Citation Nr: 21016237 Decision Date: 03/22/21 Archive Date: 03/22/21 DOCKET NO. 15-43 056 DATE: March 22, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a September 2013 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in May 2019. A transcript of the hearing is associated with the Veteran’s claims folder. This case was previously before the Board in September 2019 and August 2020, on which occasions the claims were remanded. In the August 2020 Board decision, a claim of service connection for a low back disability was remanded. In December 2020 the RO granted service connection for osteoarthritis of the lumbar spine. This constitutes a full grant of the benefits sought by the Veteran. Therefore, there is no longer a case or controversy regarding the aforementioned issue for the Board to consider. The remaining claims have been returned to the Board for further adjudication. 1. Entitlement to service connection for a right knee disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the Board’s August 2020 decision, claims of service connection for bilateral knee disabilities were remanded for further development. Specifically, the Board requested medical opinions regarding whether the Veteran’s bilateral knee disabilities are related to an in-service injury, event, or disease, and whether his bilateral knee disabilities are proximately due to, or aggravated beyond its natural progression by, his low back disability. The RO complied with the Board’s remand directives and in December 2020 the Veteran was afforded a VA examination and opinion. Regarding whether his knee disabilities were related to service, the examiner opined that it is less likely than not that the injuries were incurred in or caused by an in-service injury, event, or disease. In rendering an opinion, the examiner noted that the Veteran did not received in-service treatment for a knee disability. (12/3/2020, C&P Exam, p. 34). Regarding whether the Veteran’s bilateral knee disabilities are proximately due to, or aggravated beyond its natural progression by, his low back disability, the examiner opined that the Veteran’s knee disabilities are less likely than not proximately due to or the result of his service-connected back disability. Additionally, the examiner opined that the Veteran’s knee disabilities were not aggravated beyond their natural progression by his service-connected back disability. In rendering his opinion, the examiner noted that there is no evidence of “compensatory strain on [the] knees[,] abnormal gait or instability affecting either knee.” The examiner indicated that the mechanism by which the Veteran’s service-connected back disability would cause a knee disability is by altering his gait, and without evidence of a gait abnormality, a secondary relationship between the Veteran’s back and bilateral knee disabilities is not supported. (12/3/2020, C&P Exam, p. 3). The Board finds that the December 2020 medical opinion is inadequate for evaluation purposes as the opinion appears to be based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (a medical opinion based on inaccurate factual premise has no probative value). In this regard, the December 2020 examiner indicated that there was no evidence of a gait abnormality. This finding is not supported by the record, as the Veteran’s VA medical records indicate he has an antalgic gait. (11/15/2019, CAPRI, p. 26, 80, 86, 107, 152, 160, 210). Moreover, the December 2020 medical opinion did not address a June 2013 physical therapy report, wherein a physical therapist suggested that the Veteran’s bilateral knee pain was “likely patellofemoral from standing posture due to low back pain.” (9/5/2013, CAPRI, p. 51). In light of the aforementioned, the Board finds that the December 2020 medical opinion is inadequate for evaluation purposes. As such, the claim must be remanded. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from December 2020 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s bilateral knee disabilities are: (a.) at least as likely as not related to an in-service injury, event, or disease, including the cumulative effect of the Veteran’s more than 10 years of active duty service; or (b.) proximately due to his service-connected low back disability; or (c.) aggravated beyond its natural progression by his service-connected low back disability. If aggravation is found, the examiner should attempt to identify the baseline level of disability prior to such aggravation In rendering an opinion, the examiner must address evidence that the Veteran has an altered gait. (11/15/2019, CAPRI, p. 26, 80, 86, 107, 152, 160, 210). Additionally, the examiner must address a June 2013 physical therapy report, wherein a physical therapist suggests that the Veteran’s bilateral knee pain was “likely patellofemoral from standing posture due to low back pain.” (9/5/2013, CAPRI, p. 51). Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.