Citation Nr: 18154751 Decision Date: 12/04/18 Archive Date: 11/30/18 DOCKET NO. 15-15 697 DATE: December 4, 2018 REMANDED Entitlement to service connection for a right knee disability. Entitlement to service connection for a left knee disability. Entitlement to service connection for a left ankle disability. Entitlement to service connection for a right ankle disability. Entitlement to service connection for a left foot disability. Entitlement to service connection for a bilateral leg disability. REASONS FOR REMAND The Veteran served on active duty from October 1969 to August 1971. His awards and decorations include Air Medal, the Vietnam Service Medal with Two Bronze Stars, and the Republic of Vietnam Campaign Medal with 1960 device and 2 OS bars. These matters are on appeal from an April 2012 rating decision. Bilateral knee, ankle, and left foot disabilities The Veteran contends that he has bilateral knee, bilateral ankle, and left foot disabilities that are related to jumping out of helicopters and gunships during service. See May 2012 Notice of Disagreement. On September 2011 the Veteran underwent VA joints and feet examinations. Regarding his bilateral knee disability, he presented with a history of bilateral knee pain since 1971 and developed non-traumatic bilateral knee pain approximately 40 years ago. He stated that he was treated in the field by a medic, but did not recall seeing a medical provider. He said that he was first seen by a medical provider in 1984, but did not recall the diagnosis. Regarding bilateral ankle pain, he presented with a history of bilateral ankle pain since 1970. He stated that he injured both ankles after jumping out of a gunship on several occasions. He stated he sprained both ankles on several occasions, but was not seen by a medical provider during service. He complained of intermittent pain over the past 40 years. Regarding left foot pain, he stated that he fractured his toes after jumping out of a helicopter approximately 40 years ago. He stated he did not have X-rays and was not seen by a medical provider, but has had constant pain across the anterior aspect of the metatarsal region since that time. The examiner opined that his bilateral knee, bilateral ankle, and left foot disabilities are not related to service based, in part, on the lack of treatment for these disabilities during service. He stated that the most remote medical records to review were 40 years after separation. To the extent that the examiner relied on the absence of evidence in the Veteran’s service treatment records to opine that these current disabilities are not related to his service, the Board finds the September 2011 opinion is inadequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); Dalton v. Nicholson, 21 Vet. App. 23 (2007) (an examination was inadequate where the examiner did not comment on the Veteran’s report of in-service injury and instead relied on the absence of evidence in the Veteran's service medical records to provide a negative opinion). Accordingly, on remand additional appropriate VA examinations and medical opinions should be obtained. Bilateral leg disability Regarding the claim for service connection for a bilateral leg disability, on VA examination the Veteran denied being diagnosed with a specific leg condition. On remand, VA should contact the Veteran to clarify whether he intends to continue his appeal of this issue. If he does not wish to pursue this appeal, he should withdraw it, in writing. While on Remand any additional VA treatment records should be associated with the claims file. The matters are REMANDED for the following actions: 1. Contact the Veteran and clarify whether he wishes to pursue the claim for service connection on appeal for a bilateral leg disability. If the Veteran wishes to withdraw his appeal, advise him that the withdrawal must be in writing. 2. Obtain all outstanding VA medical records related to the Veteran’s bilateral knee, ankle, and left foot disabilities, including those from the Bay Pines VAMC, dated from August 2017 to the present. All records and/or responses received should be associated with the claims file (the Veteran himself can also submit all record he believes to be pertinent). 3. Schedule the Veteran for VA examination which address the nature and etiology of his claimed bilateral knee, ankle and left foot disabilities. All indicated tests and studies should be performed. The claims folder should be provided to the examiner for review of pertinent documents. The examination report should reflect that such a review was conducted. The examiner should provide the following opinions: Is it at least as likely as not (a 50 percent probability or greater) that any current bilateral knee, ankle, and/or left foot disabilities had their onset in or are etiologically-related to the Veteran’s active duty service? The examiner should specifically comment on the Veteran’s lay statements concerning the onset and progression of his bilateral knee, ankle, and left foot disabilities. The phrase “at least as likely as not” does not mean within the realm of medical possibility, but rather the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of that conclusion as it is to find against it. (Continued on the next page)   If an opinion cannot be rendered without resorting to speculation, the physician should explain why it would be speculative to respond. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Adams, Counsel