Citation Nr: 21032522 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 17-06 392 DATE: May 27, 2021 REMANDED Entitlement to service connection for a left knee disorder remanded REASONS FOR REMAND The Veteran served on active duty from December 1965 to September 1967. This case is before the Board of Veterans' Appeals (Board) on appeal from a September 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In November 2019, the Board reopened the Veteran's service connection claim for a left knee disorder but denied the claim. The Veteran appealed this decision to the United States Court of Appeals for Veterans Claims (Court). In a December 2020 order, the Court granted a Joint Motion for Partial Remand, vacating the Board's November 2019 decision as to the issue of the Veteran's entitlement to service connection for a left knee disorder, and remanded the matter for readjudication. The Court provided that the Board's November 2019 analysis was inadequate as to whether presumption of aggravation applies, and it failed to address the Veteran's entitlement to direct service connection for his left knee disorder. Now the matter is returned to the Board. However, the Board finds that more development is necessary prior to final adjudication of the matter. The Veteran is seeking service connection for a left knee disorder and contends that his current left knee disability is a result of an in-service injury and/or his preexisting left knee condition was aggravated due to his active duty service. As to the in-service left knee injury, the Veteran provided that he slipped and slid on the wet deck of an amphibious LARK V during service. See July 2015 Correspondence. Also, the Veteran stated that he was diagnosed with Osgood-Schlatter disease in the left knee when he was in 8th grade, but later X-rays and physical examinations confirmed that the left knee was completely healed. See id. In regard to his left knee condition upon entry to service, the Board notes that the Veteran reported having "swollen or painful joints" during his induction examination. See December 3, 1965 Report of Medical History. Also, an examiner at a separation examination noted the Veteran's left knee Osgood-Schlatter disease in the separation examination report. See September 11, 1967 Report of Medical History. The Veteran underwent a VA examination for knee conditions in December 2013 and the examiner noted the Veteran's diagnosis of degenerative joint disease of the left knee. The examiner provided an etiology opinion on whether the Veteran's left knee condition is related to the diagnosis of Osgood-Schlatter disease noted on his separation examination. However, the Board notes that the December 2013 examiner did not opine on the causal relationship between the Veteran's current left knee condition and his claimed left knee injury. The Board finds the Veteran is competent to describe his in-service left knee injury and the symptoms of his knee, and it must be considered in medical opinions when determining the etiology his current left knee disability. Further, the evidence of record indicates that the Veteran had a left knee replacement surgery in 2016. See e.g., July 2020 Dentistry Procedure Note (the Veteran had left knee joint replacement surgery 4 years ago). As such, the Board finds that the Veteran must be afforded an updated VA medical examination to clarify his current left knee diagnosis and determine its nature and etiology in order to make a fully informed decision on the matter. Accordingly, the matter is REMANDED for the following action: 1. The Agency of Original Jurisdiction must schedule the Veteran for an examination by an appropriate medical examiner to determine the nature and etiology of the Veteran's current left knee disorder. The examiner must review the Veteran's claims file and a copy of this REMAND order in conjunction with the examination. (a.) The examiner must opine whether the Veteran's current left knee disorder is at least as likely as not (50 percent or greater probability) related to service, to include his claimed in-service left knee injury sustained when he slipped and slid on the wet deck of an amphibious LARK V. See July 2015 Correspondence. (a.) The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports, including those of continuity of symptomatology, must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such rejection. (b.) The examiner must clarify whether the Veteran has a current diagnosis of Osgood-Schlatter disease of the left knee. If so, the examiner must opine whether the Veteran's current Osgood-Schlatter's disease was at least as likely as not (50 percent or greater probability) aggravated beyond its natural progression by his active duty service. The examiner must also consider treatment notes and an opinion provided by the Veteran's private physician R.W. when rendering the opinion. See Medical Treatment Records received on October 30, 2015 (Dr. R.W. opined that "it is more likely than not that the patient's knee condition was aggravated beyond normal based on his time in service"). (c.) If the examiner finds that the Veteran's previous diagnosis of Osgood-Schlatter disease of the left knee noted during the September 1967 separation examination is fully resolved, the examiner must provide an explanation/rationale for such finding. Then, the examiner must opine whether the Veteran's current left knee disorder, other than Osgood-Schlatter's disease, is at least as likely as not (50 percent or greater probability) related to his previous diagnosis of Osgood-Schlatter disease of the left knee noted during the September 1967 separation examination. (d.) The Board emphasizes that the examiner must provide a complete written rationale for any opinion offered. Also, importantly, if the examiner cannot provide an opinion, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond based on given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 2. After completing the above actions and any other necessary development, the issue on appeal must be readjudicated. If the claim remains denied, a Supplemental Statement of the Case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Kim, 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.