Citation Nr: 21025618 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 17-12 269 DATE: April 28, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1980 to July 1984. The Veteran also served as a member of the Army Reserves until May 2004. These matters come before the Board of Veteran’s Appeals (Board) on appeal from a February 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a Board hearing. A transcript of the hearing has been associated with the Veteran’s claims file. In a December 2019 decision, the Board denied the service connection claims for a right knee, left knee, and lumbar spine disorder. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). In a September 2020 order, the Court granted a Joint Motion for Partial Remand (JMPR) filed by the parties to vacate and remand the claims for service connection for a right and left knee disorder. The parties also agreed that that the Veteran did not contest the service connection claim for a lumbar disorder. Therefore, that claim was abandoned. The appeal has now been returned to the Board for appellate review. In the JMPR, the parties agreed that the Board relied on an inadequate VA examination to base its decision. Specifically, the parties found that the November 2016 VA examiner relied on incorrect facts to form the nexus medical opinion. As for the service connection claim for the left knee, the VA examiner did not address all of the relevant evidence, including a September 1981 service treatment record that showed the Veteran had chronic knee problems, and that she was evaluated for pain and tenderness of the left knee. Regarding the right knee, the VA examiner indicated the Veteran’s knee pain in service was isolated, acute, and transient. However, evidence received since that time, refutes this statement. Therefore, the Court granted the JMPR and ordered the claims be remanded for an adequate VA examination. As noted above, the Veteran was last afforded a VA examination in November 2016. However, the medical opinion has been found to be inadequate. The Veteran has asserted that her bilateral knee disorder was caused by her military service. Specifically, in her March 2015 notice of disagreement, she has reported that she banged her left knee on a swinging log that she was supposed to jump over. Additionally, she indicated that her knees became bothersome and more serious after years of road marches, jumping in and out of foxholes, carrying, marching, and running with heavy backpacks, hand-to-hand combat demonstrations, and running on hard surfaces. In that statement, she also shared that drill sergeants communicated the consequences of going to sick call and obtaining physical profiles. In her August 2017 VA Form 9, the Veteran added that running five days a week in combat boots on the concrete pavement, running to and from dining facilities, and marches to and from training in combat boots contributed to her chronic knee disorder. She also indicated that while serving she tripped and fell on her knee several times. Moreover, as a result of a fall in a foxhole while in service, the Veteran states that she has pain and catching in her left knee all the time. During the August 2019 Board hearing, the Veteran testified that her knee problems began in service and have continued since that time, adding that the pain has been constant since the 1980s. She stated that she still has knee pain and both of her knees swell up (two to three times per month) just from walking and doing everyday activities. A November 1980 service treatment record reveals that the Veteran was treated for pain after running. The physician noted that she showed signs of crepitus and minor soft tissue edema. Id. During the evaluation, she reported that she was not able to straighten her leg. Ultimately, the Veteran was diagnosed with chondromalacia. Id. Regarding the Veteran’s left knee disorder, a July 1981 service treatment record shows the Veteran’s left knee was treated for pain. At that time, there was swelling in the patella region and fluid under her knee. The physician noted a need for aspiration of the fluid. Another record notes the Veteran’s chronic knee problem and shows the Veteran had pain and tenderness in her left knee after running. Her knee was tender in the sub-patella region. Moreover, she had limited range of motion due to pain, and the physician noted a presence of crepitus. See September 1981 service treatment record. Post-service treatment records note the Veteran continued to have left knee pain, including swelling, and extensive chondrocalcinosis. See November 2008 and September 2014 treatment records. In a December 2014 letter, the Veteran’s private surgical physician noted the Veteran had a history of left medical knee pain. He stated that the Veteran had a meniscal cyst, a posterior medial meniscal tear, degenerative disc disease in the medial compartment, grade II, with tricompartmental synovitis and notable inflammation within her knee. He referenced the Veteran’s military career of 24 years in the military, including10 of which when she was a drill sergeant. He noted her duties as a drill sergeant required prolonged standing and walking activities. Therefore, based on the findings and knee surgery in November 2014, it is likely as not that her current condition is related to her many years as a drill sergeant with subsequent early arthritis at age 54 within her locked knee. A review of the claims file reveals that many of these facts and findings have not been considered or addressed in a VA examination. Therefore, in compliance with the JMPR, the claims are remanded for another VA examination and medical opinion to determine the nature and etiology of the Veteran’s left and right knee disorder. The matters are REMANDED for the following action: 1. Obtain any outstanding treatment records. 2. After the foregoing development, the Veteran should be afforded a VA examination to determine the nature and etiology of any right or left knee disorder that may be present. The examiner should be given a complete copy of this remand. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and lay assertions. For each diagnosed right and/or left knee disability, the examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that the disorder is related to her military service, to include any claimed injury or symptomatology therein. In this regard, the Veteran has asserted that her bilateral knee disorder was caused by and began in military service and has continued since that time. She contends her knee problems are due to road marches, jumping in and out of foxholes, carrying, marching, and running with heavy back packs, hand to hand combat demonstrations, and running on hard surfaces and other duties related to her military service, including being a drill sergeant for the last 10 years of her military career. Additionally, she stated that while in service, she banged her left knee on a swinging log that she was supposed to jump over. She also indicated that her knees became bothersome and more serious after years. See March 2015 notice of disagreement. In her August 2017 VA Form 9, the Veteran added that running five days a week in combat boots on the concrete pavement, running to and from dining facilities, and marches to and from training in combat boots contributed to her chronic knee disorder. She also indicated that while serving she tripped and fell on her knee several times. As a result of a fall in a foxhole while in service, the Veteran states that she has left knee pain and it catches all the time. Lastly, the Veteran testified in an August 2019 Board hearing that her knee problems began in service and have continued since that time, adding that the pain has been constant since the 1980s. She stated that she still has knee pain and both her knees swell up (two to three times per month) just from walking and doing everyday activities. The examiner should consider and address all of the Veteran’s contentions. The Board notes that several treatment records indicate the Veteran had a chronic right and left knee disorder. See November 1980, July 1981, and September 1981 service treatment records. The Board points out that the Veteran indicated that drill sergeants communicated the consequences of going to sick call and obtaining physical profiles. Therefore, it is assumed she may not have gone to sick call for treatment each time she had knee pain. The examiner should note that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of conclusion as it is to find against it.) A clear rationale for all opinions must be provided and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.M. Walker 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.