Citation Nr: 20072840 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 16-11 433 DATE: November 12, 2020 REMANDED Entitlement to service connection for a left elbow disorder is denied Entitlement to service connection for a right elbow disorder is denied. Entitlement to service connection for a left foot disorder is remanded Entitlement to service connection for a right foot disorder is remanded. Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a right shoulder disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1976 to March 1979. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In June 2020, the Veteran testified before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. 1. Service Connection – Elbows The Veteran contends that his left and right elbow disorders are as a result of his active service. Specifically, he asserts that his bilateral elbows were injured due to physical activities and the rigors of his active service, to include attending Air Assault School. Board hearing transcript, June 1, 2020. Moreover, he asserts that when he injured his right shoulder, he also hit his right elbow; and that when he would seek treatment during service, he was sent away. Id. Further, the Veteran asserts he experiences left elbow symptoms, and has a diagnosis of right elbow pain and tendonitis. Id. The Veteran also asserts that he injured both elbows during a fall while stationed at Fort Campbell, Kentucky. See VA Form 21-4142 Authorization for Release of Information, April 24, 2014. Service treatment records are negative for complaints, treatments or diagnoses related to a right or elbow disorder. Post-service VA and private treatment records show a diagnosis of bilateral elbow pain and right elbow tendonitis. See e.g. June 2001 private treatment record; see also July 2014 VA treatment record. Additionally, the Board notes that the Veteran testified that he experienced bilateral elbow symptoms, to include pain. Board hearing transcript, June 1, 2020. The Veteran has alleged suffering an injury to his elbows during service, has current left elbow symptoms and has a current right elbow diagnosis. Therefore, on remand, such an etiology opinion should be obtained. See 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Service Connection -- Feet and Knees The Veteran contends that his bilateral feet and bilateral knee disorders are as a result of his active service. Specifically, with regard to his feet, the Veteran asserts that the rigors of basic training and military service, caused his foot arches to fall during service; and that his feet symptoms began during basic training and have continued since. Board hearing transcript, June 1, 2020; see also Notice of Disagreement, November 4, 2014. With regard to his knees, the Veteran asserts that his bilateral knee pain began during active service, is attributable and secondary to his knee injuries, and that his symptoms began during active service and have continued since. Id; see also Notice of Disagreement, November 4, 2014. The Veteran also asserts that he injured his feet while stationed at Fort Campbell, Kentucky. See VA Form 21-4142 Authorization for Release of Information, April 24, 2014; see also Notice of Disagreement, November 4, 2014. Service treatment records show that the Veteran reported right knee pain in August 1978; was diagnosed with a knot on his heel in March 1978; had fallen arches and pes planus bilaterally in October 1976; was treated for a left knee twisting injury in April 1977; complained of a left swollen foot in April 1976; and complained of cramps in legs, foot trouble, and aching feet due to running at his separation examination in January 1979. Post-service VA and private treatment records show bilateral feet diagnoses that include plantar fasciitis, periostitis, pain; and knee pain. See January 2006 private treatment record; see also September 2015 VA treatment record. Additionally, the Veteran testified he had diagnoses of bilateral knee arthritis. Board hearing transcript, June 1, 2020. The Board notes that the Veteran was afforded VA examinations for his claimed feet and knee disorders in September 2014. At that time, the examiner found the Veteran did not have a current diagnosis associated with his claimed feet disorders, and noted that the Veteran had normal feet at his separation examination in January 1979 and that his x-rays did not show pes planus, and his physical examination only showed a small loss of arch height in the left foot only. The VA examiner opined that it was less likely than not that the Veteran’s current foot conditions were incurred in or caused by active service; and noted that the Veteran had bilateral acute long arch sprain, had a normal physical examination upon separation from active service, and only had small loss arch height of the left foot. With regard to his knees, the examiner diagnosed bilateral degenerative joint disease of the knees. The VA examiner opined that it was less likely than not that his bilateral knee disorders were incurred in or caused by active service; and noted that the Veteran had bilateral mild arthritis of the knees that was commensurate with his age, that the Veteran was diagnosed with bilateral knee strains during active service, and that there is no evidence in the medical literature that links soft tissue injuries to the development of arthritis. The VA examiner also noted that advanced age is one of the strongest risk factors associated with osteoarthritis, and that the findings were consistent with these studies. However, these opinions did not give appropriate consideration to the Veteran’s statements regarding the onset and continuity of his symptoms, nor did the opinions adequately provide supporting rationale for the conclusions reached. Accordingly, the Board concludes that the Veteran should be afforded new VA examinations to determine the nature and etiology of his bilateral feet and bilateral knee disorders. 3. Service Connection – Right Shoulder The Veteran contends that his right shoulder disorder is as a result of his active service. Specifically, he asserts that he injured his right shoulder during a fall, and as due to physical activities and the rigors of his active service. Board hearing transcript, June 1, 2020; see also VA Form 21-4142 Authorization for Release of Information, April 24, 2014. Moreover, he asserts that around April 1977 while on march orders, he tripped and fell and injured his shoulder, and was treated in the field by a medic; and that since that time, his shoulder pain had worsened and the symptoms have continued since. See Notice of Disagreement, November 4, 2014; see generally VA Form 9, March 12, 2016; Board hearing transcript, June 1, 2020. Service treatment records show that the Veteran had a childhood injury related to his right humerus as noted on his examination upon entrance to active service. Service Treatment Record, March 12, 1976. Post-service VA and private treatment records show a diagnosis of right shoulder joint arthritis and complaints of right shoulder pain. See e.g. September 2010 private treatment record; see also July 2014 VA treatment record. Additionally, the Veteran testified he had diagnoses of right shoulder rotator cuff tear and tendonitis. Board hearing transcript, June 1, 2020. The Board notes that the Veteran was most recently afforded a VA examination for his shoulder in September 2014. At this time, the VA examiner found the Veteran did not have or ever had a shoulder condition, and noted that the Veteran believed he may have had arthritis in his right shoulder. The VA examiner opined that as there was no objective evidence of any right shoulder condition, no opinion as to the nature and etiology of such condition would be offered. However, this opinion relied on inaccurate facts, namely, that the Veteran did not have a right shoulder diagnosis and did not give appropriate consideration to the Veteran’s statements regarding the onset and continuity of his symptoms. In addition, the examiner did not adequately address the impact of the Veteran’s childhood humerus injury as noted upon entry into active service. Accordingly, the Board concludes that the Veteran should be afforded a new VA examination to determine the nature and etiology of his right shoulder disorder. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in their possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, the Veteran should be afforded an appropriate VA examination to determine the etiology of his claimed right elbow, left elbow, left foot, right foot, left knee, and right knee disorders. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran’s right and/or left elbow disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner should specifically address the Veteran’s contention that his right and/or left elbow disorder is the result of physical activities such as repelling, repetitive physical activity and a fall during service. (B) Is at least as likely as not (50 percent or greater probability) that the Veteran’s left foot and/or right foot, disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner should specifically address the Veteran’s contention that the physical activity during service caused his arches to fall. The examiner should also address the October 1976 notation of fallen arches and pes planus bilaterally, the April 1976 notation of a left swollen foot, the March 1978 notation of a knot on his heel and the January 1979 complaints of cramps in legs, foot trouble, and aching feet due to running at his separation examination. (C) Is at least as likely as not (50 percent or greater probability) that the Veteran’s left knee and/or right knee disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner should specifically address the Veteran’s contention that his physical activity and training during service resulted in his right and/or left knee disorder. The examiner should specifically address the August 1978 complaints of right knee pain and April 1977 treatment for a left knee twisting injury. In offering such opinions, the examiner should consider the Veteran’s statements. The examiner must provide a complete rationale for all opinions and conclusions reached. 3. Following the receipt of outstanding records, the Veteran should be afforded an appropriate VA examination to determine the etiology of his claimed right shoulder disorder. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner. Any indicated evaluations, studies and tests should be conducted. The need for further examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (a) Is it clear and unmistakable (obvious, manifest, and undebatable) that a right shoulder disorder preexisted active service? The examiner should address the Veteran’s reports of a broken right humerus as a child as noted in his service treatment records. (b) If so, is it clear and unmistakable (obvious, manifest, and undebatable) that the preexisting right shoulder disorder WAS NOT aggravated during service; or whether it is clear and unmistakable (obvious, manifest, and undebatable) that any increase in service was due to the natural progress? (c) If the right shoulder disorder did not preexist service, is it at least as likely as not (a probability of 50 percent or greater) had its onset in service or is etiologically related to service? The examiner should specifically address the Veteran’s contention that he injured his right shoulder during a fall around April 1977 while marching. The examiner should also address the Veteran’s contention that his right shoulder disorder is the result of his in-service physical activity and training. In offering such opinions, the examiner should consider the Veteran’s statements. The examiner must provide a complete rationale for all opinions and conclusions reached. KRISTY L. ZADORA Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Mariah N. Sim, 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.