Citation Nr: 21013664 Decision Date: 03/10/21 Archive Date: 03/10/21 DOCKET NO. 17-19 817 DATE: March 10, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1989 to August 1992. This case is before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 Regional Office (RO) rating decision. In that rating decision, the RO denied entitlement to service connection for a left knee condition and right knee strain. The Veteran requested a Board hearing at the local Regional Office in the April 2017 substantive appeal (VA Form 9). However, she subsequently withdrew her request in April 2019. In December 2019, May 2020, and November 2020, the Board remanded the case to the RO for further development and adjudicative action. Unfortunately, the Board finds that another remand of this appeal is necessary prior to adjudicating the claim on appeal as there has not been substantial compliance with the directives in the May 2020 and November 2020 Board remands. The Veteran has as a matter of law the right to compliance with the remand orders. Stegall v. West, 11 Vet. App. 268 (1998); see also D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that substantial compliance, rather than strict compliance, with the Board’s remand directives is required). In this regard, the Board remanded the appeal in May 2020 and in November 2020 to obtain a medical opinion that addresses the lay statements from the Veteran of self-treatment of her bilateral knee disability since service. As noted in the November 2020 remand, the June 2020 VA examiner is not adequate, because it failed to acknowledge and address the Veteran’s statements that she self-treated her knee pain since service and therefore did not comply with the Board’s May 2020 remand directives. The AOJ obtained another VA medical opinion in December 2020. Unfortunately, the December 2020 physician also did not address and discuss the Veteran’s lay statements as to continuous symptoms of knee pain and self-treatment since service as requested in the November 2020. The matters are REMANDED for the following action: Obtain a medical opinion from an appropriate medical professional who has not previously participated in this case for an addendum opinion as to whether the Veteran’s bilateral knee disorders are related to active service. The claims file, including a copy of this Remand, must be made available to and be reviewed by the medical professional in conjunction with the examination. The medical report should reflect full consideration of the Veteran’s documented medical history and lay assertions. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The medical professional is asked to provide an opinion on whether the Veteran’s bilateral knee disorders documented in the claims file at any point pertinent to the current appeal (even if now asymptomatic or resolved) had its onset during active service, began within a year of discharge, or is otherwise at least in part related to active military service to include the documented in-service treatment of the bilateral knee. For the purpose of providing the opinion requested, please accept as valid the Veteran’s statements that she has experienced bilateral knee pain since service, and state whether a nexus between the Veteran’s bilateral knee disability and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the medical professional to accept the history she provided, the Board is not at this time assessing the credibility of her statements). The medical professional must also consider whether the Veteran’s bilateral knee disorders have continuity of the same symptomatology since discharge from service. To this end, the addendum opinion should acknowledge and address the Veteran’s lay statements regarding self-treatment of her symptoms and pain since service - to include her use of crutches during flare-ups. In offering any opinion, the medical professional should consider medical and lay evidence dated both prior to and since the filing of the claim (September 2011) including but not limited to the November 2017 private treatment records, the January 2015 VA treatment records, the February 2020 VA examination, and the September 2020 correspondence. The medical professional should consider the Veteran’s contention that although she never met the weight requirement, she had low body fat and was in great shape and yet she still experienced problems with her knees. Notably, the absence of documented evidence of associated symptoms during and shortly after service should not, alone, serve as the sole basis for a negative opinion. The medical professional also may not dismiss the Veteran’s complaints of post-service symptoms solely because they are not documented in post-service medical treatment records. The examiner is reminded that a failure to note and discuss the Veteran’s lay statements and contentions regarding pain and symptomatology that has been chronic and continuous since service will not constitute an adequate medical opinion. In this regard, the medical professional is advised that the Veteran is competent to report his symptoms and history, and such reports must be specifically be acknowledged and considered in formulating opinions. If lay assertions in any regard are discounted, the medical professional should clearly so state, and explain why. MARTIN B. PETERS Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Berry, 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.