Citation Nr: 24012901 Decision Date: 03/27/24 Archive Date: 03/27/24 DOCKET NO. 20-21 837 DATE: March 27, 2024 REMANDED Entitlement to service connection for left knee disability is remanded. Entitlement to service connection for right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from August 1987 to June 1993 and from October 2001 to April 2002. This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) which, inter alia, denied service connection for right and left knee disabilities. The Veteran's notice of disagreement (NOD) was received by VA in October 2017. Following the issuance of a Statement of the Case in March 2020, the Veteran perfected a timely appeal via his submission of a VA Form 9 in April 2020. In December 2020, the Veteran testified at a virtual hearing before the undersigned Veterans Law Judge. Entitlement to service connection for right and left knee disabilities In conjunction with his claim filed in June 2016, the Veteran was afforded a VA examination in October 2016 at which he reported that that he had a bilateral knee disability which had begun in 1992 as a result of multiple falls. Examination showed full range of motion of both knees with no pain on motion or with weight bearing. Strength and joint stability testing were normal bilaterally. After examining the Veteran and reviewing the record, the VA examiner found "no objective evidence of bilateral knee condition on examination today, only subjective complaints of pain." See VA knee examination dated October 2016. The record also contains a VA contract medical opinion dated February 2020 which was based on review of the Veteran's electronic claims file. The examiner rendered a negative nexus opinion for direct service connection and in the rationale added, "no knee condition has been identified, based on review of medical record, including DBQ 10/2016." See Medical Opinion Disability Benefits Questionnaire (DBQ) dated February 2020. At his December 2020 Board hearing, the Veteran, through his representative, raised a secondary service connection theory of entitlement asserting that "perhaps" his knee condition is related to his service-connected back and hips. See Hearing Transcript at 7. In support of his claim, the Veteran submitted a July 2020 Knee and Lower Leg Conditions DBQ and December 2020 medical opinion completed by Craig T. Bash, M.D., who recorded diagnoses of knee strain, knee tendonitis, knee joint osteoarthritis, knee instability, and patellofemoral pain syndrome of both knees. Dr. Bash indicated that it was his opinion that "Service connection for knees secondary to service-connected hips and lumbar spine is warranted." However, the basis for Dr. Bash's diagnoses is unclear, particularly since an attached May 2020 MRI of the left knee was unremarkable but for mild scarring of the anterior cruciate ligament. Additionally, Dr. Bash's nexus rationale is unclear, appearing to address service connection on a direct basis. Given the evidence currently of record, the Board finds remand is necessary to obtain an additional VA medical opinion clarifying the nature of any current right and left knee disabilities, as well as the etiology of any such disability, to include the newly raised theory of secondary service connection. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any current right and/or left knee disability. After examining the Veteran and reviewing the record, the examiner should provide an opinion, with supporting rationale, as to the following: a) Is it at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current right and/or left knee disability had its inception during active duty or is otherwise causally related to an in-service injury or disease? b) If not, is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current right and/or left knee disability is proximately due to the Veteran's service-connected back and/or hip disabilities, to include claimed gait disturbances caused by those disabilities? c) If not, is at least as likely as not (likelihood is at least approximately balanced or nearly equal, if not higher) that any current right and/or left knee disability is aggravated by the Veteran's service-connected back and/or hip disabilities, to include claimed gait disturbances caused by those disabilities? If aggravation is found, the examiner must provide a baseline level of severity prior to aggravation. In providing the requested opinions, the examiner should consider the relevant evidence of record, to include the Veteran-provided DBQ's dated in July and December 2020, and the December 2020 medical opinion from Craig Bash, M.D. In providing the requested opinions, the examiner should also consider the Veteran's description of his in-service and post-service symptoms. If there is any medical reason to accept or reject the proposition that the reported 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? No credibility determination has been made pending the examiner's opinion. K. Conner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S.A., 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. ยง 20.1303.