Citation Nr: 20021632 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 18-20 777 DATE: March 26, 2020 ORDER Service connection for left knee disabilities, to include arthritis and residuals of knee replacement surgery is granted. Service connection for right knee disabilities, to include arthritis and residuals of knee replacement surgery is granted. REMANDED Service connection for right-sided neuropathy is remanded. FINDINGS OF FACT 1. The Veteran has current left knee disabilities including arthritis and residuals of August 2016 left knee replacement surgery. In an August 2017 written statement, the Veteran’s longterm orthopedist opined that, based on his familiarity with the Veteran’s knee problems, his review of relevant military and medical history, and the nature of the progression of the Veteran’s knee disabilities, it is more likely than not that the Veteran’s left knee disabilities are due to her military service. The orthopedist explained that the Veteran’s activities during service, including airborne training and lengthy ruck marches with 80lb packs, caused premature degeneration of the Veteran’s left knee which eventually required knee replacement surgery. In December 2015 written statements, the Veteran and her spouse both provided a detailed history of the in-service onset of the Veteran’s left knee pain and its persistence to present. Resolving reasonable doubt in the Veteran’s favor, the Board of Veterans’ Appeals (Board) finds that this competent and credible evidence establishes that service connection is warranted for the Veteran’s left knee disabilities. 2. The Veteran has current right knee disabilities including arthritis and residuals of August 2016 right knee replacement surgery. In an August 2017 written statement, the Veteran’s longterm orthopedist opined that, based on his familiarity with the Veteran’s knee problems, his review of relevant military and medical history, and the nature of the progression of the Veteran’s knee disabilities, it is more likely than not that the Veteran’s right knee disabilities are due to her military service. The orthopedist explained that the Veteran’s activities during service, including airborne training and lengthy ruck marches with 80lb packs, caused premature degeneration of the Veteran’s left knee which eventually required knee replacement surgery. In December 2015 written statements, the Veteran and her spouse both provided a detailed history of the in-service onset of the Veteran’s right knee pain and its persistence to present. Resolving reasonable doubt in the Veteran’s favor, the Board finds that this competent and credible evidence establishes that service connection is warranted for the Veteran’s right knee disabilities. CONCLUSIONS OF LAW 1. The criteria have been met for service connection for left knee disabilities, to include arthritis and knee replacement residuals. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. 2. The criteria for have been met for service connection for right knee disabilities, to include arthritis and right knee replacement surgery residuals. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1993 to May 1994. These matters are before the Board on appeal from a July 2015 rating decision. The Board notes that the Veteran’s service treatment records (STRs) indicate that the claimed right-sided neuropathy disability may be a symptom of her service-connected migraines. If the Veteran believes this is the case, she should file an additional claim for an increased rating for her service-connected migraines, either online (https://www.ebenefits.va.gov/ebenefits/) or in a local VA office. The Board notes with appreciation the Veteran’s and her spouse’s December 2015 written statements explaining the onset and development of the Veteran’s knee disabilities. The Veteran’s spouse noted that the Veteran has experienced knee pain during their 28 years of marriage of such severity that it has greatly affected both of their lives. Due to the Veteran’s current constant pain and suffering, they have had to sell their house and move to a single-level house to accommodate the Veteran’s knee disabilities. In addition, the Veteran submitted an initial statement and then a more detailed follow up statement from her treating orthopedist. This evidence was carefully reviewed and considered and ultimately assisted the Board in deciding the claims. The Veteran has truly partnered with VA in developing her claims while living with significant disability. 1. Service connection for left knee disabilities, to include arthritis and residuals of knee replacement surgery For the reasons outlined above, service connection is warranted. 2. Service connection for right knee disabilities, to include arthritis and residuals of knee replacement surgery For the reasons outlined above, service connection is warranted. REASONS FOR REMAND 1. Service connection for right-sided neuropathy is remanded. A remand is required to afford the Veteran a VA examination. The matter is REMANDED for the following action: 1. Please note that, by law, ALL remanded claims must be processed expeditiously. 2. Obtain any available VA treatment records. 3. Send the Veteran a letter asking her to identify all treatment providers for the issue on appeal and to authorize VA to obtain available records for association with the claims file. 4. Send the Veteran a letter advising of the following information, which will hopefully be helpful to the Veteran in developing the remanded claim: “VA is assisting with developing evidence for this claim by arranging a VA examination and opinion as directed below. However, you are strongly encouraged to submit additional evidence to support your claim. For example, you could submit a letter from your doctor diagnosing a disability related to your claim for service connection for right-sided neuropathy and stating that it is at least as likely as not (a 50 percent or greater probability) this condition either developed in service or was caused or aggravated by a service-connected connected disability. Alternatively, you could submit evidence describing the onset and progression of any symptoms related to a current condition. Any such letter MUST include a DETAILED explanation for the writer’s conclusion.” 5. Then schedule the Veteran for an examination with a VA neurologist to evaluate the nature and cause of the Veteran’s claimed right-sided neuropathy. The examiner’s attention is drawn to the following records (the following is a brief factual background and not intended to be a substitute for your review of the claims folder): • The December 1985 STR where the Veteran reported right upper extremity numbness possibly associated with migraines • June 1989 STR showing evaluation of right-sided numbness • February 1994 and May 1994 STRs showing neurological evaluation of the Veteran’s report of right-sided neurological symptoms assessed as possibly related to migraines or a demyelinating lesion • The Veteran’s October 2015 notice of disagreement (NOD) stating that she was treated during active service for all claimed disabilities (including right-sided neuropathy) The examiner should answer the following questions based on (1) a review of the claims file and (2) interview and examination of the Veteran. Please note that an opinion based solely on the lack of medical literature supporting a claim would not be legally adequate for the Board to decide the claim. a) Identify any right-sided neurological disabilities. b) Please state whether the Veteran has right-sided pain, numbness, tingling, etc. with functional impairment that is not attributable to any diagnosed disability. (The Federal Circuit Court held that pain, even without a diagnosis, DOES count as a disability for VA compensation purposes IF the pain causes functional impairment.) c) Is it at least as likely as not (a 50 percent or better probability) that any diagnosed neurological disability or pain with functional impairment began during active service OR is otherwise related to the Veteran’s service? d) Is it at least as likely as not (a 50 percent or better probability) that any diagnosed neurological disability or pain with functional impairment was CAUSED by the Veteran’s service-connected migraines? e) Is it at least as likely as not (a 50 percent or better probability) that any diagnosed neurological disability or pain with functional impairment was AGGRAVATED by the Veteran’s service-connected migraines? (Aggravation in this context means the disability increased in severity beyond its natural progression.) Please note that the Veteran is able to report observable symptoms, and, for the purposes of this examination, please assume the Veteran’s reports to be credible. (CONTINUED ON NEXT PAGE) A detailed explanation (rationale) is required for all opinions provided and is very much appreciated. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation.) VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board N. Robinson, 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.