Citation Nr: 20021725 Decision Date: 03/26/20 Archive Date: 03/26/20 DOCKET NO. 17-17 340 DATE: March 26, 2020 ORDER New and material evidence having been submitted, the claim of right wrist carpal tunnel syndrome (CTS) is reopened. New and material evidence having been submitted, the claim of service connection for left knee patellofemoral syndrome is reopened. REMANDED Service connection for a left knee condition. Service connection for a right knee condition, to include as secondary to a left knee condition. Service connection for a right wrist condition, including CTS. Service connection for a left wrist condition, including CTS. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from May 1985 to July 2002. The case is on appeal from a September 2013 rating decision. The decision also denied service connection for gastroesophageal reflux disease (GERD), which the Veteran appealed. Subsequently, in a March 2017 rating decision, RO granted service connection for GERD. Thus, the GERD claim is no longer on appeal. In November 2019, the Veteran testified at a Board hearing. At the hearing, the record was held open for 90 days. No additional evidence was submitted. Reopened Claims 1. Whether new and material evidence has been received to reopen a previously denied claim of service connection for right wrist CTS. 2. Whether new and material evidence has been received to reopen a previously denied claim of service connection for left knee patellofemoral syndrome. The Veteran’s claims of service connection for right wrist CTS and left knee patellofemoral syndrome were initially denied in an August 2002 rating decision on the basis that there was no evidence of treatment, findings, or diagnoses at the time of separation from service or post-service. The Veteran was notified of the decision by an August 2002 letter, which was mailed to the then current mailing address of record. Thereafter, no new evidence or notice of disagreement (NOD) was received by the VA within one year of the issuance of the August 2002 rating decision. As the Veteran did not appeal the decisions within the proper time, the rating decisions are final. See 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. The present claims to reopen a claim of service connection for right wrist CTS and for left knee patellofemoral syndrome were received in October 2012 and form the basis of the present appeals. The threshold to reopen a claim is low and does not require new and material evidence as to each previously unproven element of a claim. Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). Additionally, VA is required to presume the credibility of newly submitted evidence for the purposes of determining whether that evidence is material and sufficient to reopen a previously denied claim. Justus v. Principi, 3 Vet. App. 510, 513 (1992). The Board finds that new and material evidence has been submitted so that the previously denied claims of service connection are reopened. See 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a); see also VA treatment records; November 2019 Board hearing transcript. REASONS FOR REMAND 3. Service connection for a left knee condition. 4. Service connection for a right knee condition, to include as secondary to a left knee condition. The Veteran contends that his left and right knee conditions began during service, that he was treated multiple times during service, and that he was diagnosed with patellofemoral syndrome while in service. Alternatively, the Veteran contends that he favored his left knee that caused a right knee problem; thus, a theory of secondary service connection for the right knee. Service treatment records (STRs) provide the Veteran was seen for right knee pain in February 1996, after he his knee on a door jam. At that time, he was treated with Motrin. A medical note in February 1996 provided the Veteran has pre-patellar bursitis of the right knee. In May and June 1999, there are notes of the Veteran complaining of bilateral knee pain, with the left being worse than the right. It was also noted that the Veteran had a history of chronic knee pain for the past 6 months. STRs further provide that the Veteran was originally referred for flat feet as a source of his knee pain in October 1999. At that time, the Veteran described his knee pain as under the left kneecap, and that it was worse when squatting, bending, carrying weight, or during long drives. The Veteran was treated with Motrin. STRs also provide he was given a knee sleeve and Naprosyn for treatment. An April 2000 examination noted the Veteran wears a brace and has swollen/painful joints. In February 2001, the Veteran returned for a follow up on his left knee pain. It was noted that the Veteran’s left patellofemoral syndrome seemed to be stabilizing. On the Veteran’s March 2002 separation examination, knee trouble is noted. Specifically, patellofemoral syndrome for the left knee is noted. The Veteran was afforded a VA examination in August 2013. The examiner noted a 2001 diagnosis of left knee patellofemoral syndrome and a September 2013 diagnosis of degenerative joint disease. Further, the examiner considered the Veteran’s report of bilateral knee pain for approximately 14 years and that pain was intermittent, brought on by kneeling and squatting. The examiner concluded that the left knee condition was not related to events that occurred in service. While the Veteran was seen for left knee pain that occurred with strenuous activity in 2001 and 2009 and was diagnosed with left patellofemoral syndrome, it was most likely from overload. The examiner concluded this after reviewing the separation physical, which “appeared normal” and an initial history and physical from September 2007 that was absent any knee complaints. The examiner further concluded that the right knee condition was not secondary to the left knee, and that both conditions were likely from the same etiology. STRs reflect in-service treatment for both knees. Additionally, the Veteran testified at the November 2019 Board hearing that he was placed on a limited profile for 7 days due to a knee injury during service. Further, he testified that he sought treatment for his right knee right after service and that he sought treatment for the left knee in 1999. As such, the August 2013 VA examination and report is not completely adequate. Thus, a new VA examination with a medical opinion is warranted to determine the current diagnosis and etiology of the Veteran’s knee conditions.   5. Service connection for a right wrist condition, including CTS. 6. Service connection for a left wrist condition, including CTS. The Veteran contends that his bilateral CTS began during service, and that he was treated for bilateral wrist pain during service. Additionally, he contends that while in service, examiners diagnosed him with CTS. STRs provide the Veteran was treated for right wrist CTS in February 2002. The Veteran was noted as complaining of right wrist pain that was aggravated by bending, pressure, or flexed wrist over the last several years. However, there was not acute trauma or injury noted to the right hand or wrist. Further, STRs provide that in February 2002, there were no left wrist symptoms. During the March 2002 separation examination, painful wrist is noted, along with the Veteran receiving therapy for carpal tunnel. The Veteran also reported significant improvement with his wrist pain with the use of a wrist splint and Naprosyn in March 2002. The Veteran was afforded a VA examination in August 2013. After reviewing the Veteran’s file and conducting an examination, the examiner concluded there is no evidence of CTS. Additionally, the examiner provided there is no diagnosis of CTS made, and because the Veteran’s history and physical examination are inconsistent with CTS and there are no neurologic symptoms, no EMG was conducted. The examiner noted that the Veteran reported a 12-year history of right wrist pain and left wrist pain for 5 years. Further, the Veteran reported he was seen in service for intermittent right wrist pain and that an impression of CTS symptoms was made in service. Although the August 2013 VA examination report does not reflect a diagnosis of CTS, STRs note in-service treatment for it. Additionally, the Veteran testified at the Board hearing in November 2019 that he has continued to receive treatment for his wrists since service from the VA. As such, the August 2013 VA opinion is not completely adequate. Thus, remand for a new VA examination with a medical opinion is warranted to better determine whether there is a current diagnosis of a wrist condition, including CTS, or alternatively, if the Veteran’s wrist pain rises to the level of functional impairment in line with Saunders. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018) (holding that pain causing functional impairment can constitute a current disability). In light of the remand, updated VA treatment records should be obtained. The matter is REMANDED for the following action: 1. Obtain VA treatment records since September 2013. 2. Schedule the Veteran for an examination by an appropriate VA clinician to determine the nature and etiology of any right and/or left wrist condition(s). After review of the file, the examiner should first determine whether the Veteran has any current condition of the right and left wrist, including CTS, which may include pain alone that arises to the level of functional impairment. If a diagnosis or functional impairment is not shown, it should be explained why this is so. If there is a diagnosis or functional impairment, the examiner should then opine whether it is at least as likely as not (a 50 percent or greater probability) that any right and/or left wrist condition is related to an injury, event, or disease during service, including CTS. A rationale for all opinions expressed should be provided. 3. Also, schedule the Veteran for an examination by an appropriate VA clinician to determine the nature and etiology of any right and left knee condition(s). After review of the file, the examiner should first determine whether the Veteran has any current condition of the right and left knee, or functional impairment even if no diagnosis. If a diagnosis is not shown, it should be explained why this is so. If there is a diagnosis or functional impairment, the examiner should then opine whether it is at least as likely as not (a 50 percent or greater probability) that any left or right knee condition is related to an injury, event, or disease during service. Additionally, for the right knee condition, the examiner must opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any identified right knee condition was caused or aggravated by his left knee condition. Aggravation is an increase in severity beyond the natural progress of the disease. A rationale for all opinions expressed should be provided. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Becton, 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.