Citation Nr: 21015382 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 17-13 686 DATE: March 17, 2021 REMANDED Entitlement to service connection for right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from April 1978 to April 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a November 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In January 2021, the Veteran testified before the undersigned Veterans Law Judge. A hearing transcript has been associated with the record. Entitlement to service connection for right knee disorder is remanded. The Veteran contends that his right knee disorder was caused by a fall during physical training in service. See January 2021 Hearing Transcript (pg.5). His service treatment records are silent to any complaints, diagnosis or treatments of a right knee disorder. However, post-service treatment records reflect that the Veteran was diagnosed with degenerative disc disease of the knees in 2001 and there are numerous complaints of chronic right knee pain throughout his records. An etiology opinion has not been obtained. In determining whether the duty to assist requires VA to provide a medical examination or medical opinion with respect to a Veteran’s claim for benefits, there are four factors for consideration. These four factors are: (1) whether there is competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) whether there is evidence establishing that an event, injury, or disease occurred in service, or evidence establishing certain diseases manifesting during an applicable presumption period; (3) whether there is an indication that the disability or symptoms may be associated with the Veteran’s service or with another service connected disability; and (4) whether there otherwise is sufficient competent medical evidence of record to make a decision on the claim. 38 U.S.C. § 5103A(d); 38 C.F.R. §3.159(c)(4). With respect to the third factor above, the Court has stated that this element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and a Veteran’s service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Here, the Veteran meets the criteria to be afforded a VA examination. He was diagnosed with degenerative disc disease of the knees and has consistently complained of right knee pain. The Veteran has alleged that his conditions stem from service in his December 2014 notice of disagreement. Therefore, the Board finds that the evidence of record is sufficient to trigger the VA's duty to provide the Veteran's with an adequate VA examination for his claimed lumbar spine disorder and headaches. See McLendon v. Nicholson, supra. The matter is REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claim on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. After obtaining any outstanding records, obtain an etiology opinion by an appropriate clinician to determine the nature and etiology of the Veteran’s claimed right knee disorder. The examiner should review the entire claims file and note such review in the opinion. The need for further in-person examination is left to the discretion of the examiner. The examiner should respond to the following question: Is it at least as likely as not (50 probability or greater) that the Veteran’s current right knee disorder had its onset during service or is otherwise related to service? The examiner should specifically address the Veteran’s contention that his right knee disorder is the result of his in-service physical training and/or a result of a twisting injury while running on a road. Ensure that any medical opinion obtained includes a complete rationale for the conclusions reached. Any medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; any medical opinion must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382 (2010). 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 against it. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Adeyemi, 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.