Citation Nr: 20034582 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 19-11 303 DATE: May 18, 2020 REMANDED Entitlement to service connection for a bilateral knee disorder is remanded. Entitlement to service connection for a bilateral hip disorder is remanded. REASONS FOR REMAND The Veteran served honorably from August 1970 to August 1972. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2016 rating decision of the Department of Veteran Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. Bilateral knee disorder First, remand is required for a bilateral knee exam. VA has a duty to assist claimants to obtain evidence needed to substantiate a claim. 38 U.S.C. § 5103A (2012); 38 C.F.R. § 3.159 (2018). VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with a knee examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent   symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the third element establishes a low threshold and requires only that the evidence “indicates” that there “may” be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Where pain alone results in functional impairment of earning capacity, even if there is no identified underlying diagnosis, it can constitute a disability. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Here, an October 2013 VA treatment records showed treatment for chronic bilateral knee pain. In his July 2016 notice of disagreement (NOD), the Veteran indicated his knee pain began in service. The Veteran stated he served as an engineer during service. The Veteran explained he was constantly walking down a ladder seven decks to the bottom every hour, six hours on and six hours off. The Veteran stated this put additional strain on his knees. The Veteran’s DD214 confirmed his military occupation specialty (MOS) as an electrician’s mate that worked in the engine room. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination is required. Bilateral hip disorder Second, remand is required for a hip examination. The RO did not provide the Veteran with a hip examination. VA’s duty to assist includes providing a medical examination when is necessary to make a decision on a claim. 38 U.S.C. § 5103A(d); 38 C.F.R. § 3.159(c)(4). The RO did not provide the Veteran with a knee examination. Such development is necessary if the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or recurrent   symptoms of disability, (2) establishes that the Veteran suffered an event, injury or disease in service, or has a presumptive disease during the pertinent presumptive period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. 38 C.F.R. § 3.159(c)(4); McLendon, 20 Vet. App. at 83-86. Here, a July 2014 VA treatment record showed a diagnosis of bilateral osteoarthritis. In his July 2016 NOD, the Veteran indicated his hip pain began during service. The Veteran stated the nature of his MOS caused strain on his hips. Because there is evidence of currently diagnosed disabilities, an in-service event, and an indication that the current disabilities may be associated with the in-service event, remand for a VA examination is required. 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. 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, provide the Veteran with an appropriate examination to determine the etiology of his bilateral knee disorder. 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. First, the examiner must comment on whether there is a bilateral knee disorder or whether any complaints of bilateral knee pain alone, have resulted in functional impairment of earning capacity. Second, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the right knee disorder had onset in, or is otherwise related to, active military service. Third, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the left knee disorder had onset in, or is otherwise related to, active military service.   The examiner should assume the Veteran’s statements are credible for the limited purpose of the opinion. The examiner must specifically address the Veteran’s assertions of an in-service onset due to strain on his knees based on his MOS. See July 2016 NOD. 4. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the etiology of his bilateral hip disorder. 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. First, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the right hip disorder had onset in, or is otherwise related to, active military service. Second, the examiner must provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the left hip disorder had onset in, or is otherwise related to, active military service. The examiner should assume the Veteran’s statements are credible for the limited purpose of the opinion. The examiner must specifically address the Veteran’s assertions of an in-service onset due to strain on his hips based on his MOS. See July 2016 NOD. The examiner must also specifically address VA treatment records that show treatment for bilateral hip osteoarthritis.   5. 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 (2019). 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 C. Bruton, 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.