuss those factors. Accordingly, remand is warranted to obtain additional VA medical opinion. See Stegall v. West, 11 Vet. App. 268 (1998). In a February 2020 statement, the Veteran reported that he resides in a nursing facility. While this matter is on remand, any outstanding treatment records should be obtained, including any relevant records from the nursing facility and any outstanding VA treatment records. The matters are REMANDED for the following action: 1. After securing any necessary authorization, obtain any private treatment records as the Veteran may identify relevant to his claims, including any treatment records from The Rehab Center of Winter Park. If the Veteran provides a signed authorization form, make two requests for the authorized records unless it is clear after the first request that a second request would be futile. 2. Obtain any additional VA treatment records, to include VA treatment records from October 2019 to the present. 3. After outstanding records are obtained to the extent possible, ask the appropriate examiner to review the Veteran’s file. The necessity of an examination (preferably by videoconference) is left to the discretion of the examiner. The examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral knee disability: (a) had an onset in service; or (b) is otherwise related to service. The examiner should consider all medical and lay evidence of record, including the Veteran’s July 1978 complaints of knee swelling and pain in his report of medical history at the time of separation from service, his reports that his knees buckled and he fell onto concrete several times during basic training, his reports that he has had chronic knee pain since service which progressively worsened, his reports that he self-treated his knee pain with aspirin and massage, and the January 2012 notation from the Veteran’s VA treater that it is as likely as not that the Veteran’s knee arthritis may have resulted from service. If the Veteran’s reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). (Continued on the next page)   The examiner is asked to explain the reasons behind any opinions expressed. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Purcell, 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.