Citation Nr: 21029669 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 16-31 310 DATE: May 14, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2005 to November 2006, and from February 2012 to October 2012. This matter is before the Board of Veterans' Appeals (Board) on appeal from a July 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the claim was remanded by the Board to the agency of original jurisdiction (AOJ) for further development. After accomplishing the above, the AOJ continued to deny the Veteran's claim (as reflected in a June 2020 supplemental statement of the case (SSOC)). Unfortunately, the Veteran's claims must be remanded again. In the March 2019 remand, the AOJ was directed to obtain VA medical opinions regarding whether the Veteran's bilateral knee disabilities were related to his active service and/or his service-connected left gastrocnemius strain/left calf injury. Pursuant to the remand directives, VA medical opinions were obtained in December 2019. The examiner noted that the Veteran's knee pain began in 2006 while deployed to Iraq, but opined that his bilateral knee disabilities were less likely than not related to his active service. As rationale, she stated that "[t]here is no mention of knee pain on his post deployment health assessment on 9-19-2006. He had yearly PHAs following the initial injury and there is no mention of knee problems on any PHA after the initial injury. There are no STRs documenting a knee injury during service." However, the remand directed the examiner to consider the Veteran's lay statement that his knee pain began while carrying 70-pound plus full gear, 14-pound rifle, and performing of the low crawling maneuvers on his knees, for long distances, to get a marksman shot. See April 2014 VA examination. The examiner instead appeared to base her opinion on the absence of knee injury in service, which is not permissible. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination is inadequate where the examiner did not comment on the Veteran's report of in-service injury and relied on lack of evidence in service medical records to provide negative opinion). Likewise, the examiner opined that the Veteran's service-connected left gastrocnemius strain/left calf injury did not cause his knee injuries. However, she did not discuss whether the Veteran's current knee issues may have been aggravated by his service-connected condition. See 38 C.F.R. § 3.310 (b); El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (a medical opinion that does not specifically address aggravation is generally inadequate to decide a secondary service connection claim). The Board finds that VA addendum opinion should be obtained with complete rationale as to whether the Veteran's bilateral knee disabilities were related to service and/or were caused or aggravated by his service-connected left gastrocnemius strain/left calf injury. The matters are REMANDED for the following action: 1. Send the Veteran's claims file to an appropriate medical professional to obtain addendum opinions regarding the etiology of his bilateral knee disabilities. The Veteran's entire electronic claims file must be made accessible to the designated professional for review. A detailed rationale for any opinion expressed should be provided. 2. Following the review of the claims file, the medical opinion provider is then requested to respond to the following: (a) Is it as least as likely as not (a 50 percent probability or greater) that the Veteran's right knee disability is related to his active service? (b) Is it as least as likely as not (a 50 percent probability or greater) that the Veteran's left knee disability is related to his active service? In formulating his or her opinion, the examiner must consider and discuss the Veteran's lay statements regarding the onset of his knee pain in service, as well as whether his diagnosed bilateral shin splints or plantaris may have caused his current bilateral knee pain. (c) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's right knee disability is proximately due to or caused by his service-connected left gastrocnemius strain/left calf injury? (d) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's right knee disability has been aggravated (made worse beyond its natural progression) by his service-connected left gastrocnemius strain/left calf injury? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. (e) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left knee disability is proximately due to or caused by his service-connected left gastrocnemius strain/left calf injury? (f) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's left knee disability has been aggravated (made worse beyond its natural progression) by his service-connected left gastrocnemius strain/left calf injury? If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. 2. If the requested opinions cannot be provided without a new examination, one should be scheduled. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Kovacs, 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.