Citation Nr: 18145905 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 17-24 456 DATE: October 30, 2018 REMANDED Entitlement to a compensable rating for left wrist, status post ganglion cyst. Entitlement to service connection for a right shoulder disability is remanded. Entitlement to service connection for right arm pain is remanded. Entitlement to service connection for left arm pain is remanded. Entitlement to service connection for lumbar spine degenerative disc disease, claimed as a low back disability is remanded. Entitlement to service connection for left knee arthritis is remanded. Entitlement to service connection for right knee arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1979 to November 1989. The Veteran also had additional service in the National Guard. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2016 rating decision of the Department of Veterans Affairs (VA). The Board has recharacterized the Veteran’s left wrist claim because the medical evidence of record is not clear as to whether the award of service connection for a left wrist injury fully addresses the entirety of his claim. The Board has also recharacterized the Veteran’s right shoulder and right arm disabilities to fully address the entirety of those claims. 1. Entitlement to a compensable rating for a left wrist disability. The Veteran attended a VA examination for a left wrist injury in July 2016. The Board acknowledges that the examiner provided a nexus opinion for the Veteran’s condition; however, the examiner did not include any range of motion measurements regarding the Veteran’s left wrist. The July 2016 VA examination report has range of motion estimates for the Veteran’s right wrist, but the record is silent regarding the range of motion estimates for the Veteran’s service-connected left wrist. As such, the Board does not have the necessary medical information to adequately evaluate the severity of the Veteran’s left wrist disability. Thus, a remand is required to obtain a complete medical opinion regarding the severity of the Veteran’s service-connected left wrist disability. See 38 U.S.C. § 5103A(d) (2012); 38 C.F.R. § 3.310 (2015); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); Bloom v. West, 13 Vet. App. 185, 187 (1999) (a medical opinion without supporting clinical data or other rationale does not provide the required degree of medical certainty). 2. Entitlement to service connection for a right shoulder disability is remanded. The Veteran attended a VA examination for this issue in July 2016. The examiner found that it was less likely as not that the Veteran’s right shoulder disability was related to his military service. The Board finds this opinion inadequate because the examiner did not provide a thorough and well-reasoned opinion regarding the nature and etiology of the Veteran’s condition. Specifically, the Board notes that the examiner did not acknowledge the Veteran’s lay statements nor did the examiner acknowledge the Veteran’s in-service complaints of bilateral arm pain and bilateral shoulder pain. Thus, a remand is required to obtain a complete medical opinion regarding the nature and etiology of the Veteran’s right shoulder disability. See Barr, supra; Bloom, supra. 3. Entitlement to service connection for right arm pain is remanded. 4. Entitlement to service connection for left arm pain is remanded. The Veteran attended a VA examination for these disabilities in July 2016. The Board notes that the examiner did not acknowledge the Veteran’s in-service complaints of arm pain or lay statements. In addition, the examiner failed to provide an opinion regarding the nature and etiology of the Veteran’s claims for service connection for bilateral arm pain. Thus, a remand is required to obtain a medical opinion regarding the nature and etiology of the Veteran’s claimed bilateral arm disabilities. See Barr, supra; Bloom, supra. 5. Entitlement to service connection for lumbar spine degenerative disc disease claimed as a low back disability is remanded. The Veteran attended a VA examination for this issue in July 2016. The examiner found that it was less likely as not that the Veteran’s low back disability was related to his military service. The Board finds this opinion inadequate because the examiner did not provide a thorough and well-reasoned opinion regarding the nature and etiology of the Veteran’s condition. Specifically, the Board notes that the examiner acknowledged that the Veteran’s service treatment records showed several years of complaints regarding low back pain, but the examiner failed to explain how the Veteran’s in-service injuries did not cause the Veteran to develop his current disability. Thus, a remand is required to obtain a complete medical opinion regarding the nature and etiology of his low back disability. See Barr, supra; Bloom, supra. 6. Entitlement to service connection for left knee arthritis is remanded. 7. Entitlement to service connection for right knee arthritis is remanded. The Veteran attended a VA examination for these disabilities in July 2016. The examiner found that it was less likely as not that the Veteran’s left and right knee disabilities were related to his military service. The Board finds this opinion inadequate because the examiner did not provide a thorough and well-reasoned opinion regarding the nature and etiology of the Veteran’s conditions. Specifically, the Board notes that the examiner simply stated that the “Veteran denies any knee injury during service.” This statement is contrary to the Veteran’s contentions and his lay statements. Thus, a remand is required to obtain a complete medical opinion regarding the nature and etiology of his left and right knee disabilities. Barr, supra; Bloom, supra. The matters are REMANDED for the following action: 1. Contact the Veteran to obtain outstanding private treatment records and associate any outstanding VA treatment records. 2. Schedule the Veteran for an examination to determine the severity of his left wrist disability. (A). Full range of motion testing must be performed where possible. The joints involved should be tested in both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of the opposite undamaged joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain the basis for this decision. (B). In the event that that the Veteran reports that his disabilities result in flare-ups, the examiner should request the Veteran to identify the extent of his functional loss during a flare-up and, if possible, offer range of motion estimates based on that information. If the examiner is unable to provide an opinion on the impact of any flare-ups on range of motion, he/she should indicate whether this inability is due to lack of knowledge among the medical community or based on the lack of procurable information. 3. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s right shoulder disorder. The Veteran’s electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all right shoulder disorders that are present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s right shoulder disorder, had its onset in service or is caused by or related at least in part to his active service? The examiner’s opinion should include a discussion of the Veteran’s in-service complaints of pain in his shoulders. See September 26, 1988, service treatment record. The examiner’s opinion should also consider the Veteran’s duties as a helicopter mechanic. 4. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s right and left arm disorders. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all arm disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left and right disorders had their onset in service or are caused by or related at least in part to his active service? The examiner’s opinion should include a discussion of the Veteran’s in-service complaints of pain in his arms. See September 26, 1988, service treatment record. The examiner’s opinion should include a discussion of the Veteran’s report of left arm pain. See May 2, 1989 service treatment record. The examiner’s opinion should also consider the Veteran’s duties as a helicopter mechanic. 5. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s low back disorder. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all low back disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s low back disorder, had its onset in service or is caused by or related at least in part to his active service? The examiner’s opinion should include a discussion regarding the Veteran’s complaints of back pain throughout his service on active duty. See February 1981, service treatment record, October 5, 1981, physical examination, July 13, 1981, service treatment record, and January 29, 1986, service treatment record. The examiner’s opinion should also consider the Veteran’s duties as a helicopter mechanic. 6. Schedule the Veteran for an appropriate VA examination to determine the nature and etiology of the Veteran’s left and right knee disorders. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. After a review of the claims file, the examiner should provide answers to the following questions: (A). Identify all left and right knee disorders that are currently present. (B). Is it at least as likely as not (50 percent probability or greater) that the Veteran’s left and right knee disorders, had their onset in service or are caused by or related at least in part to his active service? The examiner’s opinion should also consider the Veteran’s duties as a helicopter mechanic. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced. The VA examination report must include a complete rationale for all opinions expressed. In providing the requested opinions, the examiner cannot rely exclusively on the absence of relevant treatment in the Veteran’s medical history. If the examiner feels that any of the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Rescan, Associate Cousel