Citation Nr: 18151051 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 17-33 900 DATE: November 16, 2018 REMANDED Entitlement to service connection for a left hand condition is remanded. Entitlement to service connection for a bilateral knee condition is remanded. Entitlement to service connection for a heart condition is remanded. REASONS FOR REMAND The Veteran served in the Army Reserves from January 2006 to July 2006 and from January 2010 to February 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. 1. Entitlement to service connection for a left hand condition is remanded. In a June 2015 VA examination, the examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reasoned that there was no consistent clear hand injury or specific diagnosis. The examiner stated that the Veteran had one complaint in service of index finger injury, and one complaint of hypothenar strain and numbness. Additionally, there were vague complaints in VA records of bilateral hand pain and swelling. The examiner concluded that the symptoms were not specific and leading to any one particular injury. However, the Board notes that at the start of the VA examination, the examiner diagnosed the Veteran with left thumb strain. The Board finds this opinion to be inadequate due to the conflicting opinion that there was no particular injury but then diagnosing the Veteran with left thumb strain. Further, the Board notes that there are continued complaints of left hand pain from the Veteran’s service treatment records to the present. Therefore, on remand, a new VA opinion, and additional examination, if necessary, is needed to determine whether the Veteran has a left hand diagnosis. The examiner should consider the Veteran’s continued reports of pain and address the left thumb strain diagnosis. 2. Entitlement to service connection for a bilateral knee condition is remanded. In a June 2015 Gulf War VA examination, the examiner diagnosed the Veteran with bilateral knee strain. The examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that the Veteran’s knee disorder was a disease with a clear and specific etiology and diagnosis, and that it was less likely than not that the Veteran’s knee disorder was related to a specific exposure event experienced during service in Southwest Asia. The examiner then stated that arthritis was the most common form of joint disease and several powerful risk factors were major trauma, repetitive joint use, and age. The examiner said that an association between service in Southwest Asia and the development of musculoskeletal disorder had not been clearly defined; therefore, it was reasonable to assume that said exposures may not be related to the Veteran’s current symptoms. The Board finds this opinion inadequate as the Veteran did not assert that the cause of her bilateral knee condition was exposure to environmental hazards during the Gulf War. In a subsequent June 2015 addendum VA opinion, the examiner opined that the Veteran’s current right knee strain was less likely than not a continuation of the symptoms/complaints/treatment as shown in the service treatment records. The examiner reasoned that there was only documentation of one incident of right knee pain, with no continuity, and no chronicity. The examiner concluded that the current problem was unlikely related to the complaint in service. The Board finds this opinion inadequate first because it did not address the left knee strain that was diagnosed and given an opinion during the June 2015 VA Gulf War VA examination. Second, the Board finds this opinion inadequate because the examiner did not consider the post-service medical treatment records showing consistent complaints of knee pain as well as the Veteran’s statements that she ran in service in adverse conditions while in full combat gear and that this affected her knees. Buchanan v. Nicholson, 451 F.3d at 1336 (Fed. Cir. 2006) (noting that VA’s examiner’s opinion, which relied on the absence of contemporaneous medical evidence, “failed to consider whether the lay statements presented sufficient evidence of the etiology of [the veteran’s] disability such that his claim for service connection could be proven without contemporaneous medical evidence”). 3. Entitlement to service connection for a heart condition is remanded. In a June 2015 Gulf War VA examination, the examiner diagnosed the Veteran with heart block. The examiner opined that the condition claimed was less likely than not incurred in or caused by the claimed in-service injury, event or illness. The examiner reasoned that the Veteran’s cardiovascular disease was a disease with a clear and specific etiology and diagnosis. Therefore, it was less likely than not that the Veteran’s cardiovascular disease was related to a specific exposure event experienced by the Veteran during service in Southwest Asia. The examiner said that an association between service in Southwest Asia and the development of cardiovascular disease had not been clearly defined and that therefore it was reasonable to assume that said exposures may not be related to the Veteran’s current symptoms. Again, the Board finds this opinion inadequate as the Veteran did not assert that her heart condition was related to environmental hazards during the Gulf War. In a subsequent June 2015 addendum VA opinion, the examiner opined that the Veteran’s current heart block was less likely than not a continuation of the symptoms/complaints/treatments as shown in the service treatment records. The examiner reasoned that there was no documentation of heart problems in service. The examiner said that there was only documentation of pain non-cardiac in origin only once, and that the current problem unlikely had its origin in service. Again, the Board finds this opinion inadequate as it not only did not address the Veteran’s assertions of continued complaints of chest pains in service, but also did not address her statement that following service she developed the heart condition that she did not have before service. See Buchanan, 451 F.3d 1336. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, schedule the Veteran for a VA examination with an appropriate examiner to determine the etiology of the Veteran’s left hand condition. The claims file and a copy of this remand should be made available for review. After review, the examiner is first asked to determine the following: (a) Whether the Veteran has a left hand diagnosis. (b) If not, the examiner is asked to address the June 2015 VA examiner’s diagnosis of a left thumb strain and explain why there is in fact no diagnosis. (c) If so, the examiner is then asked to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left hand condition was caused by or related to service. A clear and thorough rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s statements, the complaints in service of left hand pain, and the post-service treatment records showing left hand pain complaints. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Also, schedule the Veteran for a VA examination with an appropriate examiner to determine the etiology of the Veteran’s bilateral knee condition. The claims file and a copy of this remand should be made available for review. After review, the examiner is asked to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee condition was caused by or related to service. A clear and thorough rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s statements, the complaints in service of knee pain, and the post-service treatment records showing knee pain complaints. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Finally, schedule the Veteran for a VA examination with an appropriate examiner to determine the etiology of the Veteran’s heart condition. The claims file and a copy of this remand should be made available for review. After review, the examiner is asked to determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s heart condition was caused by or related to service. A clear and thorough rationale must be provided for all opinions expressed. The examiner must consider the Veteran’s statements, the complaints in service of chest pains, and the post-service treatment records showing a heart condition diagnosis. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 5. Thereafter, readjudicate the claims on appeal. If the benefit sought remains denied, issue the Veteran and her representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Saudiee Brown, Associate Counsel