Citation Nr: 18144943 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 15-09 140 DATE: October 25, 2018 REMANDED Entitlement to service connection for a right elbow disability is remanded. Entitlement to service connection for residuals of right ring finger fracture is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for congestive heart failure is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for varicose veins and residuals of repair is remanded. Entitlement to service connection for stroke is remanded. Entitlement to a compensable evaluation for service-connected bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from September 1962 to September 1965 and from November 1966 to November 1986. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2014 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). As an initial matter, the Veteran first made claims of service connection for varicose veins, right ring finger fracture, and hypertension in September 2008, which were denied in a March 2009 rating decision that was not appealed. Since that decision became final, the Veteran submitted service treatment records that existed at the time of the 2009 adjudication, but that had not previously been associated with the claims file. These records address a finger injury, treatment for varicose veins, and testing for a cardiovascular condition. VA regulations provide that if, after VA issues a decision on a claim, VA receives or associates with the claims file relevant official service department records that existed and had not been considered when VA first decided the claim, VA will reconsider the claim. 38 C.F.R. § 3.156(c)(1). Therefore, the Board will reconsider the varicose veins, right ring finger fracture, and hypertension claims as initially received in September 2008. 1. The issues of entitlement to service connection for a right elbow disability, residuals of right ring finger fracture, and stroke, and entitlement to a compensable evaluation for service-connected bilateral hearing loss are remanded. Relevant to all claims in this case, the Veteran submitted a statement in July 2018 that he had pertinent medical appointments scheduled in August 2018. It is unclear whether these appointments were at a VA medical center or with a private practitioner, as the record contains both VA and private medical treatment records, so obtaining these records falls within VA’s duty to assist. A remand is therefore necessary to attempt to obtain these records. Regardless of whether the indicated records are only from private providers, the Board notes the most recent VA treatment records are dated July 2013; on remand, the RO should obtain updated VA treatment records. 2. Entitlement to service connection for a bilateral knee disability is remanded. The Veteran’s service treatment records indicate diagnosis of chondromalacia of the right knee, as well as complaints of pain and swelling in both knees. The Veteran’s VA treatment records reflect continued complaints of knee pain. An examination is necessary to determine whether the knee pain and swelling noted in service caused or is otherwise related to the Veteran’s current bilateral knee disability. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). 3. Entitlement to service connection for varicose veins and residuals of repair is remanded. The Veteran’s most recent VA and private treatment records indicate that he is followed for residuals of varicose vein repair performed while he was in service. However, the treatment records are unclear as to whether there are any current residuals of the in-service surgical procedure to strip and repair the varicose veins; likewise, it is unclear whether there are any current varicose veins. An examination is necessary to determine whether there is any current disability, and whether this is related to the Veteran’s in-service varicose vein repair. 4. Entitlement to service connection for congestive heart failure is remanded. An August 1984 consultation result in the Veteran’s service treatment records indicates a possibility of a cardiovascular condition, including coronary artery calcification. A medical opinion is needed to determine whether the risk factors noted in service caused or are otherwise related to the Veteran’s current congestive heart failure disability. See McLendon, 20 Vet. App. at 83. 5. Entitlement to service connection for hypertension is remanded. March 1984 and August 1984 records in the Veteran’s service treatment records show multiple, repeated high blood pressure readings, and further screening to rule out hypertension. It is unclear from these records alone whether hypertension was diagnosed while in service. A medical opinion is required to determine whether the elevated blood pressure readings noted in service caused, developed into, or are otherwise related to the Veteran’s current hypertension. See McLendon, 20 Vet. App. at 83. The matters are REMANDED for the following action: 1. First, ask the Veteran to identify any private treatment that he may have had for the disabilities on appeal that is not already of record, including any records from the August 2, 2018, appointments referenced in the July 2018 written statement. After securing the necessary releases, attempt to obtain and associate those identified treatment records with the claims file. If any identified records cannot be obtained and further attempts would be futile, such should be noted in the claims file and the Veteran should be notified so that he can make an attempt to obtain those records on his own behalf. 2. Obtain all VA treatment records from the Oklahoma City VA Medical Center, and/or any other VA medical facility that may have treated the Veteran, and associate those documents with the claims file. 3. Then, schedule the Veteran for an examination with an appropriate clinician to determine whether any current bilateral knee disability is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all knee disabilities currently found. For each knee disability identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the May 1979 physical profile record for chondromalacia patella of the right knee in the Veteran’s service treatment records. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 4. Schedule the Veteran for an examination with an appropriate clinician to determine whether any residuals of varicose veins or varicose vein repair are related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all current residuals of the varicose veins and the October 1972 surgical repair. For each residual identified, including current varicose veins, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the October 1972 service treatment records describing the surgical procedure and related treatment. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 5. Schedule the Veteran for an examination with an appropriate clinician to determine whether the congestive heart failure is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should identify all heart conditions currently found. For each heart condition identified, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the Veteran’s service treatment records reflecting screenings for cardiovascular conditions. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 6. Schedule the Veteran for an examination with an appropriate clinician to determine whether the hypertension is related to the Veteran’s military service. The claims file must be made available to and be reviewed by the examiner in conjunction with the examination. Following review of the claims file and examination of the Veteran, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the hypertension disability began in or is otherwise caused by the Veteran’s active service. The examiner should address the Veteran’s lay statements regarding continuity of symptomatology since onset and/or since discharge from service. The examiner should address any other pertinent evidence of record, including the Veteran’s repeated high blood pressure readings in service and further screenings to rule out or diagnose hypertension.   All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Josey, Associate Counsel