Citation Nr: 22018970 Decision Date: 03/31/22 Archive Date: 03/30/22 DOCKET NO. 00-06 272 DATE: March 31, 2022 REMANDED Entitlement to service connection for bilateral knee disability, to include as secondary to service-connected chronic lumbar strain, residuals of right hip stress fracture, and/or sciatica of the right lower extremity, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from March 1988 to August 1988. This matter is on appeal to the Board of Veterans' Appeals (Board) from a September 1997 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2008, the Veteran testified at a hearing before a Veterans Law Judge (VLJ) who has since retired. A transcript of that hearing is of record. The Veteran was notified by letter in July 2017 and August 2018 that the VLJ who conducted the October 2008 hearing has since left the Board and she was offered an opportunity to have another hearing before a different VLJ. The Veteran declined another hearing. See March 2019 Correspondence. Therefore, the Veteran's request for a Board hearing is deemed withdrawn. See 38 C.F.R. § 20.704(d), (e). The Board notes that while the Veteran has retained representation, she is considered pro se for the current claim for service connection for bilateral knee disability. See December 2016 Correspondence, December 2016 Status Letter, December 2021 Third Party Correspondence. This case has a long procedural history, to include being remanded in March 2009, August 2011, May 2013, September 2017, December 2019, and June 2021 to the Agency of Original Jurisdiction (AOJ) for additional development. Unfortunately, while the Board regrets the delay, further development is necessary prior to final adjudication. As the Veteran raised a contention on secondary service connection grounds, in a September 2017 remand, the Board directed the AOJ to obtain an addendum VA medical opinion addressing whether the Veteran's bilateral knee disability was caused or aggravated by her service-connected chronic lumbar strain, residuals of right hip stress fracture, and/or sciatica of the right lower extremity. The Board notes that the service-connected chronic lumbar strain has since been recharacterized as chronic lumbar strain with degenerative joint disease of the L5-S1 with sciatic radiculopathy. See November 2021 Rating Decision Codesheet. However, in the May 2018 opinion, the examiner only addressed aggravation, and failed to provide an opinion on whether her bilateral knee disability was secondary to her service-connected sciatica of the right lower extremity. Further, during her October 2008 hearing, the Veteran had reported seeking treatment and an eventual surgery for her knees within a year after her separation. See October 2008 Hearing Tr. at 3-7. In the most recent June 2021 remand, the Board directed the AOJ to obtain an addendum VA medical opinion addressing direct service connection. Specifically, the examiner was asked to comment on the treatment records showing arthritis changes in 1992 and a February 2003 internal medicine examination (located in the Social Security Administration (SSA) records) which indicates a history of bilateral knee surgery in 1989. An opinion obtained in October 2021 is incomplete as the examiner did not address the report of knee surgery in 1989. Based on the foregoing, the Board finds that another medical opinion should be obtained. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to her knee claim. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken, to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to the following: (a.) Whether the current bilateral knee disability onset during service or is otherwise related to an in-service injury, event, or disease. In offering the opinion, the examiner must consider the treatment records showing arthritis changes in 1992 and the February 2003 internal medicine examination (located in the SSA records) which indicates a history of bilateral knee surgery in 1989. This is necessary for substantial compliance with the Board's remand instructions. (b.) Whether the current bilateral knee disability was caused by the service-connected chronic lumbar strain, residuals of right hip stress fracture, and/or sciatica of the right lower extremity. (c.) Whether the current bilateral knee disability was aggravated (worsened beyond natural progression) by the service-connected chronic lumbar strain, residuals of right hip stress fracture, and/or sciatica of the right lower extremity. The examiner is advised that the aggravation does not need to be permanent. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.