Citation Nr: 21023069 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-24 027A DATE: April 20, 2021 REMANDED Entitlement to service connection for left knee condition, including arthritis is remanded. Entitlement to service connection for right knee condition, including arthritis, status post knee replacement is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1971 to July 1971, and from January 1991 to May 1991. The Veteran was also a member of the Army National Guard from October 1970 through January 1997 and had periods of ACDUTRA and INACDUTRA during that service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Veteran testified before the Board in a November 2020 hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is included in the file. 1. Entitlement to service connection for left knee condition, including arthritis is remanded. 2. Entitlement to service connection for right knee condition, including arthritis, status post knee replacement is remanded. The records associated with the file show the Veteran had a total right knee replacement in 2011. Earlier records from 2002 show he was diagnosed to have a right knee medial meniscus tear, as well as right chondromalacia of the medial femoral condyle. Records from 2009 show diagnoses of right knee medical meniscal tear; arthritis; and patellofemoral degenerative joint disease. The current diagnosis of the left knee is not clear. A May 2014 VA examination suggests there is arthritis and a meniscal tear of that knee. Service records document the presence of osteoarthritis of the knees with a history of torn cartilage at the beginning of the second period of active duty. This was considered well controlled with medication; either Clinoril or Voltaren. (See Chronological Record of Medical Care dated January 7, 1991.) Service records from the early part of the second period of service, also document that the Veteran presented for medical care with complaints of recurrent knee pain that had a 20 year history. It was noted his medications included Clinoril, and he was assessed as having retropatellar pain syndrome. He was excused from physical training for 5 days, and permitted to run at his own pace for a period of 25 days. (See Screening Note of Acute Medical Care dated January 22, 1991.) Knee complaints are again documented in February 1991 and May 1991. May 1991 records continue to characterize the complaints as patella-femoral syndrome, which was considered to have existed prior to this period of service, but to have been aggravated by this service. In a December 1991 Report of Medical History, the Veteran advised his knees were still painful. In a June 1995 Report of Medical History the Veteran indicated he had painful and swollen joints, but this was not explicitly identified as referring to the knees. At that time he denied having a “‘Trick’ or locked knee, ” and he affirmatively stated he had no medical waivers or profiles. In addition, the lower extremities were normal on clinical evaluation at that time (June 1995). As indicated above, the Veteran retired from the Army National Guard in 1997, and approximately 5 years later he was seen for a right knee medial meniscus tear, as well as right chondromalacia of the medial femoral condyle. Although the Veteran was examined for VA purposes in 2014, the report does not make clear how the current findings may relate to the complaints and findings noted in the Veteran’s active duty service/non-active service records. This should be clarified on remand. In addition, it does not appear all relevant private treatment records have been associated with the file, in particular those as may date from both prior to the 1991 period of service, as well as after that date. These should be sought. The matters are REMANDED for the following action: 1. The Veteran should be asked to identify the non-VA care providers from whom he received knee treatment prior to January 1991 as well as after May 1991. The records of this treatment (not already associated with the file) should be sought. 2. Any current records of the Veteran’s VA knee treatment should be associated with the claims file 3. After the requested development has been completed, the Veteran should be examined for VA purposes. The current left knee diagnoses should be identified. The examiner also should express an opinion as to whether any current left knee disorder, and/or the total right knee replacement are as likely as not the natural progression of the knee complaints noted in 1991 service records. The reasons for the conclusion should be fully explained, and in doing so, the examiner should discuss the relationship between the 1991 diagnoses of patella-femoral pain syndrome and retropatellar pain syndrome on the one hand, and the post service diagnoses of medial meniscus tear, chondromalacia of the medial femoral condyle, and arthritis, on the other. If the examiner concludes current disability is related to the knee complaints noted during the 1991 period of service, the examiner should express an opinion as to whether those 1991 in-service complaints are symptoms of a pre-service knee disorder. If that is the case, the examiner should discuss whether the pre-service knee disorder increased in severity beyond its natural progression during the 1991 period of service. 4. All opinions should include a detailed explanation (rationale). The rationale must be consistent with the entire medical opinion and must be clearly stated. If the examiner cannot provide an opinion without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). 5. Thereafter, the claims should be re-adjudicated. MICHAEL E. KILCOYNE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Johnson, 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.