Citation Nr: 18146504 Decision Date: 11/01/18 Archive Date: 10/31/18 DOCKET NO. 16-19 143A DATE: November 1, 2018 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability, to include as secondary to a claimed right knee disability is remanded. Entitlement to service connection for a bilateral eye disability is remanded. REASONS FOR REMAND The Veteran had active service in the United States Army from June 1966 to March 1969. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from June 2015 and August 2015 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran filed a claim in September 2017 requesting an increase in his disability rating for post-traumatic stress disorder (PTSD). In a March 2018 Statement of the Case, the RO granted the Veteran’s claim for an increased rating. In April 2018, the Veteran accepted the increased disability rating of 70 percent for PTSD and submitted a formal request to withdraw the appeal relating to his PTSD. Therefore, the Board no longer has jurisdiction over the Veteran’s appeal for PTSD. 1. Entitlement to service connection for a right knee disability is remanded. The Veteran claims that his right knee disability is due to the physical strain placed on his right knee during his military service in Vietnam from July 1968 until March 1969. He described spending hours on his knees at base camp while in bunker defense, and on guard duty defense. He described spending time in fox holes or on the dug surface sitting or waiting on his knees. He stated that he walked on combat patrol while in Vietnam and needed to “quickly hit the ground or find cover of any nature without caring too much of what I fell on or where my knees landed.” In a March 2015 letter, the Veteran described a February 1969 attack of the Special Troops compound in the Bien Hoa/Long Bien area, where he was stationed. Cobra gunships had fired rocket propelled grenades into the base perimeter. During the attack, the Veteran joined the bunker defenses in returning fire. The Veteran stated that there is no documentation that he received treatment for or complained about pain in his right knee during service because there was no sick call to report to, and soldiers who were not bleeding or had broken bones were sent back on duty. When he returned to the United States, the Veteran used pain killers and compression support bandages to treat the pain in his knees. During a May 2016 primary care examination the Veteran noted that the pain in his right knee was worse than the pain in his left knee. He stated that the pain worsened with activity, and did not report swelling. The examiner noted that the pain in the Veteran’s right knee could be caused by osteoarthritis. The Veteran has never been afforded a VA or private examination to assess his right knee disability. Because the Veteran presented evidence of an in-service event, there is competent evidence of recurrent symptoms of a disability, there is an indication that the current disability may be associated with the in-service event, and there is insufficient evidence to decide the claim, the VA is obligated to obtain a VA examination for the Veteran. McClendon v. Nicholson, 20 Vet. App.79 (2006). 2. Entitlement to service connection for a left knee disability, to include as secondary to a claimed right knee disability, is remanded. The Veteran claims that his left knee disability is secondary to his claimed right knee disability. The Veteran’s claim for secondary service connection for a left knee disability is inextricably intertwined with his service connection claim for a right knee disability because one of the key elements of a secondary service connection claim is evidence of a service connected disability. 38 C.F.R. § 3.310; Allen v. Brown, 7 Vet. App. 439, 448-49 (1995); El-Amin v. Shinseki, 26 Vet. App. 136 (2013). Therefore, the determination of whether the Veteran will be entitled to service connection for a left knee disability on a secondary basis will, in part, be based on whether he is service connected for a left knee condition. Also, there is no current medical examination confirming whether the Veteran has a diagnosis for a left knee condition. Moreover, there is no medical opinion linking a left knee condition to the Veteran’s claimed right knee condition. Therefore, the Board defers adjudication of the Veteran’s secondary service connection claim for a left knee disability until the development requested for the service connection claim for a right knee disability is accomplished, medical evidence is obtained to confirm whether the Veteran has a diagnosis for a left knee condition, and a medical opinion establishes a causal relationship between the Veteran’s left knee condition and his claimed right knee disability. 3. Entitlement to service connection for a bilateral eye disability is remanded. The Veteran claims that his bilateral eye condition is due to two eye injuries that he sustained while in service. The first injury occurred while he was stationed in the Republic of Korea as a custodian of classified documents. The Veteran reported that cleaning solution splashed in his eyes while he was cleaning a safe, causing irritation and issues with his vision at night. The Veteran also reported that while he was deployed in Vietnam, a small metal particle, likely from an inbound NVA rocket, had lodged in his eye. The metal particle was removed by a medic at a temporary medical tent, his eye was cleaned and a bandage was applied. The Veteran’s statements about his injury in the Republic of Korea are corroborated by his service treatment records which show that he was treated for his eye injuries in the Republic of Korea. There is no evidence in the Veteran’s service treatment records or personnel records showing that he had a pre-existing eye condition prior to entering service. During a June 2016 VA optometry consultation, the Veteran reported that he had an eye examination several years ago. This examination is not part of the Veteran’s claims file. The Veteran complained of blurry vision, black floaters that had been ongoing since 2011, and flashes of light on the left side lasting a second and occurring one to two times per month. The examiner provided the following assessment following the examination: refractive error/presbyopia in both eyes (the shape of the eye is not able to bend light correctly causing blurred vision), NVS cataracts in both eyes, blepharitis (eyelid inflammation), dry eye, possible ocular rosacea, and glaucoma suspect. Because there is evidence of an in-service injury and medical evidence that the Veteran has had problems with his eyes, it is necessary to conduct a VA examination to determine whether the Veteran has a current disability and if so, whether there is a causal relationship between the Veteran’s eye disability and the injuries he incurred to his eyes during service. McClendon v. Nicholson, 20 Vet. App. 79 (2006). The matter is REMANDED for the following action: 1. Obtain any outstanding VA and private treatment records to be associated with the Veteran’s claims file. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any right knee disability. The electronic claims file, to include the Veteran’s service treatment records, lay statements and testimonies, and treatment records, must be reviewed by the examiner, and a note that it was reviewed should be included in the report. After reviewing the claims file and examining the Veteran, the examiner should opine to the following: whether the Veteran’s right knee disability is at least as likely as not related to an in-service injury, event, or disease. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left knee disability. The electronic claims file, to include the Veteran’s service treatment records, lay statements and testimonies, and treatment records, must be reviewed by the examiner, and a note that it was reviewed should be included in the report. After reviewing the claims file and examining the Veteran, the examiner should opine to the following: whether the Veteran’s left knee disability it is at least as likely as not (1) proximately due to his claimed right knee disability, or (2) aggravated beyond its natural progression by his claimed right knee disability. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones, 23 Vet. App. at 390 (2010). 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any eye disability. After reviewing the claims file and examining the Veteran, the examiner should opine to the following: whether the Veteran’s eye disability is at least as likely as not related to an in-service injury, event, or disease, including the injuries caused by the metal particle and the cleaning solution. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. The examiner should also explain the reasons behind any opinions expressed and conclusions reached. If the examiner is unable to offer the requested opinion, it is essential that the examiner offer a rationale for the conclusion that an opinion could not be provided without resort to speculation, together with a statement as to whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. See Jones, 23 Vet. App. at 390. (Continued on the next page)   5. Thereafter, complete any other development deemed necessary and then readjudicate the Veteran’s service connection claims. If a complete grant of the benefits requested is not awarded, issue a supplemental statement of the case to the Veteran and his representative, and provide them an opportunity to respond before returning the case to the Board. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. White, Associate Counsel