Citation Nr: 21011692 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 17-07 552 DATE: March 2, 2021 ISSUES Entitlement to service connection for left knee joint osteoarthritis (claimed as left knee injury). Entitlement to service connection for right knee injury. REMANDED Entitlement to service connection for left knee joint osteoarthritis (claimed as left knee injury) is remanded. Entitlement to service connection for right knee injury is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1984 to June 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021 the Veteran testified before the undersigned Veterans Law Judge in a video teleconference hearing. A transcript of the testimony offered at the hearing has been associated with the record. The Board finds that additional evidentiary development is required before the claim on appeal is adjudicated. 1. Entitlement to service connection for left knee joint osteoarthritis (claimed as left knee injury) is remanded. The Veteran contends that his left knee osteoarthritis is related to his active service due to injuries that he sustained while playing basketball while in service. The Board first notes that the record contains an August 2015 letter from Dr. C.C. who is a private orthopedic surgeon. Dr. C.C. notes a diagnosis of bilateral advanced degenerative joint disease of the knees. Dr. C.C. noted that the Veteran was a tanker and a basketball player while in the military. She stated that the Veteran had post-traumatic arthritis of the knees which has worsened over the years. She also stated that the Veteran was scheduled for a right knee replacement in October 2015. In offering this opinion the examiner provided a conclusionary statement with no rationale. The examination failed to provide not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Therefore, the Board finds the August 2015 private examiner’s opinion to be inadequate for adjudication purposes. The Veteran was afforded a VA examination for his left knee in May 2015. The examiner noted a diagnosis of left knee osteoarthritis. At that time the examiner opined that the Veteran’s left knee disability was less likely than not related to his active duty service. At a January 2021 Board hearing the Veteran credibly testified that while in service he injured his knees while playing basketball for the post team. He stated that at every post that he was stationed at he “twisted and jammed a knee” and this happened about nine or ten times. The Board notes that the Veteran’s service treatment records reflect several documented complaints of pain in his knees while in service. The Veteran also stated that since service he has not played basketball and has not had any strain on his knees similar to what he experienced during service. The Board finds that based on this testimony an additional opinion should be requested. The Board notes that at the time that the May 2015 VA examiner provided a negative opinion he did not have available for consideration the January 2021 testimony of the Veteran about the specific injuries that he suffered while in service to determine whether there may be a nexus between these in-service events and the Veteran’s current disability. Once VA undertakes the effort to provide an examination when developing a claim, the exam must be an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). And VA must consider all lay and medical evidence of record. 38 U.S.C. § 1154 (a); 38 U.S.C. § 5107; 38 C.F.R. § 3.303. Accordingly, the Board finds a remand is necessary so that an adequate opinion on service connection for the Veteran’s left knee osteoarthritis can be obtained. 2. Entitlement to service connection for right knee injury is remanded. The Veteran contends that his right knee injury is related to the above described injuries that he sustained while playing basketball in service. The Board notes that the Veteran has not been provided with a VA examination for his right knee injury nor has he been provided with a medical opinion to address the issue of etiology. VA must provide a medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service, or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran's service or with another service-connected disability, but (4) there is insufficient competent medical evidence on file for the Secretary to make a decision on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also 38 U.S.C. § 5103A (d)(2), 38 C.F.R. § 3.159 (c)(4)(i) (2017). The third prong, which requires that the evidence of record "indicate" that the claimed disability or symptoms "may be" associated with the established event, is a low threshold. McLendon, 20 Vet. App. at 83. Here, the Board finds that the McLendon criteria have been satisfied. Specifically, as discussed above there is competent evidence that the Veteran has a right knee disability which may be associated with his active service, including injuries sustained while playing basketball, but there is insufficient competent medical evidence on file for the Board to make a decision on the claim. As such, remand for an examination and medical opinion is necessary. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records regarding the Veteran's treatment for his service-connected right and left knee disabilities. 2. Schedule the Veteran for a new VA examination (or telehealth interview(s), review(s) of the record, etc., if an in-person examination(s) is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran's claimed left and right knee disabilities. The claims folder and this remand must be made available to the examiner for review, and the examination report must reflect that such a review was undertaken. After performing any/all necessary testing, the examiner should provide responses to the following questions: (a) Whether it is at least as likely as not (50 percent or greater likelihood) that the Veteran's left knee joint osteoarthritis had its onset in service or is otherwise related to service. (b) Whether it is at least as likely as not (50 percent or greater likelihood) that the Veteran's right knee disability had its onset in service or is otherwise related to service. When considering these questions, the examiner should consider all lay statements of record carefully, VA treatment records and private treatment records. The examiner is asked to consider and address the Veteran’s contention that he sustained injuries to both of his knees while playing basketball while in service. The examiner should view the Veteran as a reliable historian as to his service and his report of his activities in service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007). The examiner is also asked to consider and discuss the August 2015 medical opinion from Dr. C.C. which attributed the Veteran’s bilateral advanced degenerative joint disease of the knees to his military service. A detailed rationale must be provided for any opinion offered. (Continued on next page.) 3. Thereafter, readjudicate the issues on appeal. If the determination remains unfavorable to the Veteran, he and his representative should be furnished a supplemental statement of the case which addresses all evidence associated with the claims file since the last statement of the case. The Veteran and his representative should be afforded the applicable time period in which to respond. Michael A. Pappas Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Nettey, 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.