Citation Nr: 21021484 Decision Date: 04/13/21 Archive Date: 04/13/21 DOCKET NO. 17-49 074 DATE: April 13, 2021 REMANDED The issue of service connection for right knee osteoarthritis with small patellar spurs, to include as secondary to service-connected left knee degenerative arthritis and/or intervertebral disc syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from January 1966 to January 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision of the St. Petersburg, Florida Regional Office (RO). In March 2019 and January 2021, the Board remanded the appeal to the RO for additional action. There was no substantial compliance with the Board’s remand directives. Stegall v. West, 11 Vet. App. 268 (1998). Right knee disorder The matter is remanded for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR Recent rulings from the courts have held that VA medical examiners must consider the accounts of veterans seeking compensation benefits, about the course of development of claimed disorders. The January 2021 VA addendum opinion was inadequate because the examiner only cited the lack of an altered gait and did not consider the Veteran’s account of his disorder – the examiner only provided, as supporting rationale, the absence of altered gait mechanics and/or overcompensation in UpToDate. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991); Bloom v. West, 12 Vet. App. 185, 187 (1999); Stegall, supra. The remand directives follow. 2. Return the file to the VA examiner who provided the January 2021 addendum for another addendum. If the examiner is not available, have the file reviewed by a similarly qualified examiner. Another examination is not required; however, if the VA examiner indicates that he or she cannot respond to the Board’s questions without examination of the Veteran, another examination should be afforded to the Veteran. All relevant medical and non-medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner must respond to the following THREE questions: a. Given the medical evidence in this case, your experience and knowledge and the state of medical science, is the Veteran’s account of his injury or the development of his disorder consistent with the clinical findings? b. Was the Veteran’s right knee osteoarthritis with small patellar spurs caused by the Veteran’s in-service right knee torn tendon and/or duties as a helicopter mechanic? c. Was the Veteran’s right knee osteoarthritis with small patellar spurs caused or aggravated by the Veteran having to overcompensate his right knee due to his service-connected left knee degenerative arthritis and/or intervertebral disc syndrome? THE EXAMINER IS ADVISED TO CONSIDER THE VETERAN’S PERTINENT EVIDENCE IN THE CLAIMS FILE, INCLUDING THE ARTICLES, AND NOT TO ONLY RELY ON UPTODATE. Although the examiner must review the VBMS file, his or her attention is drawn to the following: • In a February 1966 service treatment record, the Veteran reported experiencing right knee tenderness. A service right knee radiograph revealed no significant abnormalities. • In a subsequent February 1966 service treatment record, the Veteran reported experiencing continued right knee pain in the lateral aspect. A physical examination revealed normal ligaments, no swelling and mild tenderness. The service medical examiner’s impression was right knee torn tendon. The Veteran was treated with an ace wrap. • In his December 1967 pre-separation medical history report, the Veteran answered in the negative to the question of whether he then had, or once had a trick or locked knee. • In the Veteran’s December 1967 pre-separation medical examination report, no right knee lower extremity abnormalities were noted. • In his January 1968 service statement of medical condition, the Veteran reported having experienced no change in his medical condition since his last separation medical examination. • In his February 2016 VA Form 21-526EZ, the Veteran asserted that his right knee disorder was secondary to his service-connected left knee disorder due to having overcompensated on his right knee. • An undated article submitted in February 2016 titled “Comparison of Classification Schemes Based on Risk Factor Associations” reflects a study conducted to compare systems of classifying disabling knee injuries and to identify one as most suitable for etiological research. The article indicated that the study was based on a “number of limitations” such as the absence of a gold standard in classifying knee injuries and a small sample size. • A 2016 article titled “Functional Rehabilitation Criteria Required for a Safe Return to Active Duty in Military Personnel following a Musculoskeletal Injury: A Scoping Review” reflects that the use of standardized protocols in treating military injuries and taking into consideration the physical requirements for each duty specialty may assist in creating a set of criteria effective at determining readiness for a safe return to active duty. • The April 2016 VA examiner diagnosed the Veteran with right knee osteoarthritis with small patellar spurs. A right knee radiograph revealed osteoarthritis with small patellar spurs, mild narrowing of the medial joint space, no joint effusion, no fracture or dislocation, superior patellar enthesophyte, mild vascular calcification, intact tibial plateau and intact patellar tendon. • In the April 2016 VA examination, the Veteran reported having injured his right knee during basic training in 1966 and having experienced right knee achiness and a poor gait post-service. • An article dated January 2010 submitted in September 2017 titled “Injuries to Air Force Personnel Associated with Lifting, Handling, and Carrying Objects” reflects that lift-handle-carry injuries were a hazard of U.S. Air Force personnel. • An August 2005 article submitted in November 2020 titled “Symptoms in the Opposite or Uninjured Leg” reflects that there was no clear evidence to suggest that an injury to one lower extremity would have any significant impact on the opposite uninjured limb unless the injury resulted in major muscle or nerve damage causing partial or complete paralysis of the damaged leg, and/or shortening of the injured lower extremity resulting in a limb length discrepancy of more than four or five centimeters so that the individual’s gait pattern has been altered to the extent that clinically there is an obvious lurching type gait. • The November 2020 VA examiner diagnosed the Veteran with right knee osteoarthritis with small patellar spurs. • In the November 2020 VA examination, the Veteran reported having initially experienced right knee trouble approximately 20 years ago. The Veteran reported that his right knee had given out during a march and that he continued to experience right knee pain post-service. The Veteran also reported having injured his right knee as a result of duties due to his duty specialty as a helicopter mechanic. (Continued on the next page)   3. Readjudicate the issue on appeal. If the benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Cohen, Associate Counsel The Board’s decision in this case is binding only with respect to this case and is not precedential or establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.