Citation Nr: 20037569 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 19-14 156 DATE: June 2, 2020 REMANDED Entitlement to service connection for a right foot disorder, to include degenerative joint disease (DJD), is remanded. Entitlement to service connection for a left foot disorder, to include DJD, is remanded. Entitlement to service connection for a right ankle disorder, to include DJD and as secondary to service-connected back disorder, is remanded. Entitlement to service connection for a left ankle disorder, to include DJD and as secondary to service-connected back disorder, is remanded. Entitlement to service connection for a right knee disorder, to include DJD and as secondary to service-connected back disorder, is remanded. Entitlement to service connection for a left knee disorder, to include DJD and as secondary to service-connected back disorder, is remanded. Entitlement to service connection for a right wrist disorder, to include DJD and as secondary to service-connected neck disorder and back disorder, is remanded. Entitlement to service connection for a left wrist disorder, to include DJD and as secondary to service-connected neck disorder and back disorder, is remanded. Entitlement to service connection for bilateral leg venous insufficiency is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 2003 to July 2004, January 2008 to February 2009, and May 16, 2013 to May 19, 2016. 1. Entitlement to service connection for a right foot disorder is remanded. 2. Entitlement to service connection for a left foot disorder is remanded. Remand is required to obtain a VA examination. In McLendon v. Nicholson, 20 Vet. App. 79 (2006), the United States Court of Appeals for Veterans Claims (Court) indicated that there was a four-part test to determine whether an examination was necessary under 38 C.F.R. § 3.159(c)(4). Id. at 81. Under this test, VA will provide a medical examination or obtain a medical opinion where there is (1) competent evidence of a current disability or persistent or recurrent symptoms of a disability; (2) evidence establishing that an event, injury, or disease occurred in service; (3) an indication that the disability or persistent or recurrent symptoms of a disability may be associated with the veteran’s service or with another service-connected disability, but (4) insufficient competent medical evidence to make a decision on the claim. Id.; see also 38 C.F.R. § 3.159(c)(4). Here, in a May 2017 private medical opinion, Dr. M. assessed the Veteran to have degenerative joint disease in the bilateral feet. Dr. M opined that the Veteran’s musculoskeletal diseases are more likely than not caused by service. However, because the medical opinion did not provide a rationale that includes the onset or continuity of the bilateral foot disorder, a VA examination is necessary. Therefore, the criteria for McLendon have been met. And as a result, the Board cannot make a fully informed decision on the issue of entitlement to service connection for a bilateral foot disorder because no VA examination has been performed and no VA examiner has opined whether the Veteran’s bilateral foot disorder was caused by service. Therefore, a VA examination is necessary. 3. Entitlement to service connection for a right ankle disorder, to include DJD and as secondary to service-connected back disorder, is remanded. 4. Entitlement to service connection for a left ankle disorder, to include DJD and as secondary to service-connected back disorder, is remanded. 5. Entitlement to service connection for a right knee disorder, to include DJD and as secondary to service-connected back disorder, is remanded. 6. Entitlement to service connection for a left knee disorder, to include DJD and as secondary to service-connected back disorder, is remanded. Remand is necessary to obtain a new VA examination for the bilateral ankle and bilateral knee disorders. When VA undertakes to obtain an opinion, it must ensure that the opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). A medical opinion is considered adequate “where it is based on consideration of the veteran’s prior medical history and examinations and also describes the disability, if any, in sufficient detail so that the Board’s evaluation of the claimed disability will be a fully informed one.” Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Here, a May 2017 private medical opinion assessed the Veteran to have degenerative joint disease in the bilateral ankles and the bilateral knees. The medical provider stated that the Veteran’s back disorder radiated to the knees and ankles. A July 2018 VA examination of the bilateral knees and ankles stated that the Veteran had a strain in the bilateral knees and is silent regarding a diagnosis for the bilateral ankles. The examiner did not provide the Veteran with any imaging of the knees or ankles and did not comment on the Veteran’s diagnosis of degenerative joint disease. Further, the VA medical opinions did not address the private medical opinion or reference the private examiner’s statement that the Veteran’s bilateral knee and ankle disorders were caused or aggravated by the service-connected back disorder. Therefore, remand is required to obtain a new VA medical opinion for the bilateral knees and bilateral ankles. 7. Entitlement to service connection for a right wrist disorder, to include DJD and as secondary to service-connected neck disorder and back disorder, is remanded. 8. Entitlement to service connection for a left wrist disorder, to include DJD and as secondary to service-connected neck disorder and back disorder, is remanded. Remand is necessary to obtain a VA examination for the bilateral wrists. Here, the May 2017 private medical opinion stated that the Veteran has degenerative joint disease of the bilateral wrists that is caused by his neck and back disorders. The medical provider stated that the neck and back disorders radiate to the wrists. The medical provider stated that the Veteran is unable to lift heavy weights or perform routine duties. However, because the private medical provider did not provide a rationale related to onset or continuity or specifically reference the Veteran’s medical history, a VA examination is necessary. Therefore, the criteria for McLendon have been met. And as a result, the Board cannot make a fully informed decision on the issue of entitlement to service connection for the bilateral wrists because no VA examination has been performed and no VA examiner has opined whether the Veteran’s bilateral wrist disorder was caused by service or service-connected disorder. Therefore, a VA examination is necessary. 9. Entitlement to service connection for bilateral leg venous insufficiency is remanded. Remand is necessary to obtain a VA examination for bilateral leg venous insufficiency. Throughout the VA treatment records, but specifically in March 2019, it is noted that the Veteran’s varicose vein in the left leg is noted in 2008 during active duty in Cuba. The Veteran currently has severe bilateral venous insufficiency. Therefore, the criteria for McLendon have been met. And as a result, the Board cannot make a fully informed decision on the issue of entitlement to service connection for bilateral leg venous insufficiency because no VA examination has been performed and no VA examiner has opined whether the Veteran’s bilateral leg venous insufficiency was caused by or incurred in service. Therefore, a VA examination is necessary. 10. Entitlement to service connection for sleep apnea is remanded. Remand is necessary to obtain a VA examination. Here, the May 2017 private medical opinion assessed the Veteran to have sleep apnea. The medical provider stated that the Veteran presents with sensorial and psychiatric diseases that are more likely than not caused by military service. However, the medical provider did not provider a rationale supporting the opinion; therefore, a VA examination is necessary. Therefore, the criteria for McLendon have been met. And as a result, the Board cannot make a fully informed decision on the issue of entitlement to service connection for sleep apnea because no VA examination has been performed and no VA examiner has opined whether the Veteran’s sleep apnea was caused by or incurred in service. Therefore, a VA examination is necessary. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral foot disorder, to include degenerative joint disease (DJD). The examiner must opine as to whether it is at least as likely as not that the Veteran’s bilateral foot disorder began in service, within one year of service separation, or is otherwise related to service. The examiner must address the May 2017 private medical opinion in any negative medical opinion rendered. 2. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral ankle disorder, to include DJD. The examiner must opine as to whether it is at least as likely as not that the Veteran’s bilateral ankle disorder began in service, within one year of service separation, or is otherwise related to service. The examiner must also opine as to whether it is at least as likely as not that: • The Veteran’s bilateral ankle disorder was caused by service-connected back disorder, or • The Veteran’s bilateral ankle disorder was aggravated beyond its natural progression by the service-connected back disorder. The examiner must address the May 2017 private medical opinion in any negative medical opinion rendered. 3. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral knee disorder, to include DJD. The examiner must opine as to whether it is at least as likely as not that the Veteran’s bilateral knee disorder began in service, within one year of service separation, or is otherwise related to service. The examiner must also opine as to whether it is at least as likely as not that: • The Veteran’s bilateral knee disorder was caused by service-connected back disorder, or • The Veteran’s bilateral knee disorder was aggravated beyond its natural progression by the service-connected back disorder. The examiner must address the May 2017 private medical opinion in any negative medical opinion rendered. 4. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral wrist disorder, to include DJD. The examiner must opine as to whether it at least as likely as not that the Veteran’s bilateral wrist disorder began in service, within one year of service separation, or is otherwise related to service. The examiner must also opine as to whether it is at least as likely as not that: • The Veteran’s bilateral wrist disorder was caused by service-connected neck disorder, or • The Veteran’s bilateral wrist disorder was aggravated beyond its natural progression by the service-connected neck disorder. • The Veteran’s bilateral wrist disorder was caused by service-connected back disorder, or • The Veteran’s bilateral wrist disorder was aggravated beyond its natural progression by service-connected back disorder. The examiner must address the May 2017 private medical opinion in any negative medical opinion rendered. 5. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s bilateral leg venous insufficiency. The examiner must opine as to whether it is at least as likely as not the Veteran’s bilateral venous insufficiency began in service or is otherwise related to service, to include in-service treatment for left leg varicose veins in 2008. 6. Schedule the Veteran for an examination (or telehealth interview, review of the record, or similar action, if an in-person examination is not feasible) by an appropriate clinician to determine the nature and etiology of the Veteran’s sleep disorder. The examiner must opine as to whether it is at least as likely as not that the Veteran’s sleep disorder began during service or is otherwise related to service. The examiner must address the May 2017 private medical opinion in any negative medical opinion rendered. Caroline B. Fleming Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Thompson, 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.