Citation Nr: 21023455 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 20-11 431 DATE: April 20, 2021 REMAND Service connection for a right knee disability. Service connection for a left knee disability.   REASONS FOR REMAND The Veteran served on active duty from November 1960 to November 1964. The case is on appeal from a December 2018 rating decision. In April 2021, the Veteran testified at a Board hearing. 1. Service connection for a right knee disability 2. Service connection for a left knee disability The Veteran seeks service connection for a bilateral knee disability. With respect to his left knee, the Veteran testified during his April 2021 Board hearing that during training at Camp Pendleton, he got caught up in concertina wire for which he was treated right away. The Veteran asserts that his current left knee disability stems from that in-service injury/event. With respect to his right knee, the Veteran indicates that the wear and tear from carrying weapons and extensive walking during active service contributed to his current disability. Service treatment records (STRs) reflect that the Veteran did not report, and the examiner did not find, any knee problems at entrance. See September 1960 Entrance Examination Report. In April 1964, the Veteran complained and received treatment for left knee pain. See also May 4, 1964 progress notes (he has no past history of knee injuries and was not aware of having injured his knee except playing football prior to the onset of symptoms). The Veteran was placed in crutches for 4 days, wore a long leg cast for 2 weeks, and was placed on light duty. See May 7, and May 18, 1964 progress notes. STRs do not show a right knee injury, treatment or complaints during service. The Veteran was afforded a VA examination in connection with his claim in December 2018. The VA examination report contains a diagnosis of degenerative arthritis of the knees bilaterally, and left knee cerclage over left patella and patella osteophyte deformity, status post remote surgical repair of patella fracture performed in the 1960’s. The report reflects that per the Veteran’s STRs, a left knee anterior scar was noted along with a history of traumatic synovitis of the right knee in 1964. While the Veteran noted that his bilateral knee pain and discomfort began right after leaving the military around 1964-1965, he also indicated that he underwent a left knee surgery in 1969 as a result of a motor vehicle accident (MVA). The examiner noted that thereafter, the Veteran has complained of limited motion for the left knee. As for his right knee, the examiner noted that the Veteran is in constant pain which appears to be associated with the right sciatic nerve. The examiner noted that STRs do not contain any evidence for evaluation, diagnosis or treatment for bilateral knee osteoarthritis, post traumatic, or due to aging while serving on active duty. He further noted that the right knee strain with traumatic synovitis in 1964 noted in his STRs, and left patella fracture residuals in the1960’s post traumatic MVA resolved. The examiner pointed out that the only residual on separation exam reported as a left knee scar. In sum, the examiner opined that left knee symptoms are most likely due to the osteoarthritis in the knee joint, and less likely due to any residual status post-surgical repair with retained cerclage. As for the right knee, the examiner opined that his right knee disability is most likely due to sciatic pain and low back pain. During a February 2020 VA Decision Review Officer (DRO) hearing, the Veteran testified that after his in-service left knee injury, he continued to experience pain but self-medicated with over the counter (OTC) medication and that his pain has continued ever since separation. He also indicated that although he had a post-service injury, his left knee problems predated such injury. As for his right knee, the Veteran indicated that not only he injured his right knee during service, but that that the overcompensation due to his left knee has gradually aggravated his right knee pain. The Veteran added that he has not had any right knee injuries after service; however, he continues to self-medicate for it. VA treatment records show that the Veteran had a total left knee arthroplasty in March 2020. During the April 2021 Board hearing, the Veteran’s son testified that he remembers his father (the Veteran) complaining of bilateral knee issues during his childhood. Additionally, the Veteran testified that he has been told by his physical therapist that the etiology of his left knee disability is most likely related to his in-service injury and that his right knee disability might be as well secondary to his left knee disability for overcompensating for the opposite knee. The Board finds that the December 2018 VA examiner’s opinion is not wholly sufficient to decide the claim as it may have been based on incomplete information. To that effect, the Veteran has consistently indicated that although he never sought further treatment for his bilateral knee pain and discomfort either during service or following his discharge from active duty, he continued to self-treat his pain with over the counter medication. The examiner’s opinion that the Veteran’s knee problems resolved suggest that the Veteran’s statements may have been disregarded. In addition, the Veteran indicated that his left knee problems predated the 1969 MVA injury. In light of the above, the Board finds that a remand is warranted for another VA examination and opinion by an orthopedic specialist to comment on the etiology and nature of the Veteran’s bilateral knee disability after consideration of the facts set forth above. In light of the remand, updated VA treatment records should be obtained. These matters are REMANDED for the following actions: 1. Obtain updated VA treatment records dated since February 2020, to include any outstanding VA treatment records not currently associated with the Veteran’s claims file. 2. Obtain and request from the Veteran any outstanding private treatment records, particularly any records pertaining to his physical therapy treatment for his bilateral knee disabilities. 3. Once all development has been conducted, schedule the Veteran for a VA examination by an orthopedist in connection with his claim for his bilateral knee disabilities. The examiner should first determine whether the Veteran has a current bilateral knee disability, which may include osteoarthritis or degenerative joint disease. (a) With respect to the left knee: The examiner is asked to provide an opinion as to whether any identified left knee disability at least as likely as not (50 percent or greater possibility) had its onset during, or is otherwise related to, his military service, to include the incident in which the Veteran got caught up in concertina wire during training, or the sudden onset of symptoms noted in the April 1964 STRs’ notes. Consideration should be given to: (1) STRs accounting for complaints and treatment sought for sudden left knee pain requiring a cast, crutches and light duty; and (2) the Veteran’s statement that ever since the onset of left knee pain he self-managed it with OTC medication. (b) With respect to right knee: (i) The examiner is asked to provide an opinion as to whether any identified right knee disability at least as likely as not (50 percent or greater possibility) had its onset during, or is otherwise related to, his military service. (ii) if no to (i), the examiner should then provide an opinion as to whether it is as likely as not (50 percent or greater probability) that any identified right knee disability is the result of, or aggravated by the Veteran’s left knee disability. Aggravation is an increase in severity beyond a temporary flare-up or natural progress of the disease. Consideration should be given to: (1) the Veteran’s statements indicating right knee pain during and ever since service; (2) that he has self-treated his right knee pain with OTC medication; and (3) that he has been told by his physical therapist that his right knee pain is secondary to his left knee disability. A complete rationale or explanation should be provided for any opinion reached. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Pagan-Diaz, William 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.