Citation Nr: 21013475 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 16-53 214 DATE: March 9, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to a left ankle disability, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1961 to August 1967. This matter is before the Board of Veterans’ Appeals (Board) on appeal from November 2015 and August 2017 rating decisions. The Veteran testified before the undersigned during a January 2019 hearing. The Board remanded this matter in June 2020. It is now returned to the Board for additional development. In a January 2021 rating decision, the Agency of Original Jurisdiction (AOJ) assigned a 30 percent rating, effective October 2016, for the Veteran’s bilateral hearing loss. In a February 2021 correspondence, the Veteran indicated he was satisfied with the 30 percent rating for his bilateral hearing loss and no longer wished to pursue his appeal for a higher rating for hearing loss. He stated that he only wished to continue his claim of service connection for a left knee disability. Therefore, the issue of an increased rating for bilateral hearing loss is no longer in appellate status and is not before the Board at this time. This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). In June 2020, the Board remanded this matter to obtain a new medical nexus opinion. In July 2020, a VA examiner provided a negative nexus opinion. The examiner noted that although the Veteran had knee complaints in October 1962, reporting his knee had bothered him for six months, there is no further mention of knee problems while the Veteran served on active duty and the Veteran’s left knee degenerative joint disease (DJD) is more likely due to his aging and not the Veteran’s in-service knee injury. The July 2020 opinion is inadequate to adjudicate the Veteran’s claim. The examiner noted DJD is due to chronic inflammation with erosion of cartilage lining the articular surfaces between joints and that prior injuries do increase the risk of developing DJD. However, the examiner did not explain why the Veteran’s DJD was more likely due to aging and not the Veteran’s in-service knee injury. Therefore, this opinion is inadequate, and a remand is necessary to obtain a new opinion that provides a reasoned rationale in support of its conclusion. See Barr v. Nicholson, 21 Vet. App. 303, 311; see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). The Veteran reported in February 2021 correspondence that although he did not seek continued medical attention for his left knee in service, he did continue to have left knee symptoms. He reported he did not seek treatment because his left knee pain did not interfere with his ability to perform his duties. Accordingly, a new opinion is necessary to address the Veteran’s competent allegations of continued left knee pain as the July 2020 negative opinion is based in part on the premise that the Veteran did not have continued knee complaints in service after the documented complaints in 1962. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) The Veteran has also raised the theory of secondary service connection. The Veteran is service connected for a left ankle condition that was treated with a cast. The Veteran contends that wearing the cast and walking up and down ladders between decks in service strained his left knee, which caused or aggravated his present left knee disability. As there is no medical opinion of record that addresses a secondary service connection theory of entitlement, a new examination is necessary. See Robinson v. Shinseki, 557 F.3d 1355, 1361 (Fed. Cir. 2009). Furthermore, VA's duty to assist requires reasonable efforts to ensure all relevant treatment records have been obtained and associated with the claims file. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159 (c); see also Sullivan v. McDonald, 815 F.3d 786 (Fed. Cir. 2016). In the February 2021 correspondence, the Veteran indicated he sought treatment from a private orthopedist for his left knee disability. There is no indication VA has attempted to obtain these records. Accordingly, VA must attempt to obtain these treatment record as they are relevant to the Veteran's claims. Id. The matter is REMANDED for the following action: 1. First, ask the Veteran to complete a VA Form 21-4142 for any private treatment provider or other medical care provider or medical facility which may have records related to the Veteran’s left knee disability. Make two requests for the records unless it is clear after the first request that a second request would be futile. 2. Obtain an opinion regarding the etiology of the Veteran’s left knee disability. Schedule the Veteran for an examination only if deemed necessary by the clinician selected to provide the opinion. The examiner must opine whether any left knee condition diagnosed is at least as likely as not related to an in-service injury, event, or disease, to include the documented left knee complaints in the Veteran’s STRs. The examiner must provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. The examiner may not dismiss the Veteran’s competent reports of continued left knee symptoms solely on the basis that they are not documented in contemporaneous medical records and must specifically consider the Veteran’s February 2021 statement that he did not seek treatment in service for his continued left knee symptoms because they did not interfere with his ability to perform his duties. If the Veteran’s current left knee disability is not found to be at least as likely as not directly related to military service, then the examiner must also opine whether any left knee disability is at least as likely as not (1) proximately due to any service-connected left ankle disability, or (2) aggravated beyond its natural progression by any service-connected left ankle disability. In responding to this request, the examiner must specifically address the Veteran’s contention that wearing an ankle cast in service and climbing up and down ladders between decks strained his left knee, either causing or aggravating the left knee disability. Aggravation and causation are distinct theories and must be addressed separately and independently of each other. If aggravation is found the examiner must attempt to establish a baseline level of severity of any left knee disability prior to aggravation by the service-connected left ankle disability. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zachery S.C. Luce, 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.