Citation Nr: 18144539 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 13-13 107 DATE: October 24, 2018 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for hypertension, to include as secondary to posttraumatic stress disorder (PTSD), is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the United States Army from January 1988 to January 1992. This matter comes before the Board of Veterans’ Appeals (Board) from a July 2010 rating decision issued by a Regional Office (RO) of the Department of Veterans Affairs (VA). The Board previously considered and remanded this matter in September 2017 for further evidentiary development. 1. Entitlement to service connection for a low back disability, a right knee disability, hypertension, and erectile dysfunction is remanded. As noted above, the Board previously remanded this matter in part to obtain any outstanding service treatment records and to obtain records relating to the Veteran’s claim for disability benefits administered by the Social Security Administration (SSA). It now appears that the Veteran’s service treatment and personnel records are complete. However, there appear to be additional outstanding SSA disability records that have not yet been added to the claims file. Specifically, although the records received from SSA in October 2017 appear to include all of the medical and procedural documents that led to two separate determinations by Administrative Law Judges since 2010, those records also indicate that the Veteran had previously filed a claim for disability benefits with SSA in 1994. As the medical records underlying that determination would appear to relate to a period shortly after the Veteran’s separation from service, the Board finds that they are likely to be highly probative to the current claims for service connection. VA is obligated to obtain records from SSA if there is a reasonable possibility that the records could help substantiate the Veteran’s claim. See Golz v. Shinseki, 590 F.3d 1317, 1322 (Fed. Cir. 2010). With respect to the claims for service connection for a low back disability, right knee disability, hypertension, and erectile dysfunction, the record does not indicate that he has been afforded medical examinations to specifically obtain evidence as to the nature and ideology of any current claimed disability. At the May 2017 Board hearing, the Veteran provided competent evidence that he first started experiences symptoms relating to these claimed disabilities while on active duty and has continued to experience these symptoms after his discharge. The Board finds that these competent reports and the June 2017 statement provided by his boxing coach from service that the Veteran was exempted from many matches in service due to high blood pressure surpasses the “low” threshold established by McLendon v. Nicholson, 20 Vet. App. 79 (2006). As such, he should be afforded medical examinations to determine the nature and etiology of any current low back disability, hypertension, right knee disability, and erectile dysfunction. 2. Entitlement to service connection for a left knee disability and a cervical spine disability is remanded. The Board finds that the issue of entitlement to service connection for a left knee disability and a cervical spine disability must also be remanded at this time to obtain additional SSA disability records. The Board also recognizes that the Veteran has been afforded medical examinations in March 2013 to specifically evaluate the etiology of a neck and left knee disability. The physician who examined the Veteran at that time provided remarkably similar rationales for her ultimate opinions that the Veteran’s current neck and left knee disability were not due to active duty service. With respect to the left knee, this physician noted that there was no report of left knee pain at the time of discharge and that there were no “post-service medical records to support a chronic left knee condition caused by his service.” Concerning the Veteran’s claimed neck disability, she stated that no complaints of neck pain or examination of the cervical spine was performed when the Veteran was struck in the occipital area in service and that the claims file shows no evidence of an ongoing or chronic neck condition while in service. However, the record is clear that the Veteran engaged in significant strenuous activities while in service and has provided competent evidence that he subsequently experienced ongoing symptoms in these joints. The record also contains a supporting lay statement from the Veteran’s in-service boxing coach, who appears to corroborate the Veteran’s report of significant in-service symptoms. For these reasons, and because the examination report does not contain any opinion with respect to the question of whether the Veteran’s in-service head and knee injury could have caused the subsequent development of his current neck and left knee disabilities, the Board finds that it must remand these claims for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records that are not currently of record and associate them with the claims file. 2. Obtain the Veteran’s federal records from SSA that are not currently of record and in particular any records underlying a 1994 denial of disability benefits. Document all requests for information as well as all responses in the claims file. 3. Schedule the Veteran for an examination by an appropriate clinician to obtain an opinion addressing the nature and etiology of any current low back, right knee disability, and erectile dysfunction. The examiner must opine whether it is at least as likely as not that the claimed conditions arose in service or are related to an in-service injury, event, or disease, including the Veteran’s documented in-service boxing experiences. (a.) With respect to the Veteran’s erectile dysfunction, the examiner should also address whether it is at least as likely as not that any current erectile dysfunction is etiologically related to the blows he took “below the belt” during boxing matches or training. 4. Schedule the Veteran for an examination by an appropriate clinician to obtain an opinion as to the nature and etiology of any current hypertension. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the reports from the Veteran’s boxing coach that he was exempt from matches due to elevated blood pressure. The examiner must also provide an opinion regarding the following questions: (a.) Is it at least as likely as not that any current hypertension is proximately due to the Veteran’s service-connected PTSD, to include the medication he receives for PTSD? (b.) Is it at least as likely as not that the Veteran’s hypertension has been aggravated by (worsened in severity beyond the natural progression of the disease) his service-connected PTSD, to include the medication he receives for his PTSD? 5. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left knee and cervical spine disability are at least as likely as not related to his in-service boxing activities and/or in-service assault. If the examiner finds that they did not arise in service, the examiner is asked to specifically address the question of whether it is at least as likely as not that the Veteran’s in-service assault and/or boxing led to the subsequent development of these disabilities. Matthew Tenner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Whitelaw, Associate Counsel