Citation Nr: 21041873 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-30 213 DATE: July 10, 2021 REMANDED Entitlement to service connection for a right knee disorder, to include as due to a service-connected disability, is remanded. Preliminary Matters The Veteran served on active duty from March 1968 to February 1970. His service personnel records confirm his service in the Republic of Vietnam, as well as his participation in combat operations therein. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the June 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Board remanded the claim for entitlement to service connection for a right knee disorder. Additionally, the Board remanded the claim for service connection for a bilateral hip disorder. Thereafter, in an August 2020 rating decision, the RO granted service connection for residuals of both a right and left hip replacement with degenerative arthritis. As such, this issue is no longer before the Board for consideration. REASONS FOR REMAND Pursuant to the Board's October 2019 remand directives, the Veteran was to be scheduled for a VA examination to help determine the nature and etiology of his right knee disorder. The examiner was asked to address whether the Veteran's right knee disorder was directly related to service, to include jumping off helicopter, or secondary to the service-connected left knee and spine disabilities. A VA examination was conducted in December 2019. At that time, the examiner diagnosed the Veteran with a right knee meniscal tear. In a corresponding medical opinion, the examiner opined that the Veteran's condition was not related to a service-connected disability. In support of the opinion, the examiner stated "No[t] enough documents to support relation between right knee condition and left knee. No correlation between left knee pain and developing right knee pain." The examiner did not address whether the Veteran's service-connected spine disability had either caused or aggravated the right knee disorder. Stegall v. West, 11 Vet. App. 268 (1998) (holding claimants are entitled to compliance with Board remand instructions). An opinion as to whether the right knee disorder was directly related to service was also not provided. A request for clarification was submitted by VA to the examiner in April 2020. Specifically, the RO asked the examiner to address direct service connection, to include consideration of the Veteran's duties during service. The examiner noted that there was no mention of a knee condition in service; therefore, there was no supportive documentation to support that his knee condition was related to service. The Board finds the December 2019 and April 2020 VA medical opinions inadequate for several reasons. First, the examiner did not properly address the theory of aggravation. Additionally, the Veteran has now been awarded service connection for both his right and left hip disabilities. On remand, an opinion addressing whether the Veteran's right knee disorder was either caused or aggravated by the Veteran's service-connected disabilities (left knee, spine, and bilateral hips) must be obtained. As it pertains to direct service connection, the VA examiner's opinion was also inadequate as it was impermissibly based solely on the absence of claimed injury in the service records. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (wherein the Court determined an examination was inadequate because the examiner did not comment on the Veteran's report of in-service injury and, instead, relied on the absence of evidence in his service treatment records to provide a negative opinion). Although the Veteran may not have complained of right knee problems in service, the examiner should consider whether his duties (including jumping off helicopters) resulted in the development of the Veteran's right knee disorder. For these reasons, a remand is required. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Provide the Veteran with a VA examination to help determine the nature and likely etiology of the Veteran's right knee disorder. After reviewing the Veteran's claims file and examining him, the examiner is asked to: (a.) For each right knee diagnosis, opine whether it was, at least as likely as not (50 percent or greater probability), incurred in service or otherwise related to it. **Specifically, address the Veteran's lay statements and duties while serving in combat in Vietnam, including jumping off helicopters. (b.) If the Veteran's right knee disorder is not found to be directly related to service, opine whether it, at least as likely as not (50 percent or greater probability), was either caused or aggravated by his service-connected left knee, spine, and/or bilateral hip disabilities. **Please note that for secondary service connection, "aggravation" need not be permanent in nature. See Ward v. Wilkie, 31 Vet. App. 233, 241-42 (2019). (c.) All opinions are to be accompanied by a rationale consistent with the evidence of record. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Casadei, 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.