Citation Nr: 21001003 Decision Date: 01/06/21 Archive Date: 01/06/21 DOCKET NO. 10-36 282 DATE: January 6, 2021 REMANDED Service connection for a neck condition is remanded. Service connection for a left arm condition is remanded. Service connection for a right arm condition is remanded. Service connection for a right knee condition is remanded. Service connection for a left knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from April 1980 to December 1981. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from March 2010 and April 2012 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony before the undersigned Veterans Law Judge in June 2014. These matters were remanded by the Board in January 2015, October 2019, and March 2020 for additional development. The Board previously remanded the issues of service connection for a left and right leg condition to obtain an opinion regarding the etiology of the Veteran’s bilateral leg complaints. The Board notes that an October 2020 rating decision granted service connection for peripheral neuropathy of the right and left lower extremity as secondary to his service-connected back disability. As these claims for service connection have been granted in full, they are not before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). 1. Service connection for a neck condition is remanded. The Veteran’s claim for service connection for a neck condition was remanded for an examination that clarified the Veteran’s neck diagnosis as the previous VA examinations were deemed inadequate. In October 2020, a new VA examination was conducted where the examiner diagnosed the Veteran with cervical strain. The examiner provided a negative nexus opinion and stated that there are insufficient medical records showing diagnosis or treatment for a neck injury or any related or ongoing cervical strain conditions or injury while the Veteran was still in service. The examiner did not address the Veteran’s complaints of experiencing neck pain following his in-service fall. As the Board noted in its October 2019 decision, a rationale that relies exclusively on lack of in-service documentation without considering the Veteran’s lay statements is inadequate. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008); Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (noting that a VA medical examination was inadequate because it relied on the lack of notation or treatment of the Veteran’s back injury in service and ignored the Veteran’s lay assertions that he sustained a back injury during service). Indeed, recently in Miller v. Wilkie, 32 Vet. App. 249, the United States Court of Appeals for Veterans Claims (Court) held that when an examiner fails to address the veteran’s reports of symptoms, VA must get a new examination. Accordingly, a new opinion is needed that fully considers the Veteran’s contentions. See Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (medical opinions must address the relevant facts). 2. Service connection for a left arm condition is remanded. 3. Service connection for a right arm condition is remanded. Regarding the claim for service connection for a right and left arm disability, the Veteran claims that such disability is related to a fall into a foxhole during service, and alternatively, secondary to his neck disability. Medical treatment records note the Veteran receives treatment for upper arm pain from neuropathy, presumably secondary to his neck disability. Therefore, the Veteran’s claims for service connection for right and left arm conditions are inextricably intertwined with his service connection claim for a neck condition. See Harris v. Derwinski, 1 Vet. App. 180 (1991). As the Veteran’s neck claim is remanded, the claims for service connection for right and left arm conditions must also be remanded. 4. Service connection for a right knee condition is remanded. 5. Service connection for a left knee condition is remanded. The Veteran’s claim for service connection for a right and left knee condition was previously remanded for an examination that adequately addressed the Veteran’s lay statements. In October 2020, a new VA knee conditions examination was obtained. The Board once again finds that the examination did not adequately address the Veteran’s lay statements. Moreover, after noting that the Veteran’s report of medical history and April 1980 examination were both negative for pre-service right and left knee joint conditions, the examiner opined that the claimed right and left knee joint condition, which clearly and unmistakable existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. On remand, appropriate steps should be taken to obtain an opinion that addresses this inconsistency as well as the Veteran’s lay statements. The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge of the onset of his neck condition, right and left arm condition, right and left knee condition, and his in-service event, injury, or disease. 2. Forward the claims file to a qualified medical professional for an opinion to determine the nature, onset and etiology of the Veteran’s neck disability, right and left arm disabilities, and right and left knee disabilities. It is left to the examiner’s discretion whether to schedule the Veteran for an in-person examination (or telehealth interview, records review, etc., if an in-person examination is not feasible) for any and/or all the above listed disabilities. The examiner must include a discussion of the Veteran’s medical history and lay report as to the onset of his symptoms. The examiner should offer comments, an opinion, and a supporting rationale that address the following: (a) Is it at least as likely as not that the Veteran’s neck disability, right and left arm disabilities, and right and left knee disabilities, characterized by pain and limited range of motion, were incurred in, aggravated by, or are otherwise etiologically related to the Veteran’s active duty service? In providing this opinion, the examiner should address the Veteran’s contentions that he injured his neck, right and left arm, and right and left knee when he fell into the foxhole during his active duty service. (b) Is it at least as likely as not that the Veteran’s neck disability, right and left arm disabilities, and/or right and left knee disabilities are caused by, aggravated by, or are otherwise etiologically related to his service-connected back, bilateral ankle, or bilateral foot disabilities? The examiner should opine as to whether the Veteran’s left and right arm disabilities are caused by, aggravated by, or are otherwise etiologically related to his neck disability. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sara Leigh, Attorney Advisor 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.