Citation Nr: 21042557 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 14-28 796 DATE: July 13, 2021 REMANDED Entitlement to service connection for a right hip disorder, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. REASONS FOR REMAND The Veteran served in the United States Army on active duty from February 1979 to February 1982. These issues come before the Board of Veterans' Appeals (Board) on appeal from a June 2013 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). These issues were before the Board in September 2017, April 2019, July 2020, and January 2021. The issues were previously remanded for further development. 1. Entitlement to service connection for right hip disorder, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is remanded. In January 2021, the Board remanded the claim of service connection for a right hip disorder for an etiology opinion as to whether any hip disorder was aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis. In an April 2021 opinion, the examiner noted that as there is no evidence for continuous or even persistently recurrent right hip findings or diagnoses over time, no chronic right hip disorder can be confirmed for Veteran. The examiner further noted that without evidence for a chronic right hip diagnosis, no etiology for a right hip disorder or progression or aggravation for a right hip disorder can be established. However, during an October 2020 VA examination, the examiner noted a diagnosis of left hip strain and functional limitations including difficulty standing, walking or sitting for prolonged periods of time. As the Veteran has had a right hip disorder at some point during the pendency of the appeal, a disorder is conceded, and an aggravation opinion is necessary. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Thus, the appeal must again be remanded for an aggravation opinion. Stegall v. West, 11 Vet. App. 268, 271 (1998). 2. Entitlement to service connection for right knee disorder, to include as secondary to service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis, is denied. In January 2021, the Board remanded the claim of service connection for a right knee disorder for an opinion as to whether any right knee disorder is aggravated by his service-connected left knee medial meniscal tear with chondromalacia and osteoarthritis. In an April 2021 opinion, the examiner noted the Veteran developed right knee degenerative joint disease as of 2013, with associated medial meniscal tear, over 30 years after time in service. The examiner further opined that while Veteran did develop mild degenerative joint disease with loss of range of motion over time, beginning in 2013, it cannot be established the Veteran's degenerative joint disease progressed more rapidly or more severely over time than expected for the disorder. The examiner reasoned that as Veteran's right knee disorder has slowly progressed or continued over years, as expected for the disorder, it is not possible that Veteran's service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis aggravated Veteran's right knee disorder. However, the Board notes that the Veteran complained of right knee pain due to compensating for his left knee as early as March 1991 and, at that time, the examiner noted the Veteran walked with a very slight limp as he favored the left leg. As the examiner noted the very slow development of the Veteran's right knee degenerative joint disease, another opinion is necessary that considers the Veteran's complaints prior to his diagnosis of degenerative joint disease. See, e.g., Reonal v. Brown, 5 Vet. App. 460, 461 (1993). Thus, the appeal must again be remanded for an aggravation opinion. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an addendum opinion from the examiner who provided the April 2021 VA opinion, or, if not available, another appropriately qualified VA orthopedic clinician. The claims file should be reviewed in conjunction with the examination. A copy of this remand should be made available to the examiner. The need for further in-person examination is left to the discretion of the examiner. Following a review of the entire record, the Veteran's competent lay statements, as well as the Veteran's report regarding the onset and progression of his current symptomatology, the examiner should opine as to the following: (A) Is it at least as likely as not (50 percent probability or more) that the Veteran's right hip disorder is aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis? (B) Is it at least as likely as not (50 percent probability or more) that the Veteran's right knee disorder is aggravated by his service-connected left knee lateral medial meniscal tear with chondromalacia and osteoarthritis? The examiner must provide a comprehensive report including a clearly stated rationale for any opinions offered and conclusions reached, citing the objective medical findings leading to the conclusions, and must not be based solely on the lack of records. In this regard, the Board emphasizes that the Veteran is competent to report his symptoms and history, and such statements by the Veteran regarding symptomatology and medical history must be specifically acknowledged and considered in formulating any opinions concerning the onset and severity of his disability. If such reports are rejected by the examiner, a reason for doing so must be provided. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. M. Donahue Boushehri, 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.