Citation Nr: 1329621 Decision Date: 09/16/13 Archive Date: 09/20/13 DOCKET NO. 07-20 050 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in North Little Rock, Arkansas THE ISSUES 1. Entitlement to service connection for a right ankle disorder. 2. Whether new and material evidence has been received to reopen the claim for service connection for a low back disorder, and if so whether service connection is warranted to include on a secondary basis. 3. Whether new and material evidence has been received to reopen the claim for service connection for a right knee disorder, and if so whether service connection is warranted to include on a secondary basis. 4. Whether new and material evidence has been received to reopen the claim for service connection for a left knee disorder, and if so whether service connection is warranted to include on a secondary basis. 5. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance or being housebound. ATTORNEY FOR THE BOARD Nadine W. Benjamin, Counsel INTRODUCTION The Veteran (appellant) served on active duty from May 1965 to June 1966. This matter comes to the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in North Little Rock, Arkansas. The claims were remanded by the Board in March 2009, March 2011, and August 2012 for additional development. The Board is satisfied that there was substantial compliance with its remand directives. See Stegall v. West, 11 Vet. App. 268 (1998); Dyment v. West, 13 Vet. App. 141, 146-47 (1999). In this regard, the RO resubmitted the request made in February 2010 to the Records Management Center (RMC) using the name the Veteran used in service. No records were found and it was determined that further efforts to obtain the records would be futile. Also the Veteran was properly notified by VA. The case has been returned to the Board and is ready for further review. When the Veteran submitted his claim in March 2006, he indicated that his low back disorder was secondary to his right ankle disorder and in his October 2007 substantive appeal, he indicated that his bilateral knee disorder was due to his right ankle disorder. Thus the issues before the Board are as noted on the first page of this decision. The issues concerning entitlement to service connection for a low back disorder, a right knee disorder and a left knee disorder are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. The issue of entitlement to SMC is being deferred pending completion of the requested development. FINDINGS OF FACT 1. A right ankle disability did not have its onset in service, and is not the result any in-service event, injury, or disease; arthritis of the right ankle did not manifest in service or within one year after separation from service. 2. In June 2002, the RO denied service connection for a back disorder, a right knee disorder and a left knee disorder. The Veteran did not file a notice of disagreement and the decision became final. 3. Evidence added to the record since the final denial of entitlement to service connection for a back disorder, a right knee disorder and a left knee disorder in June 2002 includes evidence that was not previously before agency decision makers; the evidence relates to an unestablished fact that, when considered with all the evidence of record, raises a reasonable possibility of substantiating the claims. CONCLUSIONS OF LAW 1. The criteria for service connection for a right ankle disorder have not been met. 38 U.S.C.A. §§ 1110, 1131, 5103, 5103A, 5107 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.159, 3.303, 3.307, 3.309 (2013). 2. The June 2002 decision that denied the Veteran's claim for service connection for a low back disorder is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2013). 3. New and material evidence has been received to reopen the claim for service connection for a low back disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2013). 4. The June 2002 decision that denied the Veteran's claim for service connection for a right knee disorder is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2013). 5. New and material evidence has been received to reopen the claim for service connection for a right knee disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2013). 6. The June 2002 decision that denied the Veteran's claim for service connection for a left knee disorder is final. 38 U.S.C.A. § 7105 (West 2002); 38 C.F.R. § 20.1103 (2013). 7. New and material evidence has been received to reopen the claim for service connection for a left knee disorder. 38 U.S.C.A. § 5108 (West 2002); 38 C.F.R. § 3.156(a) (2013). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS VCAA VA's duties to notify and assist claimants in substantiating a claim for VA benefits are found at 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002); 38 C.F.R. §§ 3.102, 3.156(a), 3.159, 3.326(a) (2013). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his or her representative, if any, of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a) (West 2002); 38 C.F.R. § 3.159(b) (2013); Quartuccio v. Principi, 16 Vet. App. 183 (2002). In accordance with 38 C.F.R. § 3.159(b)(1), proper notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. Notice should be provided to a claimant before the initial unfavorable decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). In addition, the notice requirements of the VCAA apply to all five elements of a service-connection claim, including: (1) Veteran status; (2) existence of a disability; (3) a connection between the Veteran's service and the disability; (4) degree of disability; and (5) effective date of the disability. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). Further, this notice must include information that a disability rating and an effective date for the award of benefits will be assigned if service connection is awarded. Id. at 486. In claims to reopen, VA must both notify a claimant of the evidence and information that is necessary to reopen the claim and of the evidence and information that is necessary to establish entitlement to the underlying claim for the benefit that is being sought. Kent v. Nicholson, 20 Vet. App. 1 (2006). In this case, as to the claims to reopen, the Board is granting in full the benefit sought on appeal. Accordingly, assuming, without deciding, that any error was committed with respect to either the duty to notify or the duty to assist, such error was harmless and need not be further considered. As to the issue regarding a right ankle disorder denied below, in October 2001, the RO sent a letter to the Veteran regarding service connection before the issuance of the rating action denying his claim. The letter was compliant as to the service connection issue. With respect to the Dingess requirements, in December 2006, the RO provided the Veteran with notice of what type of information and evidence was needed to establish a disability rating, as well as notice of the type of evidence necessary to establish an effective date. With that letter, the RO effectively satisfied the remaining notice requirements. VA also has a duty to assist claimants in obtaining evidence needed to substantiate a claim. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159 (2013). This duty has also been met, as the Veteran's service, private and VA treatment records have been obtained. Next, VA examinations and medical opinions pertinent to the issue on appeal were obtained. See 38 C.F.R. § 3.159(c)(4) (2013). To that end, when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The Board finds that the VA examinations obtained in this case are more than adequate. The examinations were conducted after a review of the file and adequate opinions were provided. Accordingly, the Board finds that VA's duty to assist with respect to obtaining a VA examination or opinion with respect to the issues on appeal has been met. 38 C.F.R. § 3.159(c) (4). Significantly, neither the Veteran nor his representative has identified, and the record does not otherwise indicate, any additional existing evidence that is necessary for a fair adjudication of the claim that has not been obtained. Hence, no further notice or assistance is required to fulfill VA's duty to assist in the development of the claim. Smith v. Gober, 14 Vet. App. 227 (2000), aff'd, 281 F.3d 1384 (Fed. Cir. 2002); Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also Quartuccio v. Principi, 16 Vet. App. 183 (2002). For the reasons set forth above, and given the facts of this case, the Board finds that no further notification or assistance is necessary, and deciding the appeal at this time is not prejudicial to the Veteran. Service Connection Service connection may be established for disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in line of duty, in the active military, naval, or air service. 38 U.S.C.A. §§ 1110. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). To establish service connection for a disability resulting from a disease or injury incurred in service, or to establish service connection based on aggravation in service of a disease or injury which pre-existed service, there must be (1) competent evidence of the current existence of the disability for which service connection is being claimed; (2) competent evidence of incurrence or aggravation of a disease or injury in active service; and (3) competent evidence of a nexus or connection between the current disability and the disease or injury incurred or aggravated in service. Horn v. Shinseki, 25 Vet. App. 231, 236 (2010); Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. Sept. 14, 2009); cf. Gutierrez v. Principi, 19 Vet. App. 1, 5 (2004) (citing Hickson v. West, 12 Vet. App. 247, 253 (1999)). In many cases, medical evidence is required to meet the requirement that the evidence be "competent". However, when a condition may be diagnosed by its unique and readily identifiable features, the presence of the disorder is not a determination "medical in nature" and is capable of lay observation. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions. Competent medical evidence may also mean statements conveying sound medical principles found in medical treatises. It would also include statements contained in authoritative writings such as medical and scientific articles and research reports or analyses. 38 C.F.R. § 3.159(a)(1). Competent lay evidence means any evidence not requiring that the proponent have specialized education, training, or experience. Lay evidence is competent if it is provided by a person who has knowledge of facts or circumstances and conveys matters that can be observed and described by a lay person. 38 C.F.R. § 3.159(a)(2). Service connection for certain chronic diseases, such as arthritis, may be established on a presumptive basis by showing that the disease manifested itself to a degree of 10 percent or more within one year (three years for active tuberculous disease and Hansen's disease; seven years for multiple sclerosis) from the date of separation from service. 38 U.S.C.A. §§ 1101, 1112; 38 C.F.R. §§ 3.307(a)(3), 3.309(a). In such cases, the disease is presumed under the law to have had its onset in service even though there is no evidence of that disease during the period of service. 38 C.F.R. § 3.307(a). The term "chronic disease" refers to those diseases listed under section 1101(3) of the statute and section 3.309(a) of VA regulations. 38 U.S.C.A. § 1101(3); 38 C.F.R. § 3.309(a); Walker v. Shinseki 708 F.3d 1331 (Fed. Cir. 2013) Where a chronic disease under 3.309(a) is shown as such in service or in the presumptive period so as to permit a finding of service connection, subsequent manifestations of the same chronic disease at any later date, however remote, are service connected, unless clearly attributable to intercurrent causes. 38 C.F.R. § 3.303(b). In cases where a chronic disease is "shown as such in service", the Veteran is "relieved of the requirement to show a causal relationship between the condition in service and the condition for which service connected disability compensation is sought." Walker v. Shinseki 708 F.3d 1331 (Fed. Cir. 2013). Instead, service connection may be granted for subsequent manifestations of the same chronic disease without any evidence of link or connection between the chronic disease shown in service and manifestations of the same disease at a later time. In other words, "there is no 'nexus' requirement for compensation for a chronic disease which was shown in service, so long as there is an absence of intercurrent causes to explain post-service manifestations of the chronic disease." Id. If evidence of a chronic condition is noted during service or during the presumptive period, but the chronic condition is not "shown to be chronic, or where the diagnosis of chronicity may be legitimately questioned," i.e., "when the fact of chronicity in service is not adequately supported," then a showing of continuity of symptomatology after discharge is required to support a claim for disability compensation for the chronic disease. Proven continuity of symptomatology establishes the link, or nexus, between the current disease and serves as the evidentiary tool to confirm the existence of the chronic disease while in service or a presumptive period during which existence in service is presumed." Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the benefit of the doubt shall be given to the claimant. 38 U.S.C.A. § 5107(b). When a reasonable doubt arises regarding service origin, such doubt will be resolved in the favor of the claimant. Reasonable doubt is doubt which exists because of an approximate balance of positive and negative evidence which does not satisfactorily prove or disprove the claim. 38 C.F.R. § 3.102. The question is whether the evidence supports the claim or is in relative equipoise, with the claimant prevailing in either event, or whether a fair preponderance of the evidence is against the claim, in which event the claim must be denied. See Gilbert, 1 Vet. App. at 54. The Veteran's service treatment records show that he was treated during service in July 1965 for complaints a sprain to the lateral aspect of his right ankle one week prior. His June 1966 service separation examination contains no reference to any right ankle complaints and clinical evaluation of the right ankle was normal. After service, the Veteran was examined by VA in May 2002. He stated that while he was in the stockade in service, he was beaten and was kicked in his right ankle. Examination showed no deformity of the right ankle and dorsiflexion was to 10 degrees with plantar flexion to 45 degrees. X-rays revealed minimal spurring at the right ankle. The diagnosis was degenerative joint disease of the right ankle. VA outpatient records show that in May 2003, mild tenderness was noted over the right ankle. In October 2003 he reported having right ankle pain. In August 2004, X-rays of the right ankle showed minimal degenerative changes. Treatment for pain continued by VA into 2011, and private treatment records show treatment into 2011. In an August 2007 letter, a private physician, R.J. E., MD, noted that the Veteran had been seen in the clinic for several years and that his history was that he sustained an injury to his right ankle in basic training in 1965 while on active duty. The examiner opined that the Veteran's current ankle problems are related to his original injury in 1965. The Veteran was examined by VA in November 2007. His history was noted and it was reported that it was in about 2004 that the Veteran was found to have instability and arthritis of the right ankle. The Veteran was examined and it was noted that the ankle was normal in appearance. He had some limitation of motion. The examiner commented that the opinion of the primary care physician that the right ankle disorder is related to the injury in 1965 is speculative and not accompanied by any objective data. In view of the apparent lack of severity of the ankle in 1965, the fact that no fractures or other significant trauma was demonstrated, that he apparently did not have any problems with the ankle until many years later, and that he had no additional injuries, the examiner thought it less likely than not that there is any relationship between the sprain treated in the service and the current ankle problems. The examiner noted that the diagnosis was degenerative arthritis of the right ankle and that the diagnosis is justified on the basis of physical examination and previous X-rays confirming arthritis of the ankle. It was pointed out that however, there is no definite evidence linking the current problems with the injury in 1965. In a September 2010 addendum, after reviewing additional records that had been associated with the claims file, the examiner reiterated the prior conclusion and stated that the additional evidence did not alter the opinion. The above noted private examiner opined in an undated statement received by the RO in June 2012 that the Veteran injured his right ankle in basic training in 1965 with additional injuries while on active duty. It was opined that the injuries sustained in 1965 and 1966 are related to the current problems of the Veteran. Discussion The Board finds that the Veteran's claim for service connection for a right ankle disorder cannot be granted. The Board notes that the evidence shows that the Veteran was treated in service for a right ankle complaint and that he has a current right ankle disorder. Arthritis is present currently but was not shown in service or within the first post service year, and therefore, establishing service connection for the current degenerative condition of the right ankle requires a nexus between that condition and the right ankle sprain noted in service. Walker, 708 F.3d at 1338-39. Treatment for right ankle complaints is not shown after service until many years after discharge, thus service connection on a presumptive basis is not for consideration. It is the responsibility of the Board to weigh the evidence, including the medical evidence, and determine where to give credit and where to withhold the same and, in doing so, the Board may accept one medical opinion and reject others. Evans v. West, 12 Vet. App. 22, 30 (1998). With regard to medical evidence, an assessment or opinion by a health care provider is never conclusive and is not entitled to absolute deference. A bare conclusion, even one reached by a health care professional, is not probative without a factual predicate in the record. Miller v. West, 11 Vet. App. 345, 348 (1998). Further, a medical opinion based on speculation, without supporting clinical data or other rationale, does not provide the required degree of medical certainty. Bloom v. West, 12 Vet. App. 185, 187 (1999). The Board is not bound to accept any opinion (from a VA examiner, private physician, or other source) concerning the merits of a claim. Hayes v. Brown, 5 Vet. App. 60 (1993). Rather, it has a duty to assess the weight or credibility of the evidence in the adjudication of the merits. See Hernandez-Toyens v. West, 11 Vet. App. 379, 382 (1998). Factors that may be considered in assessing the probative value of a medical opinion include a physician's access to the claims file or pertinent evidence, the thoroughness and detail of the opinion, the accuracy of the factual premise underlying the opinion, the scope of examination, the rationale for the opinion offered, the degree of certainty provided, and the qualifications and expertise of the examiner. See generally Prejean v. West, 13 Vet. App. 444, 448-89 (2000); Sklar v. Brown, 5 Vet. App. 140 (1993); Reonal v. Brown, 5 Vet. App. 458 (1993); Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The Veteran was treated in service for right ankle complaints and right ankle arthritis is currently diagnosed. Thus, the first and second requirements for service connection noted in Horn have been met. Here a private examiner has offered opinions which associate the current right ankle disorder with service. However the Board affords the opinion little probative weight. There is no indication that the examiner reviewed any of the Veteran's records. Further, the examiner offered no rationale for the opinions offered. See, Bloom v. West, 12 Vet. App. 185, 187 (1999). By contrast, the opinion offered by the VA examiner was reached after examining the Veteran, documenting his history, and reviewing the claims file. The examiner offered complete rationale, and further discussed why the private examiner's findings were not reliable. Thus the Board assigns greater weight to the negative opinion submitted by the VA examiner. As noted above, lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). See also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Here, the Veteran is not competent to make a medical determination regarding the etiology of his right ankle disorder. See 38 C.F.R. § 3.159 (a)(1) (competent medical evidence means evidence provided by a person who is qualified through education, training, or experience to offer medical diagnoses, statements, or opinions). Arthritis is a disease that is not capable of lay observation. Therefore, although the statements of the Veteran in support of his claim have been given full consideration by the Board, they are not considered competent evidence with regard either to a diagnosis or a nexus between the current right ankle disorder and a disease or injury in service. Barr v. Nicholson, 21 Vet. App. 303, 309 (2007). Whether the current right ankle disability in this case is the result of an ankle sprain in service in 1965 is a medical matter requiring medical evidence for its support and resolution because it may require specialized testing, such as x-rays or MRIs, and knowledge about the nature of sprains and what specific symptoms, if any, are likely to result from sprains. Therefore, medical evidence is required with regard to the nexus or connection of the current ankle disability in this case with a sprain in service because such a determination is not the kind of matter that lay evidence is competent to address. As noted, as there is no evidence of any arthritis of the right ankle manifested to a compensable degree within a year of the Veteran's discharge from active military service in, service connection is not warranted on a presumptive basis. See 38 C.F.R. §§ 3.307, 3.309. Moreover, although the Veteran has a diagnosis of arthritis currently, arthritis was not "clearly diagnosed beyond legitimate question" in service and so this is not a case where subsequent manifestations of the same chronic disease at any later date, however remote, may be service connected under section 3.303(b). 38 C.F.R. § 3.303(b); Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). In addition, because there was no diagnosis of arthritis at all in service, there is no diagnosis that might be legitimately questioned so that the Veteran might establish service connection by a showing of continuity of symptomatology under section 3.303(b). Id. Therefore, that alternative route to establishing service connection does not apply in this case. Rather, medical evidence of nexus between the right ankle condition today and the right ankle condition in service is required for service connection, and the VA negative opinion of record in this case rules out such a connection. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is resolved in favor of the Veteran. 38 U.S.C.A. § 5107(b); 38 C.F.R. § 3.102. In light of the above discussion, the Board must conclude that the preponderance of the evidence is against the Veteran's claim of entitlement to service connection for a right ankle disorder, and there is no doubt to be resolved. 38 U.S.C.A § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). New and Material Evidence Generally, a claim which has been denied in an unappealed RO decision or an unappealed Board decision may not thereafter be reopened and allowed. 38 U.S.C.A. §§ 7104(b), 7105(c) (West 2002). The exception to this rule is 38 U.S.C.A. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. Regardless of the RO's actions, the Board must make an independent determination on whether new and material evidence has been submitted. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001); Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996). A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a) (2013). The United States Court of Appeals for Veterans Claims (Court) has clarified that, with respect to the issue of materiality, the newly presented evidence need not be probative of all the elements required to award the claim as in this case dealing with a claim for service connection. Evans v. Brown, 9 Vet. App. 273 (1996). However, it is the specified bases for the final disallowance that must be considered in determining whether the newly submitted evidence is probative. Id. Such evidence must tend to prove the merits of the claim as to each essential element that was a specified basis for that last final disallowance of the claim. Id. New evidence will be presumed credible solely for the purpose of determining whether the claim has been reopened. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In June 2002, the RO denied service connection for a low back disorder, a right knee disorder, and a left knee disorder and so informed the Veteran that same month. He did not disagree with that rating action and it thus became final. See 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. The evidence considered by the RO consisted of the Veteran's service treatment records, VA treatment records dated in 1999 to 2001, private records dated from 1994 to 1995 and VA examination reports dated in May 2002. The service treatment records showed no treatment for a right knee disorder, a left knee disorder or a low back disorder. VA treatment records were negative for a left knee disorder, or a right knee disorder. VA records showed findings of low back pain and degenerative joint disease. The private records showed no treatment for a low back disorder, a left knee disorder or a right knee disorder. The RO denied the claims finding that the disorders were not shown to have been incurred in or aggravated by service. That determination is final. 38 U.S.C.A. § 7105; 38 C.F.R. § 20.1103. Evidence added to the record since the June 2002 denial consists of duplicate service treatment records, VA treatment records dated from 1999 to 2011, lay statements from the Veteran's wife, VA examinations dated in 2006, 2007, and 2010, and private treatment records beginning in 1975. Among this evidence is an undated statement from a private examiner received by VA in July 2012 in which it is stated that the Veteran had been seen in the examiner's clinic for the past five to six years and that his related history included injuries to his lower back and knees during events at Ft. McPherson Ga., while on active military duty. The examiner stated that the Veteran was provided with prescription treatment for pain and discomfort with these injuries and that the Veteran had been referred to a specialist for additional treatment and support. The examiner opined that it is more likely than not that the injuries sustained while on active duty in 1965 and 1966 are related to the current medical problems of the Veteran. This evidence now associated with the claims file is new as it was not previously of record. As well the evidence is material as it relates to an unestablished fact necessary to substantiate the claims-relating the claimed disorders to service-and it raises a reasonable possibility of substantiating the claims. Thus, new and material evidence has been received and the claims are reopened. 38 U.S.C.A. §§ 5108, 7105; 38 C.F.R. § 3.156. ORDER Service connection for a right ankle disorder is denied. New and material evidence has been received, and the claim for service connection for a low back disorder is reopened. New and material evidence has been received, and the claim for service connection for a right knee disorder is reopened. New and material evidence has been received, and the claim for service connection for a left knee disorder is reopened. REMAND The Veteran is seeking service connection for a low back disorder, a right knee disorder and a left knee disorder. He contends that he had back and bilateral knee injuries in service as the result of an uprising while he was confined in the stockade at Ft. McPherson, Georgia. The Veteran's service personnel records show he was confined in the stockade at Ft. McPherson from October 18, 1965 until May 31, 1966. There is no showing of a complaint, diagnosis or treatment for a low back disorder or for a bilateral knee disorder in the service treatment records. However, the Veteran is competent to attest to having had injuries in service, and he has currently been diagnosed with degenerative joint disease of the low back (see, e.g., VA outpatient treatment of May 2000) as well as spurring of the knees (see, VA X-ray of May 2002) and a May 2002 VA examination finding of degenerative joint disease of both knees). A VA examination with an opinion as to the etiology of the claimed disorders has not been conducted. Under McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006), VA must provide a medical examination in disability compensation (service-connection) claims when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the Veteran qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran's service or with another service-connected disability, but (4) insufficient competent medical evidence on file for VA to make a decision on the claim. McClendon, 20 Vet. App. at 81; see also 38 U.S.C.A. § 5103A (d)(2) (West 2002); 38 C.F.R. § 3.159(c)(4) (2013). Additionally, the Veteran has submitted a statement from a physician offering an opinion regarding the etiology of his low back and bilateral knee disorders. However, the statement is undated, and the address of the examiner is not on the document which has no letterhead. Based on a review of the other documents in the file it appears that the statement is from RJE, MD, of The Family Clinic. The examiner indicates that the Veteran was referred to a specialist; however further information regarding this is not provided. Accordingly, the case is REMANDED for the following action: 1. The RO must contact the Veteran and afford him the opportunity to identify or submit any additional pertinent evidence in support of his claims. The Veteran should be asked to provide clarifying information regarding the above noted undated statement from the private examiner to include confirmation as to the complete name and address of the writer, and any information regarding the indicated referral to a specialist. Based on his response, the RO must attempt to procure complete information and copies of all records which have not previously been obtained from identified treatment sources. All attempts to secure this evidence must be documented in the claims file by the RO. If, after making reasonable efforts to obtain named records the RO is unable to secure same, the RO must notify the Veteran and (a) identify the specific records the RO is unable to obtain; (b) briefly explain the efforts that the RO made to obtain those records; (c) describe any further action to be taken by the RO with respect to the claim; and (d) that he is ultimately responsible for providing the evidence. The Veteran must then be given an opportunity to respond. 2. The Veteran must be afforded the appropriate VA examination to determine whether any low back, right knee or left knee disorder found is related to his military service. All pertinent symptomatology and findings must be reported in detail. Any indicated diagnostic tests and studies must be accomplished. The claims file and all records on Virtual VA must be made available to the examiner, and the examiner must specify in the examination report that the claims file and Virtual VA records have been reviewed. The examiner must specify the dates encompassed by the Virtual VA records that were reviewed. Based on the clinical examination, a review of the evidence of record, and with consideration of the Veteran's statements, the examiner must indicate the etiology of any diagnosed low back disorder, right knee disorder or left knee disorder to include if any disorder found is related to the Veteran's active duty service. A complete rationale for all opinions must be provided. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the examiner must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. The RO must notify the Veteran that it is his responsibility to report for the examination and to cooperate in the development of the claims. The consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2013). In the event that the Veteran does not report for the aforementioned examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. 4. After the development requested has been completed, the RO must 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. 5. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the Veteran's claims must be readjudicated. If any benefit sought on appeal remains denied, the Veteran and his representative must be furnished a supplemental statement of the case and be given the opportunity to respond thereto. The appeal must then be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ M.G. MAZZUCCHELLI Acting Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs