Citation Nr: 21029449 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 16-11 517A DATE: May 13, 2021 REMANDED Entitlement to service connection for a left knee disorder, to include as secondary to a service-connected disability or disabilities, is remanded. Preliminary Matters The Veteran served on active duty from January 1969 to March 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a July 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2019, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A copy of the hearing transcript is of record and has been reviewed. In October 2019, the Board remanded the claims for entitlement to service connection for a right knee disorder and a left knee disorder. In a January 2021 rating decision, the RO granted service connection for degenerative arthritis of the right knee. The claim for service connection for a left knee disorder was readjudicated by the RO in a January 2021 Supplemental Statement of the Case and has been properly returned to the Board for consideration. REASONS FOR REMAND A remand is required in order to obtain additional medical opinions that adequately address direct service connection and the theory of entitlement to service connection for a left knee disability on a secondary basis. As it pertains to secondary service connection, VA treatment records show that the Veteran has an antalgic gait and "limps on right." See e. g., March 2018 VA treatment record. In August 2015 VA physical therapy notes, the Veteran presented with complaints of chronic back pain and bilateral knee pain, and the VA physical therapist indicated that the Veteran "demonstrates impairments in posture and chronic muscle imbalances which is likely contributing to his chronic pain." In an October 2020 VA knee Disability Benefits Questionnaire, the Veteran indicated that he was overcompensating for his right knee injury and started having pain and stiffness in the left knee. Based on this medical evidence, a VA examination and medical opinion specifically addressing secondary service connection is required. As it pertains to direct service connection, VA obtained a medical opinion in December 2020. At that time, the examiner opined that the Veteran's left knee disorder was not related to service because "there is no evidence in his C-FILE showing any issues with his left knee while he was in-service." However, the examiner did not address the Veteran's testimony that he injured his left knee in service and has had continuing symptoms ever since. The Board finds the December 2020 VA medical opinion to be of limited probative value as the examiner provided a negative nexus opinion based solely on the lack of documentation of a left knee disability in service treatment records. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination was inadequate where the examiner did not comment on the Veteran's report of in-service injury and instead relied on the absence of evidence in the service treatment records to provide a negative opinion). Accordingly, a remand is required. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the electronic claims file. 2. Then, schedule the Veteran for a VA examination of the left knee. The electronic claims file must be made available to the individual designated to provide the opinion. The examiner is asked to: (a.) Obtain a complete history from the Veteran regarding the onset and nature of his left knee pain. **The examiner should address the Veteran's statements that he was overcompensating for his right knee injury and started having pain and stiffness in the left knee and any impact his back disability is having on his left knee. **The examiner is asked to address the Veteran's testimony that he injured his left knee during boot camp and was put on profile for his left knee several times. The Veteran has indicated that he has continued to experience left knee pain since service. (b.) Then, state whether it is at least as likely as not (50 percent or greater probability) that the Veteran's left knee disorder first manifested in service or is otherwise related to service. (c.) State whether the Veteran's left knee disorder is at least as likely as not (50 percent or greater probability) either caused or aggravated by his service-connected disabilities, including a right knee disability, lumbar spine disability, and bilateral lower extremity radiculopathy disabilities. **The examiner must address the August 2015 VA physical therapy notes where the VA physical therapist indicated that the Veteran "demonstrates impairments in posture and chronic muscle imbalances which is likely contributing to his chronic pain." ** The examiner must address the October 2020 VA knee DBQ, where the Veteran indicated that he was overcompensating for his right knee injury and started having pain and stiffness in the left knee. **The examiner is reminded that secondary service connection does NOT require "permanent" worsening of the condition being claimed by the service-connected disability and requires considering whether there has been any worsening, no matter how incremental, so even if not above and beyond the condition's natural progression. See Ward v. Wilkie, 31 Vet. App. 233 (2019). (d.) A complete rationale should be provided for the opinions given. (Continued on the next page) 3. Then, readjudicate the claim on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.