Citation Nr: 21024871 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 13-02 207 DATE: April 26, 2021 REMANDED Entitlement to a separate compensable evaluation for dislocated semilunar cartilage and residual effects of the right knee is remanded. Entitlement to a separate compensable evaluation for symptomatic removal of semilunar cartilage of the right knee is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from October 1985 to March 1992. This matter comes to the Board of Veterans’ Appeals (Board) from various rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In April 2015, the Veteran appeared before the undersigned Veteran Law Judge at a videoconference hearing. The transcript is of record. The Board issued a decision in January 2019 that, in pertinent part, denied a separate compensable evaluation for a service-connected right knee disability under DC 5258 or 5259 and remanded the claim for service connection for left knee disability. The Veteran appealed the January 2019 Board decision to the United States Court of Appeals (the Court). In a February 2020 Joint Motion for Partial Remand (JMPR) the parties moved to vacate the January 2019 Board decision to the extent that it denied entitlement to a separate compensable evaluation for a service-connected right knee disability under DC 5258 and 5259 based on the August 2016 VA examination (VAX). In accordance with the JMPR the Board remanded the above issues in August 2020. 1. Entitlement to a separate compensable evaluation for dislocated semilunar cartilage and residual effects of the right knee pursuant to DC 5258 is remanded. 2. Entitlement to a separate compensable evaluation for symptomatic removal of semilunar cartilage of the right knee pursuant to DC 5259 is remanded. An addendum opinion was provided in December 2020, complying with the Board remand instructions. However, in making a determination that there was no dislocation of semilunar cartilage or removal of semilunar cartilage in the right knee the VA medical examiner failed to address the VA treatment records from July 2006 that show an arthroscopic debridement and drilling of the right medial femoral condyle and VA treatment records from July 2007 that show an arthroscopy. The examiner also reflected that the findings and procedure of an arthroscopy performed in 2002 were unspecified. Records pertaining to the 2002 arthroscopy procedure and findings are not of record. Alvin C. York VAMC referenced the July 2007 arthroscopy and July 2006 arthroscopic debridement, noting that the procedures took place at Nashville General Hospital at Meharry. Records from Nashville General Hospital at Meharry pertaining to these procedures are not of record. Thus, a remand is necessary to obtain treatment records and obtain an addendum opinion to consider the additional evidence.   3. Entitlement to service connection for a left knee disability, to include as secondary to the Veteran’s service-connected right knee patellofemoral syndrome is remanded. In August 2020, the Board remanded the claim for service connection for a left knee disability as the VA examiner’s opinion relied on inherently inaccurate information. See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Reonal v. Brown, 5 Vet. App. 460, 461 (1993) (an opinion based on an inaccurate factual premise has no probative value). The VA examiner determined that the Veteran’s left knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the August 2020 negative nexus opinion was based on service treatment records (STRs) that were negative for complaints or treatment of the left knee during service. STRs clearly showed a history of tendonitis in both knees and a March 1989 examination found that the Veteran had reoccurring knee pain that was worse in the left knee then in the right knee. In compliance with the Board remand an October 2020 medical opinion was provided. The VA medical examiner determined that the Veteran’s left knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the negative nexus opinion was once again based on inaccurate factual premises and utilized duplicative language found in the August 2020 medical opinion i.e. there was no evidence of a left knee condition in service or proximately to service. As the negative nexus opinion is based on an inaccurate characterization of the record, the opinion has no probative value. Thus, another remand is necessary for a medical opinion. The matters are REMANDED for the following action: 1. Contact the Veteran and ask that he provide a list of all his right knee arthroscopies with dates and names of the medical facilities where the procedure took place. Specifically, request information regarding the 2002 arthroscopy. Obtain all necessary authorizations and any outstanding medical records. Obtain all records from Nashville General Hospital at Meharry. The AOJ should fully document its efforts to obtain this information, and its efforts should conclude only with a positive or negative response from the repository of this information. 2. After completion of the above development, obtain an addendum opinion from the VA medical examiner who provided the December 2020 medical opinion regarding the Veteran’s meniscus. A copy of this REMAND must be provided to and reviewed by the examiner. The examiner is then asked to address the following: a. If a meniscus condition is found, state whether the condition of the Veteran's right meniscus is best characterized as having dislocated semilunar cartilage or the removal of semilunar cartilage. b. To the extent possible, state whether the episodes of swelling, crepitus, pain, and effusion are attributable to either or both, the Veteran’s dislocated or removed semilunar cartilage. If the examiner determines that an opinion cannot be provided without further examination of the Veteran, the Veteran should be scheduled for an examination of his right knee. A complete rationale should be provided for each opinion rendered. If the VA examiner is unable to provide an opinion without resorting to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Arrange for the examiner to provide an addendum opinion. A copy of this REMAND must be provided to and reviewed by the examiner. After reviewing the claims file the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran’s left knee had its initial onset in service or is otherwise etiologically related to his active service, to include being the result of an in-service injury, event, or illness. The examiner should specifically address the Veteran’s STRs that show complaints of left knee pain and a history of tendonitis. A complete rationale should be provided for each opinion rendered. If the VA examiner is unable to provide an opinion without resorting to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Smith, 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.