Citation Nr: 24010239 Decision Date: 03/04/24 Archive Date: 03/04/24 DOCKET NO. 20-10 782 DATE: March 4, 2024 REMANDED Service connection for right knee pain is remanded. Service connection for left knee pain is remanded. REASONS FOR REMAND The Veteran had active service in the United States Marine Corps Reserves from December 2008 to January 2010, and from February 2012 to March 2013. These matters come before the Board of Veterans' Appeals (Board) from a July 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran submitted a Notice of Disagreement (NOD) in June 2019 and a Statement of the Case (SOC) was issued in January 2020. The Veteran perfected the appeal by submitting a VA Form 9 in March 2020. A Supplemental Statement of the Case (SSOC) was issued in January 2024. 1. Service connection for right knee pain is remanded. 2. Service connection for left knee pain is remanded. After a review of the evidence, the Board finds that additional evidentiary development is necessary. The Board notes that the December 2019 examiner based his medical opinion solely on the absence of contemporaneous medical evidence. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) ("[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence"). His rationale was simply that "there is no evidence of chronic knee pain with onset, development, and continuance from military service." The Veteran was diagnosed as having bilateral knee tendonitis/tendinosis and reported that he developed chronic knee pain around 2012. The December 2019 VA examiner also effectively relied on an improper credibility determination while rendering an opinion as the Veteran reported that he has had symptoms during service, yet the examiner relied on the absence of contemporaneous medical evidence supporting his statements. See Sizemore v. Principi, 18 Vet. App. 264, 275 (2004) ("To the extent that the examining psychiatrist is expressing an opinion on whether the appellant's claimed in-service stressors have been substantiated, that is a matter for determination by the Board and not a medical matter"); Owens v. Brown, 7 Vet. App. 429, 433 (1995) (It is the responsibility of the Board, not the examiner, "to assess the credibility and weight to be given to evidence"). The Board also finds that the June 2018 VA medical opinion to be inadequate as it only answered whether the Veteran's bilateral knee problems had a clear and specific etiology. The examiner also made a conclusory statement that the Veteran's bilateral knee tendonitis was due to "intense physical training of the Marine Corps" without adequate rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) ("most of the probative value of a medical opinion comes from its reasoning"); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions"). The June 2018 VA medical opinion is also ambiguous as it is unclear when the "intense physical training" took place. Thus, the Board finds that the medical opinions of record are inadequate and that the matters must be remanded. When VA obtains an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Prepare a memorandum for the record that explains and identifies the period(s) of ACDUTRA or INACDUTRA. 2. Obtain an addendum VA medical opinion regarding the Veteran's bilateral knee disability. Specifically, the examiner must opine whether it is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that the Veteran's diagnosed knee disabilities were caused/aggravated by the Veteran's service, to include him "carrying packs and loads sometimes up to 80 plus pounds and hiking for up to 13 miles," and/or his service-connected disabilities. The examiner is advised that aggravation means any increase in the severity of the underlying disability beyond its natural progression. If aggravation is found, the examiner should attempt to quantify the degree of additional disability resulting from the aggravation. The examiner must provide a complete rationale for his or her opinion(s) in the examination report. The examiner may not solely rely on the absence of contemporaneous evidence and must accept the Veteran's lay statements of time of onset, duration, and description of symptoms as accurate. The examiner may, however, point out medical evidence that are contrary to the Veteran's statements or suggests alternative explanations. The examiner is also directed to explain the nature of the Veteran's current knee disabilities and the nature of such disabilities, to include possible causes, symptoms, and how long it takes for such disabilities to resolve, as compared to the Veteran's report of onset, duration, and symptoms. Lastly, the examiner must discuss the June 2018 VA medical opinion that found that the Veteran's current knee disabilities were caused by the Veteran's "intense physical training." If any of the above requested opinions cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that question. The need for another examination is left to the discretion of the examiner offering the addendum opinion. Paulette Vance Burton Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H.S. Yun 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.