Citation Nr: 21025161 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 10-10 291 DATE: April 27, 2021 REMANDED Entitlement to service connection for a bilateral knee condition is remanded. REASONS FOR REMAND The Veteran had active duty service in the United States Army from November 1990 to May 1991, as well as periods of active duty for training (ACDUTRA) from June 1988 to August 1988 and from June 1989 to September 1989. This case comes to the Board of Veterans’ Appeals (Board) on appeal from an August 2009 rating decision. This case has been before the Board on multiple occasions and was most recently remanded in May 2020 for additional development. Entitlement to service connection for a bilateral knee condition is remanded. By way of history, the Veteran originally claimed service connection for the bilateral knees as an undiagnosed illness. The Veteran’s service treatment records are silent for any complaints, findings, treatment, or diagnoses related to the knees. In April 2016, the Veteran was provided a VA examination. The examiner diagnosed superior patellar enthesopathy in both knees and opined that the Veteran’s bilateral knee condition was less likely than not related to his military service as the condition was at least as likely as not a childhood condition that the Veteran had had for years. In October 2018, an addendum medical opinion was obtained. The VA examiner explained that the Veteran’s bilateral patellar enthesopathy was an acquired disorder and not congenital in nature, but when asked whether the condition would have pre-dated the Veteran’s service, the examiner relied solely on the April 2016 VA examiner’s opinion to find that it did. In May 2020, the Board found that the April 2016 and October 2018 VA examiners had applied an incorrect standard in determining that the Veteran’s bilateral knee condition preexisted service and remanded for a new VA examination and medical opinion consistent with the presumption of soundness that the Veteran is entitled to in this case. See May 2020 Board Decision. Accordingly, the Veteran was provided another VA examination in February 2021. The examiner diagnosed bilateral knee strain and bilateral patellar enthesopathy. See February 2021 VA examination. The examiner did not provide an opinion regarding the bilateral knee strain diagnosis. As for the bilateral patellar enthesopathy, the examiner stated the March 1990 report of medical history during enlistment showed no findings to support right knee or left knee enthesopathy prior to service. Therefore, the Veteran was presumed sound upon entry and the claimed right knee and left knee enthesopathy did not preexist service. [The Board notes incidentally that, in one of the opinions, the examiner stated that because right knee enthesopathy was not shown prior to service, the left knee enthesopathy did not preexist service. The conflicting notations regarding the right and left knee in this opinion are presumed to be a typographical error as, when all the opinions by the February 2021 VA examiner are read together, it is clear that the examiner was addressing each knee separately.] The examiner additionally opined that the reports of medical history dated March 1991 and June 1992 showed no objective evidence to support right or left knee enthesopathy or conditions during service; therefore, the claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Although the February 2012 VA examiner provided an opinion as to the nature and etiology of the Veteran’s bilateral patellar enthesopathy, the examiner did not, as noted, opine as to the etiology of the bilateral knee strain. Accordingly, another remand is required to obtain an adequate medical opinion prior to adjudicating this claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matter is REMANDED for the following action: Return the claims file to the examiner who provided the February 2021 opinion regarding the Veteran’s claimed bilateral knee disability to obtain an addendum opinion. If the February 2021 examiner is not available, the claims file should be reviewed by another examiner. The examiner is asked to provide an opinion regarding whether the Veteran’s bilateral knee strain is at least as likely as not related to his military service. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. Churchwell, 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.