Citation Nr: 18140095 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 14-40 745 DATE: October 2, 2018 REMANDED Entitlement to service connection for a right knee disability, to include as secondary to service connected bilateral pes planus is remanded. Entitlement to service connection for a sinus disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from June 1989 to July 1992 with service in Southwest Asia. In addition, the Veteran had service in the National Guard. The Veteran testified at a video conference hearing in March 2018. The Board acknowledges that the Veteran submitted a Rapid Appeals Modernization Program (RAMP) opt-in election form, however this appeal had already been activated at the Board and is therefore no longer eligible for the RAMP program. 1. Entitlement to service connection for a right knee disability, to include as secondary to service connected bilateral pes planus is remanded. 2. Entitlement to service connection for a sinus disability is remanded. First, evidence indicates that there may be outstanding relevant VA treatment records. In a March 2018 hearing the Veteran reported that he was treated at the Montgomery VA Medical Center in Jackson Mississippi from December 1992 forward and at the Gulf Coast Veterans Health Care System in Biloxi Mississippi from 2010 forward, and has continued to receive VA treatment for the disabilities on appeal. Any VA treatment records are within VA’s constructive possession, and are considered potentially relevant to the issues on appeal. A remand is required to allow VA to obtain them. Next, the Veteran contends that service connection is warranted for a right knee disability, to include as secondary to his service connected bilateral pes planus. The Board cannot make a fully-informed decision on the issue of service connection for a right knee disability because no VA examiner has opined whether secondary service connection is warranted. As such a remand is warranted. Next, the Veteran contends service connection is warranted for a sinus disability. The Board cannot make a fully-informed decision on the issue of service connection for a sinus disability to include allergic rhinitis because no VA examiner has fully opined whether direct service connection is warranted. The Veteran testified in March 2018 of ongoing symptoms of allergic rhinitis since service, and his associated lay statements should be considered. As such a remand is warranted. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from 1992 forward from Montgomery VA Medical Center in Jackson, Mississippi and from the Gulf Coast Veterans Health Care System in Biloxi, Mississippi from 2010 forward. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right knee disability. The examiner must opine whether: (a.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s right knee disability, to include degenerative joint disease is caused by service including the injury while firing a tank-mounted weapon that he described during the Board hearing? (b.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s right knee degenerative joint disease (1) began during active service, (2) manifested within the applicable presumptive period after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? (c.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s right knee disability was caused by his service connected bilateral pes planus? (d.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s right knee disability was aggravated (permanently worsened beyond its natural progression by his service connected bilateral pes planus? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the Veteran’s March 2018 testimony and associated lay statements noting his knee pain began while serving in the Gulf War and that he has had ongoing symptoms since service, and that his service connected bilateral pes planus has worsened his knee pain. In addition, the March 2013 Gulf War VA examination noted right knee degenerative joint disease. The examiner found that the Veteran’s right knee degenerative joint disease was less likely than not caused by or related to Gulf War environmental exposure and such was more likely than not caused by the aging process, cumulative life activities, elevated body mass index (BMI) and genetics. If aggravation is found, please identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of his right knee disability by the service connected bilateral pes planus. 3. Obtain an addendum opinion from an appropriate clinician regarding whether: (a.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s allergic rhinitis is caused by his active service including exposure to airborne hazards in the Persian Gulf? Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the Veteran’s testimony that his symptoms of allergic rhinitis began in-service and have continued since. In addition, attention is invited to the March 2013 VA Gulf War examination which noted allergic rhinitis and the May 2014 VA supplemental opinion which noted that the Veteran has allergic rhinitis a disease with a clear and specific etiology and diagnosis which was not caused by or related to Gulf War environmental exposure. The examiner found that the Veteran’s symptoms of allergic rhinitis can occur anywhere and anytime by inhaled allergens by an individual with a sensitive immune system, coming into contact with common triggers including seasons plants, grasses, weeds, fragrances and other products. J.W. FRANCIS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Kardian