Citation Nr: 18159288 Decision Date: 12/18/18 Archive Date: 12/18/18 DOCKET NO. 16-49 683 DATE: December 18, 2018 REMANDED Entitlement to service connection for a bilateral foot disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran had active service from November 1994 to November 2014 This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. 1. Entitlement to service connection for a bilateral foot disability is remanded. The Veteran contends that her bilateral foot disability is the result of active service. In the June 2018 Appellant Brief, the Veteran, through her representative, asserted that her bilateral foot disability did not exist prior to service and was not noted upon enlistment. As a result, she contends that the presumption of soundness attaches. In the June 1994 entrance examination, the Veteran was noted to have a diagnosis asymptomatic mild pes planus. In an April 2015 VA foot examination, the examiner noted a diagnosis of bilateral flat foot. The examiner opined that the claimed disability was not related to service. The same examiner went on to opine that there was no evidence of worsening or aggravating foot conditions during service in the treatment records. The rationale provided was that the foot was normal on examination without any signs of flat foot or tenderness. When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The April 2015 VA examination is insufficient for adjudication. There is no evidence that the examiner took into consideration the Veteran’s report of continuity of symptomatology. Furthermore, no explanation was provided as to how the Veteran could have a previous diagnosis of bilateral flat feet that is now resolved. As a result, the Board finds that an additional examination would be helpful to ascertain the nature of any current bilateral foot disability, or an explanation as to how the foot disability diagnosed om entrance into service is now resolved. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. The Veteran contends that she is entitled to service connection for a left knee and right knee disability, as the claimed disabilities are the result of active service. More specifically, the Veteran asserts that she developed osteoarthritis of the left knee and right knee from exercises, such as squats and lunges, that she was required to do while in service. Service treatment records show ongoing complaints of knee pain. However, there was no diagnosis made upon separation from service. The medical evidence of record also does not show that the Veteran currently has a diagnosis of a left knee or right knee disability. In an April 2015 VA examination, the examiner opined that the Veteran does not have a current diagnosis associated with any claimed knee condition. In an October 2015 private treatment record, M.T.Z., DO assessed the Veteran for osteoarthritis of the left knee and the right knee; no clear diagnosis was made. In a June 2018 Appellant Brief, the Veteran, through her representative asserted that the October 2015 private treatment record provided a diagnosis and positive nexus opinion to service. It is unclear if the October 2015 examiner made a diagnosis or was assessing the Veteran for complaints of left knee and right knee osteoarthritis. As such, the Board finds that a VA examination would be helpful in determining if the Veteran has a current left knee and right knee disability. 4. Entitlement to service connection for sleep apnea is remanded. A January 2018 rating decision denied service connection for sleep apnea and the Veteran filed a notice of disagreement in October 2018. A statement of the case has not been issued. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). The matter is REMANDED for the following action: 1. Secure all outstanding VA medical records. If any records cannot be located, specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. If records are unable to be obtained (a) notify the claimant of the specific records that VA is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claim. The claimant must then be given an opportunity to respond. 2. After completing directive (1), schedule the Veteran for a VA foot examination to determine the nature and etiology of any bilateral foot disability. The examiner should review the claims file and note that review in the report. All indicated tests should be conducted. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology. The examiner should provide an explanation for all conclusions. The examiner should provide the following opinions: (a.) Is it at least as likely as not (50 percent probability or greater) that any bilateral foot disability is related to active service. (b.) Is it at least as likely as not that any preexisting bilateral foot disability permanently increased in severity during service and if so, whether any permanent increase in severity represented, or was more than, the natural progress of the disorder. If the examiner finds that the bilateral foot disability has resolved, the examiner should so state and provide an explanation as to how the foot disability resolved. If the examiner finds that the flat foot disability is still present, but is asymptomatic, the examiner should so state. If the examiner determines that the bilateral foot disability is not the result of active service, but can be attributed to some other cause, the examiner should so state, taking into account the Veteran’s full post-service work and medical history. The examiner should also discuss the April 2015 VA medical opinion regarding the bilateral foot disability. 3. After completing directive (1), schedule the Veteran for a VA examination to determine the nature and etiology of any left knee and right knee disability. The examiner should review the claims file and note that review in the report. All indicated tests should be conducted. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology including the documentation of knee complaints in the service medical records. The examiner should provide an explanation for all conclusions. The examiner should opine as to whether it is at least as likely as not (50 percent probability or greater) that any left knee and right knee disability is related to active service? Please discuss the matter thoroughly and provide a rationale for the opinion. If the examiner determines that the bilateral foot disability is not the result of active service, but can be attributed to some other cause, the examiner should so state, taking into account the Veteran’s full post-service work and medical history. 4. Issue the Veteran a statement of the case on the issue of service connection for sleep apnea. JOHN Z JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. D. Cross, Associate Counsel