Citation Nr: 22018337 Decision Date: 03/29/22 Archive Date: 03/28/22 DOCKET NO. 19-23 510 DATE: March 29, 2022 REMANDED Entitlement to service connection for left knee patellofemoral pain syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 2003 to September 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2018 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2021. A transcript of the hearing is associated with the claims file. 1. Entitlement to service connection for left knee patellofemoral pain syndrome is remanded. As an initial matter, evidence indicates that there may be outstanding relevant VA treatment records. At the October 2021 hearing, the Veteran reported that he had been receiving treatment at the Century Avenue VA clinic in Grand Rapids, MI, to include physical therapy, and has an appointment in October 2021 with an orthopedic doctor. The record does not contain any VA treatment records after July 2020. Any VA treatment records are within VA's constructive possession, and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A VA examiner must consider the Veteran's lay statements regarding the incurrence of a disorder, and his statements regarding the continuity of symptomatology. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). A Veteran is competent to report symptoms that are capable of lay witness observation. See Layno v. Brown, 6 Vet. App. 465, 469 (1994). When the "sole premise" of a medical conclusion is the "lack of notation or treatment" of claimed injuries or symptoms, it is inadequate for rating purposes. Dalton, 21 Vet. App. 23, 39; see Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). The Veteran was afforded a VA examination in April 2018. The examiner opined the Veteran's left knee condition is less likely than not related to service. Her reasoning is that there has been "no continuous care of the left knee condition." Although she noted the Veteran's in-service diagnosis of left knee patellofemoral pain syndrome and his reports of current left knee pain, the examiner solely relied on the lack of documented treatment for left knee pain since his separation in 2004. The Board notes that the absence of documented treatment or complaints in service or thereafter is not fatal to a service connection claim. See Ledford v. Derwinski, 3 Vet. App. 87, 89 (1992). Additionally, the Veteran provided testimony at his October 2021 hearing that further explains his current symptoms and lack of documented treatment after service. Thus, a remand is necessary to obtain an addendum opinion that properly considers and address all of the Veteran's lay statements and does not rely on a lack of documented treatment or complaints. The matters are REMANDED for the following action: 1. Obtain all VA treatment records not currently associated with the claims file, to include all VA treatment records after June 2020. The AOJ should specifically look for records from Century Avenue VA clinic in Grand Rapids, MI, and any appointments with an orthopedic doctor around October 2021. 2. See explanation above for finding the April 2018 VA examination inadequate. 3. Obtain an addendum opinion for the Veteran's left knee condition. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran's service treatment records, post-service medical records, and assertions. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran's left knee condition had its clinical onset during active service or is related to any in-service disease, event, or injury, to include his in-service knee injury and relation through continuity of symptomatology. The examiner must consider and specifically address all of the Veteran's lay statements, to his October 2021 testimony regarding his continuous use of a cane and pain since his in-service injury, and why he did not seek treatment shortly after separation. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. The examiner should not rely solely on the lack of in-service or post-service treatment. Specifically, the examiner should address the factors that affect the Veteran rather than list them. If an examiner cannot provide the requested. opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Papacalos, 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.