Citation Nr: 20004237 Decision Date: 01/17/20 Archive Date: 01/16/20 DOCKET NO. 16-61 664 DATE: January 17, 2020 REMANDED Entitlement to service connection for a back condition is remanded. Entitlement to service connection for a bilateral knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1991 to October 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2013 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Cleveland, Ohio. The Board notes that jurisdiction rests in Indianapolis, Indiana. The Veteran testified at a Travel Board hearing before the undersigned Veterans Law Judge in October 2019. A transcript of the hearing is of record. 1. Entitlement to service connection for a back condition is remanded. Service treatment records show that in July 1994, the Veteran complained of back pain. It was noted that the Veteran was in a motor vehicle accident 5 days earlier. The Veteran was assessed with acute muscle strain. In another July 1994 service treatment record, acute MS back pain was noted. The Veteran was put on limited duty and advised no bending over. In May 1995, a left trapezius strain was noted and the Veteran complained of back pain. A separate April 1995 car accident was noted. In March 1999, the Veteran complained of pain in the left mid back. In an undated service treatment record, myofascial back pain was noted to be secondary to the Veteran’s April 1995 motor vehicle accident. In a February 2010 service treatment record, low back pain during deployment was noted and the Veteran said it was worse over the past few months. A February 2011 service treatment record noted that the Veteran had 2 car accidents in Iraq in 2008. The Veteran experienced numbness and tingling in her legs. In an April 2011 service treatment record, it was noted that back pain started 2 years ago and had worsened. Numerous other entries were made in the service treatment records noting back pain. In a March 2013 VA examination, the Veteran was diagnosed with chronic myofascial lumbar strain. In a separate July 2013 VA opinion, the examiner opined that it was less likely than not that the Veteran’s back condition was related to her back pain in service in July 1994 and March 2011. The examiner reasoned that these 2 occasions represented acute muscle strain/spasms, a self-limiting condition. They were separated by 17 years. There was no indication that these occasions represented progression of a current chronic condition. At the October 2019 Board hearing, the Veteran argued that the rigors of service, wearing a helmet and carrying her travel bag, and the vehicle accidents she was in in service caused her back problem. Based on the above, the Board finds the July 2013 VA opinion inadequate for several reasons. First, the examiner only addressed the July 1994 and March 2011 complaints of back pain in service. However, there are numerous other entries of complaints of back pain throughout the Veteran’s service. Therefore, the examiner’s opinion was based on an inaccurate factual premise. Additionally, the examiner has not considered the Veteran’s lay statements that her activities in service and multiple motor vehicle accidents caused her back condition. Therefore, on remand, an additional VA opinion should be obtained to determine the etiology of the Veteran’s back condition. 2. Entitlement to service connection for a bilateral knee condition is remanded. Service treatment records show that in June 1992, the Veteran was noted to have left knee strain and was fitted for crutches. In a July 2006 service treatment record, the Veteran reported persistent ache behind the right knee. In a March 2009 service treatment record, the Veteran reported that her knee gave out and that she had sharp pain. She said this pain started in 2007. In a February 2010 service treatment record, right knee pain was noted. In a July 2010 service treatment record, the Veteran reported pain in his knees. Numerous other entries were made in the service treatment records noting knee pain. In a March 2013 VA examination, the Veteran was diagnosed with bilateral knee strain. In a separate July 2013 VA opinion, the examiner opined that it was less likely than not that the Veteran’s bilateral knee strain was related to the knee pain in service in June 1992 and January 2000. The examiner reasoned that there was no evidence of injury or chronicity of a knee condition in the Veteran’s service medical records. Also, the Veteran’s knee MRIs were completely normal. At the October 2019 Board hearing, the Veteran testified that staying in physical shape with running and exercise, as well as walking on rocks caused her knee problems. Also, the Veteran stated that during service they did “boot and shoots,” which was a short fun run in combat boots that caused pressure on her knees. Based on the above, the Board finds the July 2013 VA opinion inadequate for several reasons. First, the examiner only addressed the June 1992 and January 2000 complaints of knee pain in service. However, there are numerous other entries of complaints of knee pain throughout the Veteran’s service. Therefore, the examiner’s opinion was based on an inaccurate factual premise. Additionally, the examiner has not considered the Veteran’s lay statements that her activities in service caused her bilateral knee condition. Therefore, on remand, an additional VA opinion should be obtained to determine the etiology of the Veteran’s bilateral knee condition. The matters are REMANDED for the following actions: 1. Obtain any outstanding VA or private treatment records. Request that the Veteran assist with locating these records, if possible. Associate these records with the claims file. 2. Then, obtain a VA opinion from an appropriate examiner to determine the etiology of the Veteran’s back condition. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s back condition is related to service. A clear rationale must be provided for all opinions expressed. The examiner must consider the numerous complaints of back pain throughout service, as well as the Veteran’s account of her duties in service and the rigors associated with it, such as wearing a 50 pound helmet, and carrying a heavy travel bag, as well as her multiple motor vehicle accidents. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 3. Also, obtain a VA opinion from an appropriate examiner to determine the etiology of the Veteran’s bilateral knee condition. The claims file and a copy of this remand must be made available for review. Following a review of the pertinent evidence, the examiner must determine whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s bilateral knee condition is related to service. A clear rationale must be provided for all opinions expressed. The examiner must consider the numerous complaints of knee pain throughout service, as well as the Veteran’s account of her duties in service and the rigors associated with it, such as running, exercise, and “boot and shoots” in combat boots. If the examiner is unable to provide an opinion without resorting to mere speculation, then the examiner must state this and provide any information needed to make an opinion, if possible. 4. Thereafter, readjudicate the claim on appeal. If the benefit sought remains denied, issue the Veteran and her representative a supplemental statement of the case and provide a reasonable opportunity to respond before returning the matter to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Saudiee Brown, Associate Counsel 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.