Citation Nr: 0002851 Decision Date: 02/04/00 Archive Date: 02/10/00 DOCKET NO. 98-00 371 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Lincoln, Nebraska THE ISSUE Entitlement to service connection for a right knee disorder claimed as secondary to a left knee disorder. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD Carole R. Kammel, Associate Counsel INTRODUCTION The veteran served on active duty from November 1974 to July 1976. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 1997 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Lincoln, Nebraska, which denied service connection for a right knee disorder as secondary to the service-connected left knee disorder. In May 1990, the Board denied entitlement to service connection for a right knee disorder on a direct basis. In a December 1994 rating decision, the RO found that no new and material evidence had been submitted to reopen a claim for service connection for a right knee disorder. Although the veteran was informed of the RO's December 1994 decision that same month, she did not perfect her appeal with respect to this issue. A review of the claims file reflects that in recent correspondence submitted by the veteran, she has raised the issue of entitlement to service connection for a right knee disability on a direct basis. Therefore, the issue of whether new and material evidence has been submitted to reopen a claim of entitlement to service connection for a right knee disability is referred to the RO for appropriate action. In November 1996, the veteran filed a claim for service connection for a right knee disorder as secondary to the service-connected left knee disorder. The Board considers this a new claim and the issue has been framed as that listed on the front page of the decision. FINDING OF FACT There is competent medical evidence that the veteran's right knee disorder was caused by the service-connected left knee disorder. CONCLUSION OF LAW The claim of entitlement to service connection for a right knee disorder as secondary to the service-connected left knee disorder is well grounded. 38 U.S.C.A. § 5107(a) (West 1991). REASONS AND BASES FOR FINDING AND CONCLUSION As a preliminary matter, the Board finds that the veteran's claim of entitlement to service connection for a right knee disorder as secondary to the service-connected left knee disorder is well grounded under the provisions of 38 U.S.C.A. § 5107(a) (West 1991). That is, the Board finds that the veteran's claim is plausible and capable of substantiation. In this respect, service connection may be granted for disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C.A. § 1110 (West 1991). A disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a) (1999). See Allen v. Brown, 8 Vet. App. 448 (holding that when aggravation of a non-service-connected disorder is proximately due to or is the result of a service- connected disability, that extent of aggravation is service connected on a secondary basis.) The Board finds the veteran's claim to be well grounded based on the November 1998 opinion of a VA physician who opined that the veteran's right knee disorder was the result of, or had been caused by, the stress and extra pressure placed on it by the service-connected left knee disorder. ORDER The claim of entitlement to service connection for a right knee disorder as secondary to the service-connected left knee disorder is well grounded. REMAND Based on the foregoing medical opinion of the VA physician in November 1998, the Board finds the veteran's claim to be well grounded. The Board observes, however, that while the November 1998 VA examiner had previously treated the appellant for her right knee, there is no indication that his opinion was based on a contemporaneous and thorough examination of the veteran or a review of her medical history. In this regard, the Board observes that in 1993, the veteran suffered a post-service injury to her right knee at work which necessitated a right knee arthroscopy and debridement of the patella and several additional surgeries. Therefore, prior to final appellate review, the Board is of the opinion that an additional clarification is warranted prior to further Board action on this claim. See Abernathy v. Principi, 3 Vet. App. 461, 464 (1992) (if an examination report is incomplete, the Board must await its completion, or order a new examination, before deciding the veteran's claim). Therefore, in order to fully and fairly adjudicate the veteran's claim, this case is REMANDED to the RO for the following action: 1. The RO should contact the veteran and request that she identify specific names, addresses, and approximate dates of treatment for all health care providers, private and VA, from whom she has received treatment since service for her right knee disability. When the requested information and any necessary authorization have been received, the RO should attempt to obtain copies of all pertinent records which have not already been obtained. 2. Thereafter, the veteran should be afforded a VA examination by a Board certified orthopedist, if available, to determine the nature and extent of any right knee disability found on examination. Any special diagnostic tests including X-rays, range of motion studies, stability tests and strength tests deemed necessary should be performed. The claims folder must be provided to the examiner for review prior to the examination. After a complete review of the claims file, to specifically include the November 1998 VA opinion and relevant post-service history with respect to the right knee, the examiner must then provide an opinion whether it is at least as likely as not that any currently diagnosed right knee disorder is either caused or aggravated by the appellant's service-connected left knee disorder. If any right knee disorder is found to have been chronically worsened by the veteran's service-connected left knee disability, the physician is requested to render an opinion as to the degree of the right knee disability which would not be present but for the service-connected left knee disability. The opinions expressed should be accompanied by a written rationale. The examination report should be typed. 3. After the development requested has been completed, the RO should review the examination report to ensure that it is in complete compliance with the directives of this REMAND. If the report is deficient in any manner, the RO must implement corrective procedures at once. 4. Then, after undertaking any development deemed necessary in addition to that specified above, the RO should readjudicate the issue of entitlement to service connection for a right knee disorder secondary to the service- connected left knee disorder. If the benefit sought on appeal is not granted, the RO should issue a supplemental statement of the case. The veteran and her representative should then be provided an opportunity to respond. Thereafter, the case should be returned to the Board for further appellate consideration, if otherwise in order. By this REMAND, the Board intimates no opinion as to any final outcome warranted. No action is required of the veteran until she is otherwise notified by the RO. F. JUDGE FLOWERS Member, Board of Veterans' Appeals