Citation Nr: 20003271 Decision Date: 01/14/20 Archive Date: 01/14/20 DOCKET NO. 16-46 729A DATE: January 14, 2020 ORDER Service connection for degenerative changes of the lumbar spine is granted. Service connection for medial compartment narrowing of the left knee is granted. REMANDED Service connection for a right ankle disorder, to include as secondary to the service-connected left ankle disability. Service connection for an eye disorder.   FINDINGS OF FACT 1. The Veteran’s current degenerative changes of the lumbar spine are a result of service. 2. The Veteran’s current medial compartment narrowing of the left knee is related to service. CONCLUSIONS OF LAW 1. The criteria for service connection for degenerative changes of the lumbar spine have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for medial compartment narrowing of the left knee have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1982 to January 1989 and from September 2004 to January 2005. The case is on appeal from a September 2014 rating decision. By rating decision in December 2018, service connection was granted for a psychiatric disorder, a left ankle disorder, hearing loss, and tinnitus. This represents a full grant of the benefits sought with respect to those issues. The Veteran recently filed a claim for a total disability rating based on individual unemployability (TDIU) in October 2019. The RO has not yet adjudicated the claim, and thus, the issue is not before the Board as none of the issues on appeal are rating issues. Furthermore, the issue of lower extremity radiculopathy secondary to the now service-connected lumbar spine disorder was raised in an October 2019 submission, but has not been addressed by the RO. As such, the Board does not have jurisdiction over it, and the Board refers this matter to the RO for appropriate action. 38 C.F.R. § 19.9(b). Service Connection A. Legal Criteria Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. A veteran seeking compensation under these provisions must establish three elements: “(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service.” Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). The Veteran’s complete service records are unavailable. See July 2014 Correspondence. When some or all of a veteran’s service treatment records (STRs) or service personnel records (SPRs) are unavailable, it has been held that there is a heightened obligation on the part of VA to explain findings and conclusions and to consider carefully the benefit of the doubt rule. Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O’Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). B. Discussion 1. Service connection for a lumbar spine disorder. The Veteran maintains that his current back disability is a result of parachute injuries during service. Review of the available records shows that the Veteran was Airborne qualified and received a Parachutist’s Badge. In addition, STRs reflect pain in the buttock/back area in October 1984. The coccyx was noted to be nonmobile and the assessment was gluteal contusion. See STRs in June 2014. Private treatment records in March 2013 reflect the Veteran’s history of back pain. See December 2018 records. The diagnoses included lumbago, lumbar bulging/herniated disc, lumbar degenerative disc disease (DDD), lumbar facet degeneration/hypertrophy, and lumbar spinal stenosis. Back surgery in March 2013 included a lumbar laminotomy and partial facetectomy with decompression of the nerve root and bilateral ligamentum flavum release/removal, right L3-4. In addition, magnetic resonance imaging (MRI) in August 2017 showed moderate degenerative changes most significant at L3-4. A December 2018 VA ankle examination report notes that the Veteran was a paratrooper during the first period of active duty and did not go to sick call for most strains/injuries as a result of parachute jumps because it would have affected his jump status. The examiner stated that the majority of long-serving Airborne troops on jump status eventually show significant ankle and back degeneration secondary to continuous trauma due to the requirements of the field. The Veteran’s report of back pain beginning in association with parachute jumps during service and thereafter is plausible, and is entitled to probative weight. Moreover, an October 2019 opinion from the Veteran’s private doctor states that back injuries are extremely common in association with parachute jumps/landings, noting medical literature identified parachuting as a cause of both acute injury and chronic degenerative changes. The doctor added that the deterioration of the service-connected left ankle establishes traumatic landings during service. Further, in addition to the indication of a traumatic injury to the coccyx in the STRs in October 1984, there was noted to be likely cumulative microtrauma to the spine from other jumps. The doctor concluded that it is at least as likely as not that degenerative changes of the Veteran’s spine are the result of service. The Board finds the October 2019 private medical opinion to be persuasive and of great probative value. It is apparent in the opinion that the claims file was reviewed and considered in rendering the opinion. Additionally, the opinion was based on an accurate history, contains a well-reasoned explanation, and is consistent with the December 2018 VA examination report. As such, this opinion is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Resolving any reasonable doubt in favor of the Veteran, the Board finds that degenerative changes of the lumbar spine are related to service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection for degenerative changes of the lumbare spine is warranted. 2. Service connection for left knee disorder. The Veteran also maintains that left knee symptoms are a result of parachute jumps/landings during service. See October 2019 submission. As noted above, the Veteran’s complete STRs are unavailable. The record reflects that the Veteran was Airborne qualified and received a Parachutist’s Badge. In addition, the Veteran’s report of left knee pain beginning in association with parachute jumps during service and thereafter is plausible, and is entitled to probative weight. Further, the impression of x-ray examination of the left knee in June 2016 was mild narrowing in the medial compartment. See September 2017 CAPRI records. Additionally, as reflected in the December 2018 VA ankle examination report, the Veteran did not go to sick call for most strains/injuries as a result of parachute jumps during service because of the effect such would have had on his jump status. The VA examiner noted that the majority of long-serving Airborne troops on jump status, such as the Veteran in this case, eventually show significant joint degeneration secondary to continuous trauma due to the requirements of the field. Moreover, an October 2019 opinion from the Veteran’s private doctor states that injuries to the lower extremities are extremely common in association with parachute jumps/landings, noting medical literature identified parachuting as a cause of both acute injury and chronic degenerative changes. The doctor added that the deterioration of the service-connected left ankle establishes traumatic landings during service. Although the Veteran’s initial complaints of left knee pain are reflected in association with a fall after service in 2006, the doctor concluded that it is at least as likely as not that the Veteran’s left knee disorder is due to traumatic parachute landings and/or repetitive cumulative microtrauma during service. The Board finds the October 2019 private medical opinion to be persuasive and of great probative value. It is apparent in the opinion that the claims file was reviewed and considered in rendering the opinion. As such, this opinion is entitled to significant probative weight. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008). Resolving all reasonable doubt in favor of the Veteran, the Board finds that left knee medial compartment narrowing is related to service. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. Accordingly, service connection for medial compartment narrowing of the left knee is warranted. REASONS FOR REMAND 1. Service connection for a right ankle disorder, to include as secondary to the service-connected left ankle disability. The Veteran maintains that his right ankle condition is a result of parachute jumps/landings during service, or is secondary to an altered gait due to his service-connected left ankle disability. See October 2019 submission. The record reflects an award of service connection for arthritis of the left ankle based on a December 2018 VA examination report reflecting a well-known connection between ankle stressors from parachuting and subsequent weakness and degeneration, noting that the majority of long-serving Airborne troops on jump status eventually showed significant ankle degeneration secondary to continuous trauma due to the requirements of the field. Although a right ankle disorder has not been diagnosed, VA treatment records in September 2017 note painful range of motion along both the medial and lateral ankle compartments. As such, VA examination is warranted. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). The Board notes that, even without a current diagnosis, the Veteran’s report of pain may constitute a current disability to the extent it results in functional impairment. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that pain causing functional impairment can constitute a current disability). 2. Service connection for an eye disorder. VA treatment records in July 2014 reflect complaints of blurred vision. The primary diagnosis was retinal nevus of the left eye, and cataracts without vision effects were noted. In view of the evidence, to include the unavailability of the complete STRs, the Board finds VA examination is warranted with respect to the etiology of an eye disorder. Lastly, in light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records dated from March 2019. 2. Thereafter, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any right ankle pain. All necessary tests should be conducted. The examiner should first identify whether there is any current right ankle condition. If there is no diagnosis, the examiner should determine if the Veteran’s pain rises to the level of functional impairment in line with Saunders. If not, this should be explained. If there is a right ankle diagnosis, or functional impairment of the right ankle, the examiner should provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any such disorder or impairment had its onset during, or is otherwise causally related to, the Veteran’s service, to include parachute jumps. In rendering the opinion, the examiner should address the Veteran’s lay contentions, and, consideration should be given to the December 2018 VA opinion, as well as the October 2019 private opinion. If not, the examiner should also provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any such disorder or impairment was caused, or aggravated, by service-connected left ankle disability. Aggravation is an increase in severity beyond the natural progress of the disease. Rationale for all opinions expressed should be provided. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of an eye disability, to include retinal nevus of the left eye. All necessary tests should be conducted. (Continued on the next page)   The examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any eye disorder or impairment had its onset during, or is otherwise related, to service. Rationale for all opinions expressed should be provided. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Taylor The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.