Citation Nr: 18146291
Decision Date: 10/31/18	Archive Date: 10/31/18

DOCKET NO. 16-33 064
DATE:	October 31, 2018
REMANDED
Entitlement to service connection for bilateral knee pain is remanded.
Entitlement to service connection for left ankle pain is remanded.
Entitlement to service connection for bilateral hearing loss is remanded.
REASONS FOR REMAND
The Veteran served on active duty from November 2007 to October 2014.
1. Entitlement to service connection for bilateral knee pain is remanded.
2. Entitlement to service connection for left ankle pain is remanded.
3. Entitlement to service connection for bilateral hearing loss is remanded.
At the outset, the evidence of record indicates that the Veteran has been undergoing hormone replacement therapy since 2009 in San Diego. However, these records have not been associated with the claims file and suggest that there may be additional outstanding medical records that could potentially address the Veteran’s claims for service connection for left ankle and bilateral knee disabilities. To this end, the Board notes that there appears to be a significant (roughly 30-month) gap between the Veteran’s records of treatment in service and the VA outpatient treatment records contained in the claims file, which presently begin in May 2017. Given the history presented, the Board notes that it would seem near-certain that significant medical treatment was provided during this period. Therefore, on remand, the RO should contact the Veteran to identify and obtain any outstanding VA and/or private medical records related to treatment of the claimed disabilities.
Furthermore, the Veteran was afforded a VA examination in August 2016, and a subsequent medical opinion was obtained in February 2018, to determine the nature and etiology of the left ankle disability. The August 2016 examiner indicated that the Veteran’s left ankle disability began in 2012, while the addendum opinion referred to an acute injury in July 2011. However, while the Veteran’s service treatment records contain numerous references to a right ankle disability during service, they are devoid of any mention of the aforementioned incidents. The Board therefore finds that a remand is necessary for a new VA examination to clarify whether the Veteran did, in fact, suffer from a left ankle injury in service and whether that injury is related to military service.  
The matters are REMANDED for the following action:
1. Contact the Veteran and request authorization to obtain any outstanding records pertinent to the claims, including any private treatment records, following proper VA procedures (38 C.F.R. § 3.159(c)).
2. Obtain an opinion from a VA clinician to determine the nature and etiology of the Veteran’s left ankle disability. The entire claims file must be made available to the clinician, and the opinion should include discussion of the Veteran’s documented medical history and assertions. After reviewing the claims file, the examiner should answer the following question completely:
(a.) Does the Veteran have a current left ankle disability?
(b.) If so, is it at least as likely as not (a fifty percent probability or greater) that the Veteran’s left ankle disability is related to a disease, event, or injury in service?
A complete rationale for any opinion provided is requested. The absence of evidence of treatment for any of the aforementioned disabilities in the Veteran’s service treatment records cannot, standing alone, be a sufficient rationale for providing a negative opinion. The examiner is also advised that the Veteran is competent to report physical symptoms and history, and such prior lay statements must be specifically considered in formulating any opinions. If the examiner rejects the Veteran’s prior statements, the examiner should provide a reason for doing so.
 
A. C. MACKENZIE
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Mukherjee, Associate Counsel