Citation Nr: 21027892 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 16-24 945A 23DATE: May 7, 2021 REMANDED Entitlement to service connection for right knee disability is remanded. REASONS FOR REMAND The Veteran has active service from August 1995 to October 2008 that is honorable for VA purposes, and service from October 2008 to June 2010 that is not honorable for VA purposes (6/30/2010 Administrative Decision). This case is before the Board of Veterans' Appeals (Board) from a December 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran appeared before the undersigned Veterans' Law Judge (VLJ) at a March 2020 hearing. In May 2020 and December 2020, the Board remanded this issue for additional development, specifically an examination that adequately addresses the nature and etiology of any right knee disability. A December 2020 examination with an accompanying opinion is of record. The Board finds that the December 2020 medical opinion is insufficient given the examiner's failure to acknowledge or discuss the Veteran's lay statements of consistent pain since service and the Veteran's wife's description of the Veteran's pain since 2010. Additionally, the examiner relied on the lack of medical records displaying complaints, diagnostic results, or treatment for a right knee condition as the reason for his negative nexus opinion (1/26/2021 C&P Exam). Given the absence of adequate rationale or analysis that the Board can consider and weigh against other evidence of record, remand for a new opinion is necessary. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). Additionally, the opinion does not address the Veteran's contention during his March 2020 hearing that his right knee disability may have been caused by his service-connected foot or back disabilities (3/06/2020 Correspondence, pg. 8). In this regard, the Board notes in a May 2019 addendum opinion, the examiner acknowledged it is not uncommon to attribute arthritis of a person's knees or hip on the original underlying conditions. Although the examiner indicated that plantar fasciitis did not cause osteoarthritis of the Veteran's right foot or calcaneal spurs on both of his heels, it is not clear that the examiner also excluded the Veteran's knee disability, to include pain. The May 2019 opinion also referenced in service X-ray evidence of arthritis in the Veteran's foot (2/01/2021 CAPRI). The medical evidence of record does not address whether the presence of arthritis in the Veteran's foot during service suggests its presence in his knee also. In light of the foregoing, the Board finds remand is required for a new medical examination. Accordingly, the matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriately qualified clinician to determine the nature and etiology of any existing right knee disability. The examiner should review the entire claims file and this remand in conjunction with the examination. The examiner is requested to opine whether it is at least as likely as not (i.e., a likelihood of 50 percent or more) that any currently diagnosed right knee disorder is a result of service or any incident occurring during service, including specifically the Veteran's description of being on his feet all day as a cook, in addition to working patrol/guard duty during service. The examiner should address the May 2019 opinion regarding August 2008, in-service X-ray evidence of arthritis in the Veteran's foot. The examiner should address whether this suggests arthritis was present in the Veteran's right knee during service. If arthritis or any other chronic disease is found, is it at least as likely as not that such disease manifested to a compensable degree within a year of his separation from active duty service? The examiner should further provide an opinion as to whether any right knee disability is at least as likely as not (50 percent probability) proximately due to any service-connected disability, to include plantar fasciitis with pes planus, residuals fracture left foot, and back disabilities. The examiner should address whether it is as likely as not (50 percent probability) that the Veteran's service connected disabilities, to include plantar fasciitis with pes planus, residuals fracture left foot, and back disabilities, aggravated any right knee disability beyond its natural progression. If aggravation is found, the examiner should identify baseline level of disability prior to such aggravation. The examiner is reminded to consider the Veteran's lay reports that his right knee disorder began in service, as early as 1996, and since then he describes persistent, chronic limitation of motion and pain in his right knee. A reason must be provided if the Veteran's lay reports are rejected. Lay statements cannot be rejected solely due to a lack of medical documentation. If there is a medical reason to accept or not accept the Veteran's contentions the examiner should provide them. If the absence of medical documentation is relevant, the relevance must be explained because the absence of evidence is not positive evidence of the existence or non-existence of an event. If the examiner is able to gather additional understanding or information regarding the circumstances surrounding any inservice injury or event, the examiner should include that information in his remarks. The examiner should reconcile any conflicting medical evidence of record to the extent possible. The examiner must provide all findings, along with a complete rationale for his or her opinion(s) in the examination report. If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and explain why this is so, (e.g., whether an opinion is beyond what any medical practitioner might be able to provide, based on the evidence of record and current medical knowledge). Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. A. Myers 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.