Citation Nr: 22005643 Decision Date: 02/02/22 Archive Date: 02/02/22 DOCKET NO. 19-22 126 DATE: February 2, 2022 REMANDED The claim of entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran had active duty for training (ACDUTRA) from October 1984 to February 1985, and active duty from February 1986 to August 1991. This matter comes before the Board of Veterans' Appeals (Board) from a July 2017 rating decision by the Agency of Original Jurisdiction (AOJ). The Board denied the Veteran's claim in January 2020. He appealed to the United States Court of Appeals for Veterans Claims (Court). In September 2020, the Court granted the parties' Joint Motion for Remand (JMR), and remanded the matter for action consistent with the terms of the JMR. In the September 2020 JMR, the parties agreed that the Board erred in finding that VA had satisfied its duty to assist, specifically its duty to obtain an adequate medical examination and opinion. They pointed out that on VA examination in August 2016, the examiner premised his negative nexus opinion in part on his determination that the record was silent regarding any knee condition. The parties noted that service treatment records reflected complaints of right knee symptoms and an assessment of ligament strain in November 1986 and September 1988. They additionally noted that the Veteran reported a history of trick or locked knee and leg cramps on separation examination in February 1991, and that he also reported right knee pain while standing for extended periods, and while running. They agreed that the examiner's opinion was based, in part, on an inaccurate factual premise, and that remand was required to ensure that an adequate VA medical opinion was obtained. The parties also pointed out that the Veteran, in his July 2019 substantive appeal, had stated that he had experienced right knee pain continually since service. They agreed that, on future examination, the examiner should address the Veteran's contentions. In March 2021, the Board remanded this matter to the Agency of Original Jurisdiction (AOJ) to conduct further development consistent with the September 2020 JMR. The AOJ arranged for the Veteran to be examined by a third-party contractor, but in October 2021, the Veteran informed VA that he was unable to attend the examination and did not wish for another appointment. Although the Veteran is free to decline further examination, the Board is required to ensure substantial compliance with the prior Court and Board remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). As such, the Veteran's claims file should be forwarded to a VA medical examiner for review, without an in-person examination. The VA examiner is asked to provide a medical opinion regarding the nature and etiology of the Veteran's right knee disability, with consideration of the Veteran's statements regarding continuity of symptomatology. The matters are REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding the Veteran's right knee disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is it at least as likely as not that the right knee disability (1) began during, or is otherwise related to, active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinions. In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? The examiner must specifically discuss the following information: (a.) Service treatment records reflect complaints of right knee symptomology and an assessment of a medial collateral ligament (MCL) strain and lateral collateral ligament (LCL) in November 1986 and September 1988. (b.) At separation examination, the Veteran reported a history of a tricked or locked knee and leg cramps from a ligament pull in 1986. He also reported right knee pain while standing for extended periods of time or running, including an instance where he failed a physical training test because of his sore knee. (c.) In an April 2017 written statement, the Veteran reported that he has experienced continual knee difficulties since a football injury in 1986. In the July 2019 Appeal to the Board of Veterans Appeals, the Veteran reported that he stopped medical treatment because he was informed that he would experience continuing issues with his knee, so he treated his condition with over-the-counter medication. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Casey, 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.