Citation Nr: 21021857 Decision Date: 04/14/21 Archive Date: 04/14/21 DOCKET NO. 17-28 466 DATE: April 14, 2021 REMANDED Entitlement to service connection for right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 to September 2000. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision. In October 2019, the Board denied service connection for right knee disability. The Veteran appealed to the United States Court of Appeals for Veterans Claims (the Court). In November 2020, the Court granted the parties’ November 2020 Joint Motion for Remand (JMR) to vacate the October 2019 Board decision and to remand for readjudication. 1. Entitlement to service connection for right knee disability is remanded. The Veteran asserts that his current right knee disability is related to his work in aircraft maintenance during service or related to running during service. He reports that he was constantly on his knees in cramped spaces during service and that he has had knee pain since service. As agreed in the JMR, remand of this matter is necessary to afford the Veteran a VA examination and opinion that adequately addresses whether his claimed right knee disability is related to service. The Veteran underwent VA examination in August 2014. The August 2014 VA examiner opined that the Veteran’s right knee condition was less likely related to his service. The VA examiner explained that medical records contain no mention of right knee complaints or abnormal findings except during the separation examination when the Veteran mentioned subjective right knee pain without any abnormal physical findings or clinical notes after separation of right knee complaints. However, a report of medical assessment conducted during the Veteran’s separation in August 2000 contains a diagnosis of mild patellofemoral syndrome in the Veteran’s right knee. Accordingly, the August 2014 VA opinion was based on an inaccurate factual premise. See Reonal v. Brown, 5 Vet. App. 458, 461(1993). In addition, the August 2014 VA examiner failed to address the Veteran’s reports that he has experienced right knee pain since service. For these reasons, as set forth in the JMR, the August 2014 VA opinion is inadequate. Remand is necessary to obtain further VA medical opinion. In a September 2019 brief, the Veteran cited medical treatise evidence discussing common causes of patellofemoral syndrome, including overuse of the knee joint and trauma, such as hitting the kneecap or falling on it. Based on this medical literature and his service treatment records, the Veteran argues that there may be a link between his current right knee disability and service. This medical treatise evidence should be considered by the VA examiner who provides the medical opinion obtained on remand. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with the appropriate examiner. The examiner should review the Veteran’s file and conduct any appropriate tests. The examiner should opine regarding whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran’s right knee disability had an onset in service or is otherwise related to service. The examiner should consider all medical and lay evidence of record. The examiner should specifically address the Veteran’s assertion that his current right knee disability is related to his work in aircraft maintenance or running during service, his reports that he was constantly on his knees in cramped spaces during service, his reports that he had knee pain throughout service and since service, the August 2000 medical assessment conducted during the Veteran’s separation that contains a diagnosis of mild patellofemoral syndrome in the Veteran’s right knee, and the medical treatise evidence cited in the September 2019 brief discussing common causes of patellofemoral syndrome, including overuse of the knee joint and trauma, such as hitting the kneecap or falling on it. If the Veteran’s reports are discounted, the examiner should provide a rationale for doing so (e.g., whether there is any medical reason to accept or reject his contentions). The examiner is asked to explain the reasons behind any opinions expressed. 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 it is to find against it. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issue on appeal. Shereen M. Marcus Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Purcell 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.