Citation Nr: 20004840 Decision Date: 01/22/20 Archive Date: 01/21/20 DOCKET NO. 17-50 602 DATE: January 22, 2020 REMANDED Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for bilateral hearing loss is remanded. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected flat feet is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected flat feet is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected flat feet is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected flat feet is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1998 to February 2006. He served in the United States Marine Corps. In October 2019, the Veteran appeared at a Board hearing and testified before the undersigned Veterans Law Judge.   First, remand is required to attempt to obtain private records. VA’s duty to assist includes making reasonable efforts to obtain private medical records. 38 C.F.R. § 3.159(c)(1). The Veteran indicated that received care from a non-VA physician at Kaiser Permanente. Review of the Veteran’s claims file show no treatment records from this private provider or from Kaiser Permanente. Therefore, on remand, the RO must make reasonable efforts to obtain any outstanding records from these sources. Second, remand is required for new VA examinations. Where VA provides the Veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). A medical opinion must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions. Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). 1. Entitlement to service connection for tinnitus is remanded. 2. Entitlement to service connection for bilateral hearing loss is remanded. Remand is required for an updated examination. A February 2016 VA examination was conducted. The testing showed there was no hearing loss for VA purposes. See 38 C.F.R. § 3.385 (2018). During his October 2019 hearing, he asserted that his hearing loss had increased since 2016. Accordingly, remand is required to obtain current testing. As information regarding tinnitus could be gathered during this examination, the Board remands this issue as well. 3. Entitlement to service connection for a left knee disorder, to include as secondary to service-connected flat feet, is remanded. 4. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected flat feet, is remanded. Remand is required for an adequate examination and opinion. A March 2016 VA examination was conducted. The Veteran was found to have normal objective findings bilaterally of the knees. But during the examination, the Veteran reported bilateral knee pain. An August 2018 Knee and Lower Leg DBQ was completed. The Veteran was noted to have a diagnosis of left knee strain but no right knee diagnosis and no pain. After examination, the examiner concluded that the Veteran’s claimed condition was less likely than not proximately due to or the result of the Veteran’s service-connected condition. The Veteran’s VA treatment records show that the Veteran has continued to complain about pain in his knees and began to use a hinged brace for them. See December 2017 VA Primary Care Outpatient Note. October 2017 VA treatment notes included MRI results showing minimal medial and patellofemoral compartment degenerative joint disease. At the October 2019 Board hearing, the Veteran testified that he saw a private doctor at Kaiser Permanente, and that she told him that if he had flat feet, he would have issues with his knees too. The Veteran further testified that while he was in service, he jumped out of airplanes and helicopters, carrying packs that were about 190 pounds. The Veteran reported that he always felt instant pain in his knees when he made contact with the ground. The Veteran reported that he experienced pain to his knees in service, and continued to experience pain after separation from service. As there is no adequate medical opinion of record, a new VA examination is warranted. 5. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected flat feet, is remanded. 6. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected flat feet, is remanded. Remand is required for an adequate VA examination and opinion. A March 2016 VA examination was conducted. The Veteran was diagnosed with left hip femoral acetabular impingement syndrome (includes labral tears). The Veteran’s right hip was normal based upon objective findings. After objective testing, the examiner opined that the Veteran’s claimed condition was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner was unable to link the current complaints of left hip pain to time in the military given that there was no documentation of a left hip injury, and as to a right hip injury, the Veteran had denied right hip complaints on examination. The examination did not address secondary service connection. An August 2018 Hip and Thigh Conditions DBQ was completed. The examiner found that the Veteran did not have a current diagnosis with the claimed condition. But this report did not address prior diagnoses of record or the Veteran’s complaints of pain in his hips. At the October 2019 Board hearing, the Veteran testified that he was a general mechanic and electrician in service. The Veteran testified that he saw a private doctor at Kaiser Permanente, and that she told him that if he had flat feet, he would have issues with his hips too. The Veteran stated that as part of his duties, he would have to load generators on to the back of seven and five ton Humvees, jump out of the Humvees to do a security check, and set up the generator. The Veteran reported that he experienced pain to his hips in service, and continued to experience pain after separation from service. As there is no adequate medical opinion of record, a new VA examination is warranted. The matters are REMANDED for the following action: 1. Contact the appropriate VA Medical Center and obtain and associate with the claims file all outstanding records of treatment. If any requested records are not available, or the search for any such records otherwise yields negative results, that fact must clearly be documented in the claims file. Efforts to obtain these records must continue until it is determined that they do not exist or that further attempts to obtain them would be futile. The non-existence or unavailability of such records must be verified and this should be documented for the record. Required notice must be provided to the Veteran and his representative.   2. Contact the Veteran and afford him the opportunity to identify by name, address and dates of treatment or examination any relevant medical records. A specific request should be made for records from Kaiser Permanente, and from any of the Veteran’s treatment providers working there. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 3. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to assist in determining the etiology of bilateral hearing loss and tinnitus. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his active service. (a.) The examiner must determine whether bilateral hearing loss exists for VA purposes.   (b.) If bilateral hearing loss exists for VA purposes, the examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder manifested in or is otherwise related to the Veteran’s military service. (c.) If tinnitus is present, the examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder manifested in or is otherwise related to the Veteran’s military service. The examiner must address: 1) the October 2019 Board hearing testimony; 2) the Veteran’s lay statements regarding being actively engaged with the enemy while under heavy gun, artillery, and mortar fire, and working around generators while deployed to Iraq; and 3) the February 2016 VA examination report. 4. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to assist in determining the etiology of all knee disorders. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his active service. (a.) The examiner must identify all knee disorders.   (b.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that each disorder manifested in or is otherwise related to the Veteran’s military service, to include as due to the Veteran’s in-service duties. (c.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder was caused by the Veteran’s service-connected flat feet. (d.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder was aggravated by the Veteran’s service-connected flat feet. The examiner must address: 1) the October 2019 Board hearing testimony; 2) the Veteran’s VA treatment records showing current diagnoses; 3) the Veteran’s lay statements regarding jumping out of airplanes, helicopters, and Humvees, carrying 190 pound sacks; 4) the March 2016 VA examination report; and 5) the August 2018 DBQ report. 5. After any additional records are associated with the claims file, schedule the Veteran for a VA examination to assist in determining the etiology of all hip disorders. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner must elicit from the Veteran a full history and/or description of his active service. (a.) The examiner must identify all hip disorders. (b.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that each disorder manifested in or is otherwise related to the Veteran’s military service, to include his in-service duties. (c.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder was caused by the Veteran’s service-connected flat feet. (d.) The examiner must opine whether is it at least as likely as not (a 50 percent or greater probability) that the disorder was aggravated by the Veteran’s service-connected flat feet. The examiner must address: 1) the October 2019 Board hearing testimony; 2) the Veteran’s VA treatment records showing current diagnoses; 3) the Veteran’s lay statements regarding jumping out of airplanes, helicopters, and Humvees, carrying 190 pound sacks; 4) the March 2016 VA examination report; and 5) the August 2018 DBQ report. 6. Notify the Veteran that it is his responsibility to report for any scheduled examination and to cooperate in the development of the claims, and that the consequences for failure to report for a VA examination without good cause may include denial of the claims. 38 C.F.R. §§ 3.158, 3.655 (2018). In the event that the Veteran does not report for any scheduled examination, documentation must be obtained which shows that notice scheduling the examination was sent to the last known address. It must also be indicated whether any notice that was sent was returned as undeliverable. K. MILLIKAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board P. Nguyen, 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.