Citation Nr: 21010388 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 14-28 457 DATE: February 24, 2021 REMANDED Service connection for left knee arthritis is remanded. REASONS FOR REMAND The Veteran serviced on active duty from September 1975 to April 1989 and from July 2006 to December 2007. This matter is before the Board of Veterans’ Appeals (the Board) on appeal from the March 2013 Department of Veterans Affairs (VA) Regional Office (RO) rating decision. The rating decision, inter alia, denied service connection for left knee arthritis because the evidence submitted was not new and material. The Veteran’s Notice of Disagreement (NOD) was received in November 2013. The Statement of the Case was issued in June 2014 and the Veteran’s VA Form 9, substantive appeal to the Board was received in August 2014. In April 2018 the Board reopened the claim and remanded it for further development and adjudication. Entitlement to service connection for left knee arthritis is remanded. The Veteran seeks service connection for left knee arthritis. A March 2006 private treatment note indicates that the Veteran was diagnosed with left knee osteoarthritis pursuant to a February 2004 x-ray. An April 2006 service treatment note from the Veteran’s state National Guard service indicates that he suffered a fall and injured his left knee and heel. The Veteran’s second tour of duty began in July 2006 and his service treatment records (STRs) do not contain an entrance medical examination. A September 2006 service treatment note from the Veteran’s second period of active duty indicates that he was diagnosed with bilateral knee tendonitis. The remainder of the STRs indicate that he complained of bilateral knee pain and was placed on a permanent profile. In January 2013, the Veteran underwent a VA examination for his right knee disability. During the examination, the Veteran reported bilateral knee pain. He contended that his left knee pain is related to favoring his right knee disability. Of note, an October 2020 rating decision granted service connection for degenerative joint disease, right knee and right knee strain (claimed as right knee injury). The VA produced two nexus opinions in this matter, namely in August 2019 and September 2020. The August 2019 VA medical opinion indicates that the Veteran’s left knee arthritis clearly and unmistakably existed prior ot service and was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury. The VA examiner indicated that in a review of the Veteran’s service medical records, no information was found regarding the left knee and that there is no information found to support that the Veteran’s left knee disability was aggravated beyond its natural progression during service. The September 2020 VA medical opinion concludes that the Veteran’s left knee arthritis was less likely than not incurred in or caused by the Veteran’s service, indicating that the Veteran’s knee disability was diagnosed prior to the second period of active service in July 2006 with no aggravation shown. Based on the above, a remand is necessary to obtain an addendum medical opinion. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Kowalski v. Nicholson, 19 Vet. App. 171, 179 (2005) (a VA examination must be based on an accurate factual premise). The aforementioned VA medical opinions are incomplete, as they do not address the September 2006 in-service diagnosis of bilateral knee tendonitis as well as the recorded in-service complaints of left knee pain during the second period of active duty. This evidence may suggest that the Veteran’s left knee disability was aggravated during his second period of active duty. Moreover, an addendum VA medical opinion is necessary to address whether the Veteran’s left knee arthritis is due to or aggravated by his now service-connected right knee disability. Thus, the matter is remanded for an addendum medical opinion on the issues of aggravation and secondary service connection. This matter is REMANDED for the following action: Obtain an addendum medical opinion on the issue of service connection for left knee arthritis. The need for further physical examination of the Veteran is to the discretion of the VA examiner providing the medical opinion. The claims file, including a copy of this remand must be made available to the examiner for review, and the examiner should indicate that the claims folder was reviewed in connection with providing the opinion. The VA examiner is requested to provide an opinion with respect to the following: (a.) Whether the Veteran’s left knee disability clearly and unmistakably preexisted his second period of active duty, and (b.) If so, whether the preexisting left knee disability was clearly and unmistakably aggravated beyond its natural progression by the Veteran’s second period of active duty. In providing this opinion, the VA examiner is requested to address the September 2006 in-service diagnosis of bilateral knee tendonitis and the subsequent complaints of bilateral knee pain, as well as the Veteran being placed on permanent physical profile. (c.) Whether it is at least as likely as not that the Veteran’s left knee disability has been caused or aggravated beyond its normal course of progression by the service-connected right knee disability, to include by way of gait alteration. In providing this opinion, the VA examiner is requested to address the Veteran’s contentions made during the January 2013 VA examination that his left knee pain is caused by him favoring his right knee. This opinion must explicitly address both causation and aggravation to be deemed adequate. The examiner is advised aggravation means the service-connected disability caused an increase in the severity of an existing nonservice connected disability. If aggravation is found, the examiner must attempt to establish the baseline level of severity prior to aggravation by the service-connected disability. Z. SAHRAIE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Kuksova, Kseniya 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.