Citation Nr: 18147942 Decision Date: 11/08/18 Archive Date: 11/06/18 DOCKET NO. 16-42 181 DATE: November 8, 2018 ORDER New and material evidence having been received, the claim for service connection for a lumbar spine disorder is reopened; the claim is granted to this extent only. New and material evidence having been received, the claim for service connection for hypertension is reopened; the claim is granted to this extent only. REMANDED Entitlement to service connection for a right arm disorder is remanded. Entitlement to service connection for a left arm disorder is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for radiculopathy of the left leg is remanded. Entitlement to service connection for radiculopathy of the right leg is remanded. FINDINGS OF FACT 1. In an August 1994 rating decision, the RO denied service connection for a back injury on the basis that there was no evidence of a current injury. 2. Evidence received after the August 1994 denial relates to unestablished facts necessary to substantiate that claim of service connection and raises a reasonable possibility of substantiating that underlying claim. 3. In an August 1994 rating decision, the RO continued its prior denial of service connection for hypertension on the basis that no new and material evidence showing onset in service or that it was aggravated by service was presented. 4. Evidence received after the August 1994 denial relates to unestablished facts necessary to substantiate that claim of service connection and raises a reasonable possibility of substantiating that underlying claim. CONCLUSIONS OF LAW 1. The RO’s August 1994 denial of service connection for a back injury is final. 38 U.S.C. § 7105; 38 C.F.R. § 3.104, 20.200, 20.302, 20.1103. 2. Evidence received since the final August 1994 rating decision is new and material. 38 U.S.C. §§ 5103, 5103A, 5107, 5108, 7105; 38 C.F.R. § 3.156. 3. The RO’s August 1994 continued denial of service connection for hypertension is final. 38 U.S.C. § 7105; 38 C.F.R. § 3.104, 20.200, 20.302, 20.1103. 4. Evidence received since the final August 1994 rating decision is new and material. 38 U.S.C. §§ 5103, 5103A, 5107, 5108, 7105; 38 C.F.R. § 3.156. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from September 1976 to April 1983. New and Material Evidence 1 Whether new and material evidence has been received to reopen a claim of service connection for lumbar spine disorder. In this case, the Veteran did not submit a notice of disagreement (NOD) in response to the August 1994 rating decision denying service connection on the basis that there was no evidence of a back injury. 38 U.S.C. § 7105. Evidence received since that decision includes a February 2014 VA back conditions examination showing a current diagnosis, and the Veteran's March 2014 NOD showing ongoing back pain since service. This evidence is new to the record, relates to a previously unestablished relationship to service, and raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim is reopened, and any deficiencies of notification and development in this case will be addressed on remand. 2 Whether new and material evidence has been received to reopen a claim of service connection for hypertension. In this case, the Veteran did not submit a NOD in response to the August 1994 rating decision continuing the prior denial of service connection for hypertension on the basis that no new and material evidence had been presented showing that it had its onset in service or was aggravated by service. 38 U.S.C. § 7105. Evidence received since that decision includes a February 2014 VA hypertension examination including a medical opinion relating hypertension to service. This evidence is new to the record, relates to previously unestablished relationship to service, and raises a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). Accordingly, the claim is reopened, and any deficiencies of notification and development in this case will be addressed on remand. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral arm disorder is remanded. The Board of Veterans’ Appeals (Board) cannot make a fully-informed decision on the issue of service connection for a bilateral arm disorder because no VA examiner has opined whether the Veteran has a current bilateral arm disorder related to her service duties of packing parachutes, as discussed in her March 2014 NOD. 2. Entitlement to service connection for a lumbar spine disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a lumbar disorder because no VA examiner has considered the Veteran's report of ongoing problems since service, as discussed in her March 2014 NOD. 3. Entitlement to service connection for a bilateral knee disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a bilateral knee disorder because no VA examiner opined whether the Veteran has a current bilateral knee disorder related to in-service injuries from playing basketball, as discussed in a March 2014 statement. 4. Entitlement to service connection for a left ankle disorder is remanded. The Board cannot make a fully-informed decision on the issue of service connection for a left ankle disorder because no VA examiner opined whether the Veteran has a current left ankle disorder related to in-service injuries from playing basketball, as discussed in a March 2014 statement. 5. Entitlement to service connection for hypertension is remanded. The Board cannot make a fully-informed decision on the issue of service connection for hypertension because no VA examiner opined whether the Veteran’s hypertension clearly and unmistakably preexisted service; and, if, so, whether it was aggravated by service. While a positive opinion was provided by the February 2014 examiner as discussed above, such opinion did not consider the evidence suggesting that the Veteran's hypertension may have preexisted her military service. 6. Entitlement to service connection for radiculopathy of the bilateral legs is remanded. The Veteran asserts that her radiculopathy is secondary to her lumbar spine disorder. March 2014 statement. Since service connection for her lumbar spine disorder is being remanded, the issue of service connection for radiculopathy of the bilateral legs must also be remanded. The matters are REMANDED for the following action: 1. Furnish the Veteran with a 38 C.F.R. § 3.159(b) notice letter addressing her reopened claims for service connection for a lumbar spine disorder and hypertension. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all records identified by the Veteran, including any outstanding VA treatment records and records from Dr. S. pertaining to the Veteran's bilateral knee replacements. 2. Accord the Veteran a VA orthopedic examination, with a medical professional of appropriate expertise who has reviewed the claims file, to determine the nature, extent, and etiology of any bilateral arm, bilateral knee, and left ankle disorders. The most up-to-date Disability Benefits Questionnaire(s) should be utilized. The examiner is requested to review the record and offer an opinion as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed bilateral arm, bilateral knee, and left ankle disorders are related to the Veteran's military service. A complete rationale should be given for all opinions and conclusions expressed. The examiner should consider the Veteran's reports in her March 2014 NOD and accompanying statement of arm injuries from packing parachutes and bilateral knee and left ankle injuries from playing basketball. 3. Obtain an addendum medical opinion from the February 2014 VA hypertension and back conditions examiner (or, if unavailable, from a medical professional with appropriate expertise) to determine the etiology of any diagnosed hypertension, lumbar spine disorder, and bilateral lower extremity radiculopathy. If the examiner finds that a physical examination is necessary to determine whether the Veteran has bilateral lower extremity radiculopathy, schedule the Veteran for a VA examination with a medical professional of appropriate expertise. The most up-to-date Disability Benefits Questionnaire(s) should be utilized. A complete rationale should be given for all opinions and conclusions expressed. For the Veteran's hypertension, the examiner is requested to review the record and offer opinions as to the following: (a) Is there clear and unmistakable evidence (obvious, manifest, and undebatable) that any currently diagnosed hypertension preexisted the Veteran’s active service (September 1976 to April 1983). (b) If so, state whether there is clear and unmistakable evidence that the preexisting hypertension was NOT aggravated (i.e., permanently worsened) during service; or whether, it is clear and unmistakable that any increase in service was due to the natural progress of the disorder. (c) If hypertension is NOT found to clearly and unmistakably exist prior to the Veteran’s service, the examiner should opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed hypertension is related to the Veteran's service. For the Veteran's lumbar spine, the examiner is requested to review the record and opine as to whether it is at least as likely as not (i.e., probability of approximately 50 percent) that any diagnosed lumbar spine disorder is related to the Veteran's military service. The examiner should consider the Veteran's report in her March 2014 NOD of ongoing problems since service. The examiner should also opine as to whether it is at least as likely as not that any bilateral lower extremity radiculopathy is caused or aggravated by the lumbar spine disorder. (Continued on the next page)   If bilateral lower extremity radiculopathy is found to have been aggravated by the lumbar spine disorder, the examiner should quantify the approximate degree of aggravation. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Barstow, Counsel