Citation Nr: 18157547 Decision Date: 12/12/18 Archive Date: 12/12/18 DOCKET NO. 14-06 916 DATE: December 12, 2018 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a right wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 1961 to December 1962 and from August 1969 to January 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified before the undersigned Veterans Law Judge. The Board remanded the appeal for further development in June 2015. In May 2018, the Board requested a Veterans Health Administration (VHA) expert medical opinion. In September 2018, the Board provided him a copy of the opinion and informed him of his right to submit any additional evidence within 60 days of the notification letter. The Veteran responded indicating he had no further argument or evidence to submit; therefore, the Board will proceed with adjudication of this appeal. 1. Entitlement to service connection for a back disability is remanded. 2. Entitlement to service connection for a bilateral knee disability is remanded. 3. Entitlement to service connection for a right wrist disability is remanded. Pursuant to the Board’s May 2018 VHA request, a medical opinion was rendered in September 2018. The VHA expert opined that it was less likely than not that the Veteran’s back, right wrist, and bilateral knee disabilities had their onset in or were otherwise related to either of his periods of service. She also opined negatively on his right wrist and bilateral knee disabilities being proximately due to his back disability. However, the VHA expert did not discuss the Veteran’s lay statements and testimony regarding twisting and straining of the low back during his first period of active duty when addressing whether the Veteran’s back disability clearly and unmistakably preexisted his second period of service in August 1969, as specifically requested in the Board’s May 2018 VHA request. Additionally, she relied solely on the lack of medical documentation in the Veteran’s service treatment records (STRs) of any right wrist or bilateral knee disability to support her conclusion with regards to direct service connection. See Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (the lack of contemporaneous medical records does not, in and of itself, render lay evidence incredible or serve as an “absolute bar” to service connection); Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). Moreover, regarding secondary service connection, the VHA expert did not provide a rationale for her proximate causation opinion on the Veteran’s bilateral knee disability, and did not address the aggravation prong at all for both his right wrist and bilateral knee disabilities. Thus, the opinion is inadequate and an addendum opinion is warranted on remand. Any outstanding treatment records should also be secured.   The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any relevant outstanding private treatment records. 3. Then obtain an addendum opinion from an appropriate VA examiner to address the etiology of the Veteran’s back, bilateral knee, and right wrist disabilities. The claims folder should be made available and reviewed by the examiner. No additional examination of the Veteran is necessary, unless the examiner determines otherwise. The examiner should address the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s low back disability had its onset in or is otherwise related to his period of service from October 1961 to December 1962? In addressing this question, please consider the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty. Please support your conclusion with rationale. (b) If the answer to question (a) is no, is there is clear and unmistakable (obvious, manifest, and undebatable) evidence that a low back disability preexisted the Veteran’s second period of service beginning in August 1969? In addressing this question, please discuss the Veteran’s STRs and his competent and credible lay statements and testimony regarding twisting and straining of the low back during his first period of active duty, as well as the January 1969 motorcycle accident. Please support your conclusion with rationale. (c) If the answer to question (b) is yes, is there clear and unmistakable (obvious, manifest, and undebatable) evidence that the pre-existing low back disability did NOT increase in severity during his second period of active duty from August 1969 to January 1970? In addressing this question, please discuss the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and the September 1969 injury. Please support your conclusion with rationale. (d) If the answer to question (b) is no, or the answer to question (b) is yes and the answer to question (c) is no, is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s back disability had its onset in or is otherwise related to his period of service from August 1969 to January 1970? In addressing this question, please consider the Veteran’s competent and credible lay statements regarding twisting and straining of the low back during kitchen duty and the September 1969 injury. Please support your conclusion with rationale. (e) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s bilateral knee disability: (i) had its onset in or is otherwise related to either period of service; (ii) is proximately due to the low back disability; or (iii) has been aggravated (worsened) by the low back disability? The examiner must note the Veteran’s competent and credible lay statements regarding the injuries he sustained to the knees when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustains to his knees as a result of falling when his back gives way. (f) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s right wrist disability: (i) had its onset in or is otherwise related to either period of service; (ii) is proximately due to the low back disability; or (iii) has been aggravated (worsened) by the low back disability? The examiner must note the Veteran’s competent and credible lay statements regarding the injuries he sustained to his right wrist when he braced himself from falling while working in a wet and slippery kitchen during service and the current injuries he sustains to his right wrist as a result of falling when his back gives way. The examiner should note that inquiries (e)(ii) and (e)(iii) and (f)(ii) and (f)(iii) require two opinions: one for proximate causation and one for aggravation. In addressing all questions, please do not rely solely on the absence of documented treatment, and please consider the Veteran’s competent and credible lay statements. A comprehensive rationale must be furnished for all opinions expressed. If you cannot provide the requested opinion without resorting to speculation, please expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Asante, Associate Counsel