Citation Nr: 18157752 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-47 543 DATE: December 13, 2018 REMANDED Entitlement to service connection for low back pain is remanded. Entitlement to service connection for left lower extremity pain is remanded. Entitlement to service connection for bilateral knee conditions is remanded. Entitlement to service connection for asthma is remanded. REASONS FOR REMAND The claimant had active service in the Army from August 1973 to September 1973 for National Guard basic training. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in June 2015 by a Department of Veterans Affairs (VA) Regional Office (RO). The claimant has provided an account of one event, which occurred during active duty for training, alleged to have caused his low back pain, bilateral knee condition, and left lower extremity (LLE) pain. In the notice of disagreement received in September 2015, he claims that during basic training he took part in a five-mile hike carrying 90-100 pounds of gear. Halfway through the hike, his “lower extremity gave out.” He claims that the fall caused him to hit his right knee on the ground and that he was medevacked to a hospital where he was diagnosed with a torn ligament. He further states “to this day, I still suffer from the injury which has now affected my left knee, lower back, and lower extremities.” The claimant also states that he recovered from the injury and resumed basic training when he began to experience breathing difficulties. In disability compensation claims, VA must provide a VA medical examination when there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability, and (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. McClendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The claimant is competent to describe the in-service event of falling while hiking. No documentation or lay evidence beyond the claimant’s own account is available, and it is also noted that the STRs of record are incomplete. In an April 2015 status letter, the RO informed the claimant that STRs are unavailable, all efforts to obtain STRs have been exhausted, and that further attempts would be futile. Partial STRs were later associated with the file, but they only contain documents pertaining to separation. The Board must resolve all reasonable doubt in favor of the claimant. 38 C.F.R. § 3.102. As such, the Board finds the account is credible enough to raise the possibility that an in-service incident occurred and VA’s duty to provide a medical opinion regarding the claimed conditions has been triggered. 1. Low Back Pain The claimant has provided documentation showing degenerative spondylosis of the thoracic spine which is contained in an August 2016 radiology report from a chest x-ray. There is also documentation that the claimant was treated for low back pain at a pain clinic in January 2015. The document contains no details regarding a specific diagnosis. Another document from April 2015 primarily provides a history of medications and lists back pain as one condition being treated. Reviewing the reports together suggest the presence of persistent and/or recurrent symptoms of a disability. As such, a medical opinion addressing the nature and etiology of the condition is necessary. 2. Left Lower Extremity The claimant contends that he experiences left lower extremity (LLE) pain that is service-connected. The January 2015 document from the pain clinic describes the presence of LLE pain that does “radiate to the gluteal region and posterior LEs at times.” This document also fails to provide a specific diagnosis for this condition. However, reports of pain may constitute a current disability to the extent that pain results in functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1364 (Fed. Cir. 2018) (holding that pain causing functional impairment can constitute a current disability). Because the record shows there is a reasonable possibility that this condition had its onset during service, a medical opinion addressing the current nature and etiology of the LLE condition is necessary. In addition, in a September 2015 notice of disagreement, the claimant contends that the LLE condition is secondary to a right knee injury incurred in service. If a service connected right knee injury is found to be present, an evaluation of the LLE pain as secondary to the right knee injury will also be necessary. Also, because the LLE pain is described as radiating from the back, an opinion as to whether the LLE condition is secondary to the back condition is necessary. 3. Bilateral Knee Condition The claimant contends that bilateral knee conditions began in service. While there is no currently diagnosed knee condition in the record, references to lower extremity pain, in the context of this claim, are broad enough to include the knees. The claimant provides a detailed account of the onset of knee issues, claimed as due to the fall that took place during a hike. The claimant contends that his right knee was injured during the fall itself and that his left knee was affected secondary to the right knee condition. A VA examination is necessary to determine the current nature and etiology of any knee conditions present. If a right knee condition is found to be service-connected, the described LLE symptoms and account of the claimant indicate the need for an opinion as to whether the left knee pain is secondary to the right knee condition. 4. Asthma The claimant contends that his asthma was aggravated by his active service. A VA examination was conducted in August 2016. The examiner found that the condition was less likely than not proximately due to or the result of the claimant’s service connected condition. At the time of the examination, the claimant had not established service connection for any disability, thus an opinion regarding secondary service connection is inappropriate. On the VA Form 21-526EZ completed by the claimant in April 2015, he specifically claims that his asthma condition was aggravated by service. However, the claimant’s file does not show evidence of asthma prior to service and the VA examiner states that the condition began in 1973, so evaluation for direct service connection is also appropriate. A new examination is necessary to evaluate whether the claimant’s current asthma condition is service-connected. The matter is REMANDED for the following action: 1. Identify and obtain any pertinent outstanding VA and private treatment records and associate them with the claims file. 2. Forward the claims file to an appropriate examiner to provide an addendum opinion to the August 2016 VA examination regarding service connection for asthma. The examiner is asked to answer the following: a) Is it at least as likely as not (50 percent or greater probability) that the claimant’s current asthma condition was incurred in or caused by an in-service injury, event, or illness? b) Is it at least as likely as not (50 percent or greater probability) that the claimant’s current asthma condition was aggravated beyond its normal progression by an in-service injury, event, or illness? The examiner is asked to provide a detailed rationale for any opinions given. 3. Forward the claims file to an appropriate examiner to provide an opinion regarding the claimed low back, left lower extremity, and bilateral knee disabilities. After review of the claims file, the examiner is asked to provide opinions as to the following: Provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the claimant’s low back pain, left lower extremity, and bilateral knee disabilities are etiologically related to, or had its onset during the claimant’s active service. For purposes of this opinion only, the examiner is asked to assume that the Veteran fell during service. (Continued on the next page)   The examiner is asked to provide a detailed rationale for any opinions given. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals J. Jack, Law Clerk Department of Veterans Affairs