Citation Nr: 21031770 Decision Date: 05/24/21 Archive Date: 05/24/21 DOCKET NO. 16-48 998 DATE: May 24, 2021 REMANDED Entitlement to service connection for bilateral knee condition is remanded. REASONS FOR REMAND The Veteran served honorably on active duty from March 1983 to July 1986. This matter comes before the Board of Veteran's Appeals (Board) on appeal from a December 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). By way of background, this matter came before the Board in May 2018. In its decision, the Board remanded the issue of service connection for a bilateral knee condition for further development. Specifically, the RO was instructed to obtain Federal records from Fort Benning, Georgia and inpatient records from Martin Army Community Hospital. In July 2020, this matter came back before the Board. In its decision, the Board remanded the issue of service connection for a bilateral knee condition for further development. Specifically, the Board instructed the RO to obtain an addendum opinion whether the Veteran's bilateral knee disorder had onset in or otherwise related to service. In rendering that opinion, the examiner was directed to specifically address the following: 1) the Veteran's assertion that he hurt his knees in service during parachute jumps; 2) any relevant treatment records including the December 2017 Gallup Indian Medical Center treatment records noting complaints of knee pain; 3) the [July 1984] STR noting complaints of left knee pain; and 4) the August 2014 VA examination. Unfortunately, there has not been substantial compliance with the Board's previous remand directives regarding the issue of bilateral knee condition. Although further delay is regrettable, another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Furthermore, the Board has advanced the case on the docket pursuant to 38 C.F.R. § 20.902(c). Service connection for bilateral knee condition is remanded. The Veteran contends that his current bilateral knee condition is due to his active duty service. Specifically, he asserts that the parachute jumps he did for airborne training contributed to his bilateral knee condition. See September 2016 Statement in Support of Claim: October 2020 C&P Exam. In October 2020, the Veteran was afforded a VA examination for his bilateral knees. The examiner opined that the Veteran's claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. For rationale, the examiner concluded the following: "The Veteran participated in airborne activities during service and was separated in 1986. He had complaints of left knee pain in 1984 but there were no other complaints of left or right knee pain. Even though airborne activities are associated with joint injuries, there is no evidence that this Veteran has a chronic knee condition that began in the service. There are no bilateral knee complaints in the five years after separation and he did not have knee complaints for over three decades. As there is no evidence of chronic knee pain, the current claimed bilateral knee disorder is less likely than not caused by or is otherwise related to active service." The Board finds the October 2020 inadequate for the following reasons. First, the examiner failed to consider the Veteran's lay statements. The Veteran specifically stated that the onset of his pain started in 1984, as evidenced by Service Treatment Records (STR), and that his bilateral knee pain worsened during service from his airborne activities. Moreover, the examiner does not address why the Veteran's bilateral knee pain is not caused by or related to his in-service airborne activities, as directed to by the July 2020 Board remand. Stegall, 11 Vet. App. at 271; See McKinney v. McDonald, 28 Vet. App. 15, 30-31 (2016) ("the VA examiner's failure to consider [the Veteran's] testimony when formulating her opinion renders that opinion inadequate."). Second, the examiner relied on the absence of documented complaints of knee pain after 1984, and the lack of records post-service documenting a knee condition. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). In general, an adequate medical opinion must support its conclusion with analysis that can be weighed against contrary opinions and be based upon prior medical history and examinations. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Here, the Veteran's reports of knee pain are evidenced by his STR and are consistent with the circumstances of airborne training during service. However, the examiner made no attempt to explain why the claimed event in-service did not cause or contribute to the Veteran's bilateral knee condition. Further, the Board notes the examiner inaccurately commented in Section VII of the October 2020 Knee and Leg Conditions Disability Benefits Questionnaire. The examiner was asked to comment on the question: "Does the Veteran now have or has he or she ever had recurrent patellar dislocation, "shin splints" (medial tibial stress syndrome), stress fractures, chronic exertional compartment syndrome or any other tibial or fibular impairment?" The examiner commented "no" to this question. However, the record documents the Veteran reported presence of shin splints in service. See August 2014 C&P Exam. Additionally, VA medical treatment records documents the finding of leg length discrepancy. See August 2014 VA Medical Treatment Record. After noting these conditions, the examiner was asked to describe the relationship between these conditions and the Veteran's diagnosed condition; however, the examiner's discrepancy prevented a response. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value). It is noted that a medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record. Stefl v. Nicholson, 21 Vet. App. 102, 124-25 (2007). A "medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two." Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board cannot make a fully informed decision on the issue of bilateral knee condition because the October 2020 VA medical exam is inadequate. Due to the foregoing, a remand is necessary to obtain an adequate VA examination and medical opinion. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records and associate them with the claims file. 2. Obtain an addendum opinion from the examiner who provided the October 2020 VA examination, or, if that examiner is unavailable, to another qualified examiner. If the examiner determines that a new examination is necessary, such examination should be scheduled. The examiner must review the electronics claims file, including a copy of this remand. The examiner is requested to opine whether it at least as likely as not (50 percent or greater probability) that the Veteran's bilateral knee condition has onset in or is otherwise related to active service, including his airborne training jumps? The examiner must address 1) the Veteran's assertion that he hurt his knees in service during jumps which contributed to his current knee condition; 2) any relevant treatment records including the December 2017 Gallup Indian Medical Center treatment records noting complaints of knee pain; 3) the July 1984 STR noting complaints of left knee pain; and 4) the August 2014 and October 2020 VA examinations, including the Veteran's statement that he had shin splints in service. The examiner is reminded that the Veteran is competent to provide information about observable symptoms and events, including those he experienced in service. The examiner should assume, for the purposes of the opinions, that the Veteran's reports are both accurate and credible. The examiner must provide a complete and fully articulated explanatory rationale for any opinion expressed that is based on the examiner's clinical experience and medical expertise; established medical principles; and the evidence in the electronic claims file. Tiffany Dawson Veterans Law Judge Board of Veterans' Appeals Law Clerk for the Board N. Jamordee 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.