Citation Nr: 21015754 Decision Date: 03/18/21 Archive Date: 03/18/21 DOCKET NO. 15-36 202 DATE: March 18, 2021 REMANDED Entitlement to service connection for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 to September 2010. This matter comes on appeal before the Board of Veterans’ Appeals (Board) from the January 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In November 2018, the Veteran testified regarding this matter at a Video Conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the record. In March 2019, the Board granted service connection for obstructive sleep apnea and remanded the claims for service connection for a right shoulder, low back, right knee, and left knee disabilities for further development, including VA examinations and etiology opinions. In December 2020, the RO granted service connection for a right shoulder, low back, and right knee disabilities, which is considered a full grant of the benefits on appeal for those claims. As such, these issues are no longer before the Board for appellate consideration. A.B. v. Brown, 6 Vet. App. 35 (1993). The RO denied service connection for a left knee disorder, and that claim remains on appeal. See Supplemental Statement of the Case dated December 11, 2020. The Board finds that there has not been substantial compliance with its March 2019 remand directives regarding the left knee claim. See D’Aries v. Peake, 22 Vet. App. 97, 105 (2008) (holding that there must be substantial compliance with the terms of a Court or Board remand); Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). Accordingly, remand of the claim is warranted, as set forth below. VA Opinion Once VA undertakes the effort to provide an examination or medical opinion when developing a service-connection claim, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In its March 2019 remand, the Board directed that the VA examiner “MUST address service treatment records showing treatment and complaints pertaining to the Veteran’s knees[.]” See Board Decision and Remand dated March 15, 2019 at pg. 6. In the December 2020 medical opinion, the examiner concluded that the Veteran’s left knee strain is less likely than not related to service, and in the supporting rationale identified two service treatment records, noted as a June 2010 record reflecting only right knee pain and the July 2010 separation examination, said to be silent for a left knee condition. See VA Medical Opinion dated December 10, 2020 at pg. 2. Notably, however, the examiner acknowledged elsewhere in the opinion form that the July 2010 separation examination reflects “chronic knee joint pain.” Thus, the opinion is internally inconsistent, which diminishes its probative value. See Obert v. Brown, 5 Vet. App. at 30, 33 (1993). Additionally, it suggests that the December 2020 VA examiner made a less than thorough review of the claims file. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (the probative value of a medical opinion comes from its being factually accurate, fully articulated, and having a sound reasoning for the conclusion). The examiner also failed to adequately consider the Veteran’s lay statements of record regarding the onset and continuity of symptoms of knee pain during service, including those noted by the examiner in the December 2020 VA examination report. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (finding a medical examination inadequate where the examiner impermissibly ignored the appellant’s lay assertions regarding onset of symptoms or injury during service). For these reasons, the Board finds the December 2020 VA medical opinion inadequate. See Barr, supra. Accordingly, remand is necessary to obtain a medical opinion addressing the etiology of the Veteran’s left knee disorder to ensure that the Board’s evaluation of the Veteran’s claim is a fully informed one. See Stegall, supra. The matter is REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Then, obtain an opinion from an appropriately qualified VA clinician, other than the examiner who authored the December 2020 VA opinion, as to the nature and etiology of the Veteran’s left knee disorder. The claims file, and a copy of this Remand, must be made available to and be reviewed by the examiner. *The need for another examination(s) is left to the discretion of the medical professional offering the addendum opinion. If an examination(s) is performed, all indicated studies, tests, and evaluations must be conducted, and all findings reported in detail and correlated to a specific diagnosis. After a complete review of the claims file, the examiner is asked to respond to the following: (a) Identify the currently diagnosed left knee disorder(s) present at any point during the appeal period, which commenced on January 28, 2013. (b) Provide an opinion as to whether it is at least as likely as not (50 percent or higher probability) that the currently diagnosed left knee disorder(s) onset during service, manifested within one year after service separation, or is otherwise etiologically related to service. NOTE: The examiner MUST address service treatment records showing treatment and complaints pertaining to the Veteran’s knees AND the Veteran’s lay assertions of record describing the onset of knee pain during service. Although the examiner must review the entire claims file, the examiner is requested to consider the following potentially relevant evidence, which is identified by VBMS label and receipt date in parenthesis: (i) Reference to “chronic knee joint pain” in service treatment records, i.e. Chronological Record of Medical Care entry dated July 20, 2010 (see VBMS entry with document type “STR - Medical,” receipt date 09/15/2015, at page 7 of 71); and (ii) Veteran’s Board hearing testimony describing the onset of bilateral knee pain during service (see VBMS entry with document type “Hearing Transcript,” receipt date 11/16/2018, at pages 6-7). * The Board’s reference to evidence in this context should not be construed as a determination of its credibility. * All opinions are to be accompanied by a rationale consistent with the evidence of record. If an opinion cannot be provided without resorting to pure speculation, the VA examiner should explain why speculation would be required in this case. 3. Thereafter, ensure that the examiner has substantially responded to the questions posed by the Board, and if not, take corrective action. Then, readjudicate the remanded claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Farrell 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.