Citation Nr: 18154514 Decision Date: 11/30/18 Archive Date: 11/30/18 DOCKET NO. 09-22 969 DATE: November 30, 2018 REMANDED Entitlement to service connection for arthritis of the joints, to include as secondary to diabetes mellitus, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from December 1963 to January 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2008 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO). A hearing was conducted in August 2010 before Veterans Law Judge who has since retired. The Veteran was provided an opportunity for a new hearing, but did not request one. In April 2011 and January 2015, the Board remanded the appeal. 1. Service-connection for arthritis of the joints (also claimed as secondary to diabetes mellitus) is remanded. The Veteran engaged in combat in Vietnam. See Veteran’s DD Form 214, service personnel records (SPRs), and December 2017 Statement (Veteran asserts being dropped in Vietnam by helicopter for Operation Starlite, also known as the Battle of Van Tuong). His service treatment records (STRs) indicate that he sustained right knee trauma in May 1967. However, the March 2012 and March 2016 medical opinions only address secondary service connection, to include on the basis of aggravation. Moreover, the most recent 2016 medical opinion addressing secondary service connection is inadequate, as it relies on a temporal requirement that is not outlined in 38 C.F.R. § 3.310. Frost v. Shulkin, 29 Vet. App. 131 (2017). Thus, an addendum opinion is needed on remand, which also addresses direct service connection. Updated treatment records should also be secured. The matter is REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Then obtain a medical opinion from an examiner other than the March 2016 examiner addressing the etiology of the Veteran’s bilateral knee and cervical spine arthritis. A new examination is not required unless deemed necessary by the examiner. The examiner must review the entire claims file in conjunction with their review. (a) The examiner should specifically address whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s cervical spine and bilateral knee arthritis: (1) had their onset during service or are otherwise related to the Veteran’s service, to include the rigors of his combat service. In addressing this question, please consider the Veteran’s documented in-service right knee trauma in May 1967; his participation in combat activities in the Republic of Vietnam and whether the current knee and cervical spine disabilities are consistent with the circumstances, conditions or hardships of such service; and the Veteran’s lay statements. (2) are proximately due to his service-connected diabetes. Please note that it is not necessary that diabetes be service-connected, or even diagnosed, at the time his cervical spine and knee disabilities are incurred, and reliance on this fact in support of a negative opinion will render it inadequate. (3) have been aggravated (worsened beyond natural progression) by service-connected diabetes. Please note that it is not necessary that diabetes be service-connected, or even diagnosed, at the time his cervical spine and knee disabilities are incurred, and reliance on this fact in support of a negative opinion will render it inadequate. (b) In the event that the right knee arthritis is service-connected, the examiner should also opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left knee arthritis: (1) is proximately due to his service-connected right knee arthritis. Please note that is not necessary that the right knee disability be service-connected, or even diagnosed, at the time his left knee disability is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. (2) has been aggravated (worsened beyond natural progression) by service-connected right knee arthritis. Please note that is not necessary that the right knee disability be service-connected, or even diagnosed, at the time his left knee disability is incurred, and reliance on this fact in support of a negative opinion will render it inadequate. Please provide a complete rationale for all opinions. If unable to opine without speculation, please provide a basis for that conclusion. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G.Rouse, Associate Counsel