Citation Nr: 18155663 Decision Date: 12/04/18 Archive Date: 12/04/18 DOCKET NO. 12-07 121 DATE: December 4, 2018 REMANDED Entitlement to an initial rating in excess of 20 percent for lumbosacral sprain is remanded. Entitlement to an initial rating in excess of 10 percent for right knee degenerative arthritis is remanded. Entitlement to an initial rating in excess of 10 percent for left knee degenerative arthritis is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a right hip disability, to include as secondary to service-connected back and bilateral knee disabilities, is remanded. REASONS FOR REMAND The appellant served on active duty in the Air Force from October 2005 to October 2009. This matter comes before the Board of Veterans’ Appeals (Board) from an April 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia, which denied service connection for hypertension and a right hip disability and granted service connection for lumbosacral sprain and degenerative arthritis of the left and right knees, assigning initial 20 percent and 10 percent ratings, respectively. The Board remanded this matter in June 2017. A Supplemental Statement of the Case (SSOC) was issued in September 2018. The appellant was most recently afforded examinations to determine the severity and manifestations of his service-connected back and bilateral knee disabilities in June 2017. Since then, he has indicated that the severity of such service-connected disabilities has increased. See e.g. October 2018 Informal Hearing Presentation. In support of his contention, he submitted private medical records relating to treatment of his knee disability. Thus, upon remand, the appellant must be afforded appropriate examinations to determine the current severity and manifestations of his service-connected back and bilateral knee disabilities. With respect to hypertension, a new VA examination was conducted in June 2017. However, the opinion is inadequate. Prehypertension was noted prior to separation from service in September 2009. Readings from that month were 144/90, 140/88, and 140/87. The appellant has since diagnosed as having hypertension. The June 2017 examiner indicated that there was no nexus establishing causality between current blood pressure readings and the appellant’s active service. The rationale for this conclusion was that the appellant was not medically discharged from active service and his records indicated that he was medically qualified to complete his term of active service. The examiner, however, did not address the question of whether the appellant’s current hypertension had its inception during active service, was manifest to a compensable degree within one year of separation, or is otherwise causally related to active service, to include the elevated blood pressure readings noted prior to service separation. Thus, an addendum opinion should be obtained. With respect to the right hip disability claim, the appellant was most recently afforded a VA examination in June 2017. An addendum opinion was obtained in October 2017. The VA examiner stated that the appellant had no current disability but he neglected to address the right hip sprain diagnosed by the October 2010 contracted examiner. The current disability requirement has been met by the October 2010 diagnosis of right hip sprain, even if such since has resolved, as the right hip sprain was present during the period on appeal. The Board remanded the right hip issue in order to obtain an etiological opinion regarding such diagnosed right hip sprain. See Stegall v. West, 11 Vet. App. 268 (1998); see also Barr, supra. Thus, upon remand, a medical opinion should be obtained which addresses whether the appellant’s right hip sprain was incurred in or caused by his active service, or caused or aggravated by his service-connected back and/or bilateral knee disabilities. The matters are REMANDED for the following action: 1. Schedule the appellant for an examination to determine the current severity and manifestations of his service-connected lumbosacral sprain. Access to the appellant’s electronic VA claims file should be made available for the examiner to review. 2. Schedule the appellant for an examination to determine the current severity and manifestations of his service-connected bilateral knee degenerative arthritis. Access to the appellant’s electronic VA claims file should be made available for the examiner to review. The examiner should address at what point in the arc of motion knee pain limits function both regularly and during flare-ups, even if a flare-up is not observed on the day of the examination. In addressing the nature of any disability during a flare-up the examiner must address the severity of the flare-up, the frequency and duration of any flare-ups, and all precipitating and alleviating factors. The examiner should identify any additional symptoms or pathology in addition to pain and limitation of motion, such as subluxation, instability, meniscal pathology, locking, or effusion. The Board notes that a September 2017 MRI report identified tears of multiple ligaments and meniscal pathology. 3. Obtain a medical opinion from a clinician, who did not offer the May 2016 or June 2017 hypertension opinions, as to the etiology and likely date of onset of the appellant’s hypertension. After reviewing the record, the clinician should provide an opinion, with supporting rationale, as to whether is it at least as likely as not (i.e., at least a 50 percent probability) that the appellant’s hypertension had its onset during active service, within one year of service separation, or is otherwise causally related to active service, to specifically include the documented in-service prehypertension in September 2008. 4. Schedule the appellant for a medical examination by an examiner who has not previously examined him in order to obtain a medical opinion as to the nature and etiology any right hip disability diagnosed since October 2009, to include the appellant’s right hip sprain, diagnosed in October 2010. After reviewing the record, the clinician should identify all current hip disabilities identified on examination. Then, he or she should provide an opinion, with supporting rationale, as to whether is it at least as likely as not (i.e., at least a 50 percent probability) that any right hip disability diagnosed since October 2009 (to include the right hip sprain diagnosed in October 2010) had its onset during active service or is causally related to such service. If not, provide an opinion as to whether it is at least as likely as not that any such disability was proximately due to or the result of his service-connected lumbosacral sprain and/or bilateral knee degenerative arthritis. If neither, provide an opinion as to whether it is at least as likely as not that any such disability was aggravated by service-connected lumbosacral sprain and/or bilateral knee degenerative arthritis. If aggravation is found, the examiner must attempt to establish a baseline level of severity prior to aggravation. The examiner is informed that the current disability criterion has been met by the diagnosis of right hip sprain in October 2010, as such occurred during the period on appeal, even if the sprain has since resolved. K. Conner Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Behlen, Associate Counsel