Citation Nr: 21024467 Decision Date: 04/22/21 Archive Date: 04/22/21 DOCKET NO. 15-24 108 DATE: April 22, 2021 ORDER Entitlement to a rating in excess of 10 percent for right knee instability under Diagnostic Code (DC) 5257 is denied. Entitlement to a 10 percent rating for limitation of right knee extension under DC 5261 is granted for the entire appeal period. Entitlement to service connection for a bilateral hip disorder, to include as secondary to the Veteran’s service-connected right knee disorder, is denied. REMANDED Entitlement to service connection for a left knee disorder, to include as secondary to the Veteran’s service-connected right knee disorder, is remanded. FINDINGS OF FACT 1. The Veteran’s right knee has manifested, at worst, slight instability during the course of the appeal. 2. The Veteran’s right knee has manifested a functional 10 degree limitation of extension for the entire appeal period. 3. The Veteran’s bilateral hip disorder is not etiologically related to, or aggravated by, his service-connected right knee disorder. CONCLUSIONS OF LAW 1. The criteria for entitlement to a rating in excess of 10 percent for right knee instability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. 2. The criteria for a 10 percent rating for limitation of right knee extension have been met for the entire appeal period. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5261. 3. The criteria for entitlement to service connection for a bilateral hip disorder, to include as secondary to the Veteran's service-connected right knee disorder, have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. § 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1978 to October 1982. 1. Entitlement to a rating in excess of 10 percent for right knee instability 2. Entitlement to a compensable rating for limitation of right knee extension prior to October 2, 2020, and in excess of 10 percent thereafter Disability evaluations are determined by the application of the facts presented to VA’s Schedule for Rating Disabilities (Rating Schedule) at 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civilian occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Separate diagnostic codes identify various disabilities and the criteria for specific ratings. Relevant regulations do not require that all cases show all findings specified by the Schedule; however, findings sufficient to identify the disease and the resulting disability and, above all, coordination of the rating with impairment of function will be expected in all cases. 38 C.F.R. §§ 4.7, 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. In establishing an appropriate initial assignment of a disability rating, the proper scope of evidence includes all medical evidence submitted in support of the veteran’s claim. Fenderson v. West, 12 Vet. App. 119 (1999). In cases where an assigned disability rating has been challenged or appealed, it is possible for a veteran to receive a staged rating. A staged rating is an award of separate percentage evaluations for separate periods, based on the facts found during the appeal period. Id. at 126-28; see also Hart v. Mansfield, 21 Vet. App. 505 (2007) (in determining the present level of a disability for any increased evaluation claim, the Board must consider staged ratings). If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining will be resolved in favor of the veteran. 38 C.F.R. § 4.3. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. In determining the appropriate evaluation for musculoskeletal disabilities, particular attention is focused on functional loss of use of the affected part. Under 38 C.F.R. § 4.40, functional loss may be due to pain, supported by adequate pathology and evidenced by visible behavior on motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Under 38 C.F.R. § 4.45, factors of joint disability include increased or limited motion, weakness, fatigability, or painful movement, swelling, deformity or disuse atrophy. Under 38 C.F.R. § 4.59, painful motion is an important factor of joint disability and actually painful joints are entitled to at least the minimum compensable rating for the joint. This regulation also requires that, whenever possible, the joints involved are tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. See Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Where functional loss is alleged due to pain upon motion, the provisions of 38 C.F.R. § 4.40 and § 4.45 must be considered. DeLuca v. Brown, 8 Vet. App. 202, 207-08 (1995). Within this context, a finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant. Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Pain itself does not rise to the level of functional loss as contemplated by § 4.40 and § 4.45 but may result in functional loss only if it limits the ability to perform the normal working movements of the body with normal excursion, strength, coordination or endurance. Mitchell v. Shinseki, 25 Vet. App. 32, 43 (2011). In Sharp v. Shulkin, the United States Court of Appeals for Veterans Claims (Court) decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. 29 Vet. App. 26 (2017). The Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. The intent of the Rating Schedule is to recognize actually painful, unstable or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. During the course of the appeal, the Veteran’s right knee is rated as 10 percent disabled under DC 5257. In a December 2020 rating decision, the Agency of Original Jurisdiction (AOJ) granted an additional rating of 10 percent disabled from October 2, 2020, for limitation of extension of the right knee under DC 5259-5261. Included within 38 C.F.R. § 4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). Under DC 5260, a noncompensable rating is assigned when flexion of the leg is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260. Under DC 5261, a noncompensable rating is assigned when extension of the leg is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. 38 C.F.R. § 4.71a, DC 5261. Under DC 5257, which evaluates recurrent subluxation or lateral instability of a knee, and assigns a 10 percent disabling for a slight impairment, 20 percent disabling for a moderate impairment, and 30 percent disabling for a severe impairment. Under DC 5258, a maximum 20 percent rating is warranted for semilunar cartilage, dislocated, with frequent episodes of “locking”, pain, and effusion into the joint. Lastly, under DC 5259, a maximum 10 percent rating is warranted for removal of semilunar cartilage that is symptomatic. Separate ratings under DCs 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, for a knee disability already rated under DCs 5260 and/or 5261, a claimant would have additional disability justifying a separate rating if there is instability and/or subluxation of the knee joint under DC 5257. See generally VAOPGCPREC 23-97. Furthermore, the rating criteria do not preclude separate ratings for meniscal injury under DCs 5258 and 5259 where there are separate ratings for limitation of motion under DCs 5260 and/or 5261, or instability under DCs 5257. Lyles v. Shulkin, 29 Vet. App. 107 (2017). The normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38 C.F.R. § 4.71, Plate II. The terms “slight,” “moderate,” “moderately severe,” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6. The use of terminology such as “slight” or “moderate” by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. For the musculoskeletal system and muscle injuries, the applicable rating criteria, found at 38 C.F.R. § 4.71a, were amended effective February 7, 2021. The old rating criteria applies to rating periods prior to February 7, 2021; however, whichever set of criteria is more favorable applies to periods after February 7, 2021, if the claim was pending prior to this date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran’s claim was pending prior to this date, the more favorable criteria will apply. Under the new rating criteria for DC 5257, other impairments of the knee are rated under either recurrent subluxation or instability, or patellar instability. Under recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or, (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Under patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note 1 indicates for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note 2 indicates that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration. Historically, the Veteran injured his right knee in service and underwent arthroscopy based on a diagnosis of rule out (R/O), or possible, torn meniscus. The arthroscopy was negative for meniscal tear and resulted in a diagnosis of synovial plica of the right knee. A Medical Board offered a diagnosis of right quadriceps atrophy secondary to knee pain, and chondromalacia patellae of the right knee. The Veteran filed the current claim for an increased rating in October 2011. During a May 2013 VA examination, the Veteran was diagnosed with residuals from an injured right knee, including an old fracture deformity of the distal femoral shaft. The examiner referred to a history that the Veteran had undergone arthroscopic surgery in the 1980’s to repair a meniscus tear. The Veteran noted that the knee sometimes felt “wobbly” going up and down stairs and noted weakness, pain, and swelling. At that time, the Veteran reported flare-ups when he overused the knee. Upon initial and repetitive examination, right knee flexion was measured to 95 degrees, and extension was measured to zero degrees. The examiner found no objective evidence of painful motion. There was no change of motion with repetitive testing. The examiner found functional loss consisted of less movement than normal, pain on movement and disturbance of locomotion. There was pain/tenderness to palpation of the joint line or soft tissues. Stability testing was normal, and the examiner found no history of recurrent patellar subluxation or dislocation. There was full muscle strength in all planes of motion. The examiner identified a history of meniscal tear with residual signs and symptoms. August 2018 private medical records reflect that the right knee had a full range of motion, but exhibited some pain. There was no quadriceps atrophy, effusion or deformity. The Veteran denied locking or buckling. The private physician diagnosed right knee chondromalacia and patellofemoral chondrosis, and prescribed a patella wrap with hinges. See also July 2017 Private Medical Records. During the course of the appeal, he has also received VA treatment for right knee pain. See, e.g., June 13, 2018 VA Treatment Records. The examiner noted “mild” limitation of extension but did not provide a description in terms of degrees. At a hearing in December 2018, the Veteran described problems with morning pain and stiffness of the right knee which caused him problems ambulating stairs. He had pain of 7/10 severity in the morning which generally got better throughout the day. He generally had good and bad days, and had had swelling a few times which lasted a day or two. He had been prescribed a knee brace. He was nervous using stairs due to episodes of give-way. During a December 2019 VA examination, the Veteran was diagnosed with right knee patellofemoral chondrosis and residuals of a right knee injury. The examiner noted a history of right knee injury status post meniscectomy. At that time, he reported pain while going up and down stairs, but reported no flare-ups. Upon initial and repetitive examination, right knee flexion was measured to 90 degrees, and extension was measured to zero degrees. There was no additional motion loss with repetitive testing. However, the examiner found that functional loss due to pain would result in range of motion from 5 to 85 degrees. Stability testing was normal, and the examiner found no history of recurrent patellar subluxation or dislocation. The right knee exhibited no objective evidence of pain during passive range-of-motion testing and no pain while used in non-weight bearing. There was no muscle atrophy or ankylosis. The examiner noted a history of meniscal tear. During an October 2020 VA examination, the Veteran was diagnosed with right knee patellofemoral chondrosis and residuals of a right knee injury. At that time, he reported intermittent pain and stiffness, but again reported no flare-ups. Upon initial and repetitive examination, right knee flexion was measured to 85 degrees, and extension was measured to 5 degrees. Stability testing was normal, and the examiner found no history of recurrent patellar subluxation or dislocation. The right knee exhibited objective evidence of pain during passive range-of-motion testing but no pain while used in non-weight bearing. The examiner found that functional loss due to pain would result in range of motion from 10 to 75 degrees. As noted above, the Veteran has testified to experiencing right knee pain, swelling, numbness, and a feeling of instability while going up or down stairs. His functional impairments include morning pain and stiffness, and as well as increased symptoms with prolonged standing and walking. The Veteran is competent to attest to matters of which he has first-hand knowledge, including experiencing these symptoms. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). The Board finds the Veteran’s statement to be credible and probative of the issue. While the Veteran did report flare-ups with overuse during the May 2013 VA examination, he has since denied experiencing flare-ups during VA examinations where additional range-of-motion limitations could have been assessed. Further, he did not report flare-ups during his December 2018 Board hearing. Nonetheless, the 2020 examiner considered the Veteran’s history and estimated additional motion limitation from 10 to 75 degrees due to functional impairment due to pain. The Board finds that Sharp has been satisfied. The evidence of record reflects that the right knee exhibits pain on motion and is painful and “wobbly” while going up and down stairs. Objective testing during VA examinations does not reflect any clinical right knee instability. The Veteran has been prescribed a knee brace which reflects some medical evidence of instability. See 85 Fed. Reg. 76453, 76458 (Nov. 30, 2020) (acknowledging that “A qualified medical professional’s prescription (of a knee brace) … provides objective evidence of.. instability.”) Under the old rating criteria, in the absence of clinical evidence of subluxation or lateral instability, the Board finds that the lay and medical evidence demonstrates no more than mild instability. As such, the criteria for a rating in excess of 10 percent under DC 5257 has not been met. Additionally, under the new rating criteria, while the Veteran has been prescribed a knee brace, he has not manifested recurrent subluxation or instability with sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, or unrepaired or failed repair of complete ligament tear causing persistent instability; and he has not manifested patellar instability with a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair. Therefore, a rating in excess of 10 percent disabled for the right knee is not warranted under the new rating criteria at any time since the effective date of the new criteria. The Board notes that the Veteran is in receipt of a 10 percent disability rating for limitation of right leg extension under DC 5261 since October 2, 2020. This is based upon the 2020 VA examiner’s assessment that functional loss due to pain would result in a 10 degree loss of extension. Notably, the December 2019 VA estimated that functional loss due to pain would result in range of motion of 5 degrees of extension. An assessment in the clinic setting in 2018 described “mild” limitation of extension but did not provide a description in terms of degrees. The Board also observes that the examinations prior to 2018 did not take into account the Veteran’s description of limitations. The Board must interpret reports of examination in light of the whole recorded history and reconcile these reports into a consistent disability picture. 38 C.F.R. § 4.2. Resolving reasonable doubt in favor of the Veteran, and applying the provisions of 38 C.F.R. §§ 4.40 and 4.45, the Board finds that the Veteran has manifested functional limitation of extension to 10 degrees for the entire appeal period. As such, a separate 10 percent rating under DC 5261 is warranted for the entire appeal period. However, a higher rating based upon limitation of motion in either flexion or extension is not warranted. In this respect, there is no lay or medical description of right knee extension limited to 15 degrees, even during flares or with use, for any time during the appeal period. The Veteran had, at worse, a measured 5 degree loss with an estimated 10 degree loss as a result of functional impairment due to pain. A separate compensable rating for limitation of flexion requires 45 degrees of limitation. The Veteran does not describe this type of motion loss, and the clinical evaluations measure flexion no worse than 85 degrees and estimated that functional loss due to pain would result in motion loss to 75 degrees. Even with consideration of 38 C.F.R. §§ 4.40 and 4.45, these findings fall well short of the criteria for a compensable motion loss under DC 5260. The Board notes that VA examiners have recorded a history of meniscal surgery which would implicate the application of the meniscal codes under DCs 5258 and 5259. However, the Board has closely reviewed the service treatment records (STRs) and find that these are inaccurate factual assumptions. The STRs reflect that the Veteran underwent arthroscopy for a suspected meniscal tear, but clearly document that no meniscal tear was found. He had an arthroscopy diagnosis of synovial plica of the right knee. As such, the Board assigns no probative value to the VA examiner references to a history of meniscal surgery. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (holding that the Board may reject a medical opinion based on an inaccurate factual basis). The Board emphasizes that these examiners did not provide these assessments by interpreting the STRs but merely reported a history provided by the Veteran. Thus, the Board finds no medical interpretation of the STRs which could constitute a competent medical opinion. See generally LeShore v. Brown, 8 Vet. App. 406 (1995). Thus, the Board finds that the criteria of DCs 5258 and 5259 do not apply. The Board has also considered rating the right knee under DCs 5256, DC 5262, and DC 5263. However, there is no lay or medical evidence of ankylosis, nonunion or malunion of tibia and fibula, or genu recurvatum. There is no further doubt to be resolved in the Veteran’s favor. 3. Entitlement to service connection for a bilateral hip disorder, to include as secondary to the Veteran’s service-connected right knee disorder, Service connection will be granted if the Veteran has a disability resulting from personal injury or disease incurred in the line of duty, or for aggravation of a preexisting injury or disease incurred in the line of duty during active service. 38 U.S.C. § 1110, 1131; 38 C.F.R. § 3.303. To establish service connection, the evidence must show competent evidence of (1) a present disability, (2) an in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). A valid service connection claim requires competent evidence of a current disability. Boyer v. West, 210 F.3d 1351, 1353 (Fed. Cir. 2000); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). However, the presence of a disability at any time during the claim process – or relatively close thereto – can justify a grant of service connection, even where such disability has become asymptomatic. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a non-service-connected disorder that is aggravated by a service-connected disability. 38 C.F.R. § 3.310(b). Compensation may be provided for the degree of disability over and above the degree of disability existing prior to aggravation. Allen v. Brown, 7 Vet. App. 439, 448 (1995). Whenever there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the veteran. 38 U.S.C. § 5107(b). The Veteran’s October 1982 separation examination does not reflect any bilateral hip issues. During the course of the appeal, the Veteran has sought treatment for hip pain. See, e.g., August 2013 VA Treatment Records. August 2016 private medical records reflect a diagnosis of bilateral hip strain; December 2018 private medical records reflect a diagnosis of bilateral hip degenerative joint disease. During a December 2019 VA examination, the Veteran was diagnosed with degenerative arthritis of both hips. He noted that the hip pain may be due to his work on a forklift. The examiner opined that the Veteran’s bilateral hip disorder is a separate entity from the service-connected right knee disorder and not medically related to it. An August 2020 VA examiner opined that service treatment records did not reflect hip problems, and the degenerative arthritis of both hips developed many years after service. Further, based on orthopedic medical literature, there is no clear evidence to suggest an injury to one joint would have any significant impact on another joint, absent an injury that resulted in major muscle or nerve damage causing paralysis or a specific shortening of a limb resulting in a specific altered gait pattern called a “Trendelenburg gait.” In the Veteran’s particular case, although he has a slightly altered gait pattern, the examiner opined that medical record review, history, and examination does not support an injury of this severity. The examiner also noted that it is not unusual for one person to have two joints that share a similar disease even though they are not etiologically related. Based on this rationale, the examiner determined that the bilateral hip disorder is not etiologically related to or aggravated by the service-connected right knee disorder. During the December 2018 Board hearing, the Veteran testified that his hip pain did not begin during service, but that he believes the hip pain is related to his service-connected right knee disorder. The Veteran is competent to attest to matters of which he has first-hand knowledge, including experiencing hip pain. See Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). To the extent that the Veteran has testified that his hip pain did not begin during service, the Board finds the Veteran’s statement to be credible and probative of the issue. However, the Veteran is not competent to determine the etiology of his bilateral hip disorder. The Veteran is not competent because he lacks the requisite medical training necessary to formulate an opinion in this regard and the medical matters here are not susceptible to lay observation (unlike a broken leg). Id. Therefore, the Veteran’s medical opinion linking his bilateral hip disorder to his service-connected right knee disorder has no probative value. The Veteran did related to a VA physician that his private orthopedic doctor thought that the Veteran may be overcompensating his gait due to his right knee which has some probative value with regard to a potential relationship. See Jandreau, 492 F.3d at 1376-77. However, this recollection has limited probative value as the reasoning and rationale relating to potential additional bilateral hip disability is not known. The probative value of this opinion is significantly less than the opinion of the 2020 VA examiner who specifically considered the type of gait impairment demonstrated by the Veteran as well as his history of clinical findings and injuries. In this case, the best evidence of record is the well-reasoned August 2020 VA examiner’s opinion based on a review of the medical records, medical literature, and an analysis of this particular Veteran’s disorders. That examiner determined the bilateral hip disorder is not caused or aggravated by the service-connected right knee disorder. The claim of entitlement to service connection for a bilateral hip disorder is denied. There is no reasonable doubt of material fact to be resolved in the Veteran’s favor. REASONS FOR REMAND 1. Entitlement to service connection for a left knee disorder, to include as secondary to the Veteran’s service-connected right knee disorder, is remanded. In a June 2020 remand, the Board instructed the Agency of Original Jurisdiction (AOJ) to obtain a VA examination in which “[t]he examiner should address June 1987 VA treatment records indicating bilateral knee pain and any other relevant VA treatment records associated with the claim file as a result of this remand.” (Emphasis in the original.) In an October 2020 opinion, a VA examiner opined that she was unable to locate the June 1987 VA treatment records for review. The Board notes that the relevant records are located in the claims folder on page 18 of 22 in a November 18, 2019, package of treatment records. A remand is needed to obtain an additional VA opinion that includes review of these records. The matters are REMANDED for the following action: 1. Obtain VA treatment records since June 2019 and associate them with the claims file. 2. Forward the claims folder to a qualified examiner for an addendum opinion regarding the nature and etiology of the Veteran’s left knee disorder. The examiner should address the following question: Is it at least as likely as not (i.e., probability of 50 percent or greater) that any diagnosed left knee disorder occurred in or is otherwise etiologically related to the Veteran’s eligible period of military service? The examiner should address June 1987 VA treatment records indicating bilateral knee pain and any other relevant VA treatment records associated with the claim file as a result of this remand. If an examination is needed, one should be scheduled. All opinions expressed must be supported by complete rationale. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Howell, 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.