Citation Nr: 21041453 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 13-34 301 DATE: July 9, 2021 REMANDED The appeal regarding entitlement to service connection for a left knee disability is remanded. REASONS FOR REMAND The Veteran had active service from August 1955 to August 1959. This matter comes before the Board of Veterans' Appeals (Board) from an August 2012 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in March 2018. A transcript is of record. The Board remanded the appeal in May 2018. In October 2019, the Veteran was advised that the Veterans Law Judge (VLJ) who presided over his March 2018 hearing was no longer employed by the Board, and offered him an additional hearing. In October 2019, the Veteran declined an additional hearing. In November 2019, the Board denied service connection for a bilateral knee disability. The Veteran appealed the Board's November 2019 decision to the United States Court of Appeals for Veterans Claims (Court), which in an August 2020 order, granted the parties' joint motion for remand (JMR), vacating the Board's November 2019 decision and remanding the case for compliance with the terms of the JMR. In the August 2020 JMR, the parties determined the Board relied on an inadequate March 2019 VA examination report in denying service connection for a right knee disability. The parties agreed that the Veteran's claim of entitlement to service connection for a left knee disability was inextricably intertwined with the claim of entitlement to service connection for a right knee disability because the Veteran asserts that the left knee disability was caused or aggravated by his right knee disability. In February 2021, the Board granted service connection for a right knee disability and remanded the issue of entitlement to service connection for a left knee disability to obtain an opinion regarding the etiology of that disability. In May 2021, an examiner reviewed the record and determined that the Veteran's left knee disability was not proximately due to or the result of the Veteran's service connected condition. He stated that it was unclear why the Veteran was service-connected for right knee degenerative arthritis, but that it was more likely than not that the left knee disability was due to "natural causes, which include age, chronic wear and tear, family history, etc." He stated that gait accommodation due to the veteran's right knee condition would not cause degenerative arthritis of the contralateral knee, and that such was accepted medical knowledge and practice. He reiterated that simple gait accommodation would not cause this condition. He also stated that there was no evidence of aggravation beyond its natural course, noting that his rationale regarding gait accommodation also applied to aggravation. In June 2021, the Veteran's representative argued that the May 2021 opinion was inadequate. The representative's brief pointed out that examination in March 2019 had identified an instable gait requiring a cane for support. It also noted that during his Board hearing, the Veteran had testified that his left knee symptoms began shortly following his right knee surgery. The June 2021 brief includes references to medical treatise materials indicating that altered gait can affect the joints, and that such is accepted by orthopedists. The representative argued that a complete gait analysis could not be performed with a mere review of the record. The Board concludes that an examination should be conducted, to include review of the treatise materials identified by the Veteran's representative and a discussion of the Veteran's testimony regarding onset of his left knee symptoms. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the etiology of his left knee disability. The claims file must be made available to the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Following review of the record and examination of the Veteran, the examiner should provide an opinion with respect to whether it is at least as likely as not that the Veteran's left knee disability was caused or aggravated by the Veteran's service-connected right knee disability. In rendering this opinion, the examiner should discuss the medical treatise evidence identified in the representative's June 2021 brief, as well as the Veteran's testimony regarding onset of his left knee symptoms following surgery on his service-connected right knee. The examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Then, readjudicate the Veteran's claim, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.