Citation Nr: 18153134 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 16-54 081 DATE: November 28, 2018 ORDER Service connection for right knee disability is granted. REMANDED Service connection for lower back condition is remanded. Service connection for bilateral foot condition is remanded. Service connection for pulmonary hypertension is remanded. FINDING OF FACT The Veteran’s right knee disability had its onset in service. CONCLUSION OF LAW The criteria for service connection for right knee disability are met. 38 U.S.C. §§ 1110, 1111, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from August 1974 to June 1980. Service Connection Service connection will be granted if it is shown that a Veteran has a disability resulting from an injury or disease contracted in the line of duty, or for aggravation of a preexisting injury or disease contracted in the line of duty in the active military, naval or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Generally, to prove service connection, the record must contain evidence concerning: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and a disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In certain cases, competent lay evidence may demonstrate the presence of any of these elements. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). Service connection may be granted for any disease diagnosed after discharge, when all of the evidence, including that pertinent to service, establishes that a disease was incurred in service. 38 C.F.R. § 3.303(d). 1. Service connection for right knee condition As an initial matter the Veteran has a diagnosis of osteoarthritis, also noted as tricompartmental degenerative changes. The Veteran asserts that her right knee disability began in service as a result of “being in the Army, from during physical training, ruck marches, and running in combat boots.” In support of her claim, the Veteran submitted a letter from a friend who served with the Veteran on active duty. She wrote that they were stationed at Fort Bragg together and assigned to the same company and, “took PT (physical training) together. Among other calisthenics, we ran four miles per day in combat boots on paved harden surfaces…. Often, [the Veteran] complained of pain in her lower back and both knees. Sometimes she would ask for ice to put on her knees before returning to work.” The Board finds these lay statements are competent and credible lay evidence regarding the Veteran’s in-service injury. The Board concludes that the Veteran has a current diagnosis of right knee arthritis that began during active service and is related to injuries sustained while performing PT, running, and ruck marches on active duty. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). In an August 2015 letter, the Veteran’s orthopedic provider, the Chief of Orthopedic Surgery at Womack Army Medical Center, provided a positive nexus opinion. He wrote, “I have been her orthopedic provider for the last few years, caring for her chronic knee pain due to osteoarthritis. It is possible that her prior active duty service may have contributed to her current degenerative disease.” This opinion is based on a review of the Veteran’s relevant medical history, and the Board finds this opinion probative. In sum, all three elements necessary to establish service connection are established by the competent and credible lay and medical evidence of record. Accordingly, service connection for right knee disability is warranted. REASONS FOR REMAND 1. Service connection for lower back condition is remanded. 2. Service connection for bilateral foot condition is remanded. The Veteran asserts in her Substantive Appeal that her low back pain and bilateral foot pain is a result of her time in the Army when she ran on hard surfaces while carrying heavy things on her back and from wearing combat boots all day with wool socks. She further asserts that when she left the service, she “came out with knee, back and feet problems.” To date, she has not been afforded a VA examination and medical opinion to help her substantiate her claims. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), a medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See also 38 U.S.C. § 5103A (d)(2) (2012); 38 C.F.R. § 3.159 (c)(4)(i). The Board requires a medical opinion to properly adjudicate the Veteran’s claim. 3. Service connection for pulmonary hypertension is remanded. The Veteran asserts in her Notice of Disagreement and her Substantive Appeal that her pulmonary hypertension is due to medications that she was taking while in the Army, to include “pain medication that [she] took ... for her back, knee and the strong birth control pills…” To date, she has not been afforded a VA examination and medical opinion to help her substantiate her claim. Under McLendon v. Nicholson, 20 Vet. App. 79 (2006), a medical examination or medical opinion is necessary in a claim for service connection when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, (2) evidence establishing that an event, injury, or disease occurred in service or establishing certain diseases manifesting during an applicable presumptive period for which the claimant qualifies, and (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the Veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence on file for the Secretary to make a decision on the claim. See also 38 U.S.C. § 5103A (d)(2) (2012); 38 C.F.R. § 3.159 (c)(4)(i). The Board requires a medical opinion to properly adjudicate the claim. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including carrying heavy things on her back and running in combat boots on hard surfaces. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral foot disability. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including running in combat boots on hard surfaces. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of her pulmonary hypertension. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including taking pain medication for her knees, back, and feet, and taking prescribed birth control pills while on active duty. 4. Then, the record should again be reviewed. If any benefit sought on appeal remains denied, the Veteran and her representative should be furnished with a supplemental statement of the case and be given the opportunity to respond. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Nelson, Associate Counsel