Citation Nr: 18146288 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 16-39 634 DATE: October 31, 2018 REMANDED Service connection for a left knee disorder is remanded. Service connection for hypertension is denied. REASONS FOR REMAND Service connection for (1) a left knee disorder and (2) hypertension is remanded. The Board cannot make a fully-informed decision on the issues of service connection because adequate VA examinations have not been obtained. For the hypertension claim, the September 2014 VA examination opinion is contradictory. The examiner first found that the Veteran had mild hypertension prior to service, as documented by the on the March 1986 enlistment examination (with a reading of 140/84). Then the examiner found that the Veteran had a normal blood pressure on the June 1993 separation examination (with a reading of 142/92). A VA medical opinion is necessary to determine if the Veteran had hypertension that pre-existed service and if so was aggravated beyond the natural progression by service, or whether he has hypertension that is otherwise due to service. For the left knee disorder claim, the September 2014 VA examiner’s opinion appears to be solely based on a lack of medical treatment over the years. During the VA examination, the Veteran provided lay testimony of a pre-service injury that worsened during service and chronic symptoms. An examiner may not ignore that lay evidence and base his opinion that there is no relationship to service on the absence of in-service corroborating medical records. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007). An addendum medical opinion is necessary to address this claim. In the July 2012 VA medical record, the Veteran indicated that he was transferring his care to VA for insurance reasons and indicated treatment with his prior provider for hypertension. A remand is required to allow VA to obtain authorization and request these records. Evidence indicates that there may be outstanding relevant VA treatment records. A remand is required to allow VA to obtain them. The matters are REMANDED for the following actions: Following a review of the claims file, the VA medical opinion provider should offer an opinion on the following: 1. Obtain any unassociated VA medical records. 2. Ask the Veteran to complete a VA Form 21-4142 for his prior private treatment providers, as indicated in his July 2012 report of transfer of treatment to VA. Make two requests for the authorized records from any identified facilities, unless it is clear after the first request that a second request would be futile. 3. After the requested record development has been accomplished, obtain an addendum medical opinion for the hypertension claim. The claims file should be reviewed. If a VA examination is deemed warranted by the VA medical opinion provider, one should be obtained. The examiner must opine whether: (a) Does the Veteran currently have hypertension? (b) Does the evidence of record clearly and unmistakably show that hypertension existed prior to his entry into active duty in January 1990? (i) If the answer is yes, does the evidence of record clearly and unmistakably show that the preexisting hypertension was not aggravated by service or that any increase in disability was due to the natural progression of the disease? Please identify any such evidence with specificity. (c) If the answer to (b) is no, is it at least as likely as not that any currently diagnosed hypertension, is related to, or developed during, the Veteran’s active duty? 4. After the requested record development has been accomplished, obtain an addendum medical opinion for the left knee disorder claim. The claims file should be reviewed. If a VA examination is deemed warranted by the VA medical opinion provider, one should be obtained. The examiner must opine whether: (a) Does the Veteran currently have a left knee disorder? (b) Does the evidence of record clearly and unmistakably show that left knee disorder existed prior to his entry into active duty in January 1990? (i) If so, what type of left knee disorder? (ii) If the answer is yes, does the evidence of record clearly and unmistakably show that the preexisting left knee disorder was not aggravated by service or that any increase in disability was due to the natural progression of the disease? Please identify any such evidence with specificity. (c) If the answer to (b) is no, is it at least as likely as not that any currently diagnosed left knee disorder, is related to, or developed during, the Veteran’s active duty? The examiners are asked to provide a complete rationale for all opinions. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Lindio