Citation Nr: 18114792 Decision Date: 06/28/18 Archive Date: 06/28/18 DOCKET NO. 14-38 169 DATE: June 28, 2018 REMANDED Entitlement to service connection for a left knee disorder, to include as secondary to service-connected hysterectomy, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected hysterectomy, is remanded. Entitlement to service connection for a right shoulder disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1981 to May 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2015 the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. While the Veteran limited her substantive appeal (VA Form 9) to the issues pertaining to service connection for bilateral knee disorders, the issue of entitlement to service connection for a right shoulder disorder was certified to the Board and testimony was offered on such matter at the hearing. Therefore, the Board has jurisdiction over such matter. 1. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected hysterectomy. 2. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected hysterectomy. The Veteran underwent bilateral knee replacements in 2012 and contends that service connection for her bilateral knee disorder is warranted. Specifically, she maintains that the condition that led to her knee replacement surgeries, generally osteoarthritis with chondromalacia, was due to marching, running, and kneeling during service. Alternatively, the Veteran contends that a loss in bone density from her service-connected hysterectomy led to her knee problems. In October 2012, a VA clinician issued an opinion regarding the relationship between the Veteran’s bilateral knee disorder and her service-connected hysterectomy. A separate opinion also addressed the relationship between the Veteran’s hysterectomy and loss of bone density. Taken together, the Board finds that these opinions are adequate to decide the issue of whether the Veteran’s bilateral knee disorders are related to her hysterectomy. However, no opinion has been proffered as to whether the Veteran’s bilateral knee disorders are directly related to service. Although service treatment records are silent for any complaints, treatment, or diagnosis referable to the left or right knee during service and the Veteran’s statements concerning the onset of her condition have been contradictory, in the October 2012 opinion referenced above, the clinician stated that factors that can lead to osteoarthritis include jobs that involve kneeling, squatting, and lifting. A letter from the Veteran’s orthopedist also states that there is some evidence that repetitive kneeling or squatting causes slight increased risk of development of osteoarthritis. Given these statements, an addendum opinion is necessary in order to address whether the Veteran’s previous osteoarthritis of the bilateral knees was due to her in-service duties, which involved frequent lifting, kneeling, and squatting. 3. Entitlement to service connection for a right shoulder disorder. The Veteran has reported experiencing right shoulder pain, and evidence of record reflect a current diagnosis of a right shoulder disorder. Specifically, October 2012 x-rays show sclerosis of the upper margin of the greater tuberosity which could be related to early changes of impingement syndrome, and a January 2014 MRI shows a focal distal tear of the anterior aspect of the supraspinatus tendon insertion, with tendinopathy and scattered microtearing, acromial spurring, and fluid in the subacromial subdeltoid bursa. The Veteran contends that this is due to a shoulder injury she suffered during service. In this regard, service treatment records show the Veteran injured her right shoulder in October 1987. She was assessed with bicipital tendonitis with mild rhomboid myositis. In October 2012, a VA clinician opined that the Veteran’s current shoulder condition was less likely than not related to her in-service injury. The supporting rationale is inadequate; however, as it appears to rely solely on the lack of continuous documented care following service. While that is a factor that may be considered, it cannot provide the entire basis for the proffered opinion. As such, an addendum is required. Finally, the Veteran referenced treatment records from 1997 at her Board hearing. It does not appear that any such records are on file. As such, she should be so notified and invited to submit any copies that may be in her possession. Any VA treatment records not currently associated with the file should be added as well. The matter is REMANDED for the following action: 1. Notify the Veteran that no treatment records from 1997 appear in her file and afford her the opportunity to submit any copies in her possession or the appropriate releases for VA to obtain them directly. 2. Obtain all outstanding VA treatment records. 3. Forward the file to an appropriate examiner in order to obtain an addendum opinion regarding whether the Veteran’s previous bilateral knee osteoarthritis with chondromalacia is at least as likely as not (i.e., a 50 percent or greater probability) caused by her in-service lifting, squatting, and kneeling. A rationale for any opinion offered should be provided. 4. Forward the file to an appropriate examiner in order to obtain an addendum opinion regarding whether the Veteran’s diagnosed right shoulder disorder is at least as likely as not (i.e., a 50 percent or greater probability) related to her documented in-service shoulder injury. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Alexander Panio, Counsel