Citation Nr: 21032470 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 16-43 910 DATE: May 27, 2021 REMANDED Entitlement to a disability rating in excess of 10 percent for right knee arthralgia with old Osgood-Schlatter's disease is remanded. Entitlement to a disability rating in excess of 10 percent for lumbar strain with degenerative disc disease and foraminal stenosis prior to December 10, 2019, and in excess of 20 percent thereafter is remanded. Entitlement to service connection for a left knee disability is remanded. INTRODUCTION The Veteran served on active duty from December 1985 to December 1989. When this case was previously before the Board in January 2019, the above-noted issues were remanded for additional development. The case has since been returned for further appellate review. REASONS FOR REMAND While additional delay of the above-noted claims is unfortunate, the Board finds further development is required before the Veteran's claims are decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Left Knee Claim Initially, the Board notes the Veteran has asserted in the alternative that his current left knee disability may be related to either an injury he sustained while on temporary duty deployment in service, or alternatively, may be caused or aggravated by his service-connected right knee or back disabilities. During a December 2019 VA examination, the examiner diagnosed the Veteran with Osgood-Schlatter's disease, chondromalacia, and a meniscal tear. However, the examiner found the Veteran's left knee disability was less likely than not incurred in service or caused/aggravated by his right knee disability. In support of his conclusion that the Veteran's left knee disability was not incurred in service, the examiner focused primarily on the lack of documented treatment in service. The examiner also indicated the Veteran reported not experiencing left knee pain until 2018; however, he then curiously cited to a 2015 examination report wherein the Veteran reported left knee discomfort. Examiners simply are not free to ignore a veteran's statements related to lay observable symptoms. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Further, an absence of contemporaneous service treatment records does not preclude granting service connection for a claimed disability. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). With respect to his conclusion that the Veteran's left knee disability was neither caused nor aggravated by his service-connected right knee disability, the examiner found such a theory "does not fit within the realm of a peer reviewed logical manifestation of diseases as written over centuries in the medical books." However, the examiner failed to cite to even a single medical treatise or study in the centuries of medical books which support his own conclusion. To be considered adequate, a medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Based on the foregoing insufficiencies, the Board finds a new examination and medical opinion is warranted. Further, the examiner did not provide an opinion with respect to the Veteran's claims of a secondary connection between his left knee disability and his service-connected lumbar spine disability. For the foregoing reasons, the Board finds a new medical examination and opinions must be obtained. Increased Ratings Claims Next, the Board notes the Veteran most recently underwent VA back and knee examinations to assess his service-connected lumbar spine and right knee disabilities in December 2019. However, the examiner failed to provide non-weight bearing, weight bearing, or passive range of motion assessments. The examiner also failed to acknowledge or discuss all procurable factors relative to the Veteran's right knee and lumbar spine flare-ups, to include frequency, duration, characteristics, precipitating and alleviating factors, and the severity of the flare-ups. To be considered adequate, a musculoskeletal examination must include a comprehensive assessment of the veteran's flare-ups, as well as range of motion measurements in weight bearing, non-weight bearing, and in passive motion. See Sharp v. Shulkin, 29 Vet. App. 26 (2017); see also Correia v. McDonald, 28 Vet. App. 158 (2016). As such, a remand is again required as the December 2019 VA examiner failed to provide these critical evaluation assessments. Accordingly, these matters are REMANDED for the following actions: 1. Afford the Veteran a VA examination by an examiner with sufficient expertise, who has not previously examined the Veteran, to fully assess the severity of the Veteran's service-connected lumbar spine and right knee disabilities. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. Ensure the examiner provides all information required for rating purposes, to specifically include both active and passive range of motion testing, as well as weight-bearing and nonweight-bearing range of motion assessments. In addition, the examiner must consider and discuss all procurable and assembled data such as the frequency, duration, characteristics, precipitating and alleviating factors, and the severity of the flare-ups, and then provide an assessment of the functional loss during flares, if possible in degrees of motion lost. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should be directed to clearly explain why that is so. 2. Also, afford the Veteran a VA examination by an examiner with sufficient expertise, who has not previously examined the Veteran, to address the etiology of the Veteran's claimed left knee disability. All pertinent evidence of record must be made available to and reviewed by the examiner. Any indicated studies should be performed. Following a review of the relevant records and lay statements, the examiner should state an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) that any left knee disability diagnosed during the pendency of this appeal, to specifically include Osgood-Schlatter's disease, chondromalacia, or meniscal tear: a) originated during his period of active service or is otherwise etiologically related to his active service; b) was caused by his service-connected lumbar spine disability; c) was worsened to any degree by his service-connected lumbar spine disability; d) was caused by his service-connected right knee disability; or e) was worsened to any degree by his service-connected right knee disability. The examiner must provide a complete rationale for all opinions offered. In this regard, the examiner must discuss and consider the Veteran's competent lay statements regarding the onset and nature of his left knee disability. If the examiner is unable to provide any requested opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, 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.