Citation Nr: 21062298 Decision Date: 10/07/21 Archive Date: 10/06/21 DOCKET NO. 17-14 396 DATE: October 7, 2021 REMANDED Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a lower back condition is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Marines Corps from August 1979 to June 1982. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a June 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Travel Board hearing in July 2019. A transcript of the proceeding has been associated with the claims file. The Veteran's claims for service connection for low back and left knee conditions were denied by the Board in a December 2019 decision, which was subsequently appealed by the Veteran to the United States Court of Appeals for Veterans Claims (Court). The Court granted a Joint Motion for Remand (JMR) in October 2020. The case was returned to the Board for readjudication consistent with the Court's order. In April 2021, the Board remanded the Veteran's claims to provide VA examinations. VA examinations were completed in May 2021. In June 2021, the Board found the new examinations did not substantially comply with its April 2021 remand directives and remanded the claims again. Unfortunately, while VA obtained an addendum opinion for each claim, they are still inadequate to support a Board decision on either claim and another remand is required. 1. Entitlement to service connection for a left knee condition The Board cannot make a fully-informed decision on the issue of service connection for a left knee condition because no VA examiner has opined whether the Veteran's diagnosed arthritis, a chronic condition listed in 38 C.F.R. § 3.309(a), either (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. A remand is required to obtain a medical opinion on this issue. 2. Entitlement to service connection for a lower back condition The Board cannot make a fully-informed decision on the issue of service connection for a low back condition because no VA examiner has opined whether the Veteran's diagnosed arthritis, a chronic condition listed in 38 C.F.R. § 3.309(a), either (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. In addition to the above issue, an addendum opinion is needed on the issue of direct service connection for a low back condition. In July 2021, a VA examiner stated that there was "no indication of traumatic arthritis or old fracture or injury on the xrays consistent with trauma or fall reported." However, an x-ray interpretation from December 2013 stated there was "decrease in height of T11, T12, L1, L2, consistent with old process." The July 2021 VA examiner did not explain whether this "old process" could be the Veteran's reported in-service injury. A remand is required to obtain medical opinions on these issues. The matters are REMANDED for the following action: 1. Obtain an opinion from an appropriate medical professional as to the onset and etiology of the Veteran's claimed left knee condition. The examiner must review the claims file. The examiner is asked to provide a response to the following: Does the Veteran have arthritis of the left knee which at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? The examiner is advised that, in this Veteran's case, the lack of in-service medical documentation is not evidence for or against the Veteran's claim. The Veteran's entire record of in-service medical treatment has been lost. The Board finds the Veteran's report of his fall during service, confirmed by lay statement of an independent witness, to be credible. For purposes of this opinion, the examiner should assume that the Veteran fell while carrying full gear on Mt. Fuji as he has described. Provide a rationale to support these opinions. Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an in-person examination. 2. Obtain an addendum opinion from the July 2021 examiner, if available, or from any appropriate medical professional, as to the onset and etiology of the Veteran's claimed low back condition. The examiner must review the claims file. The examiner is asked to provide a response to the following: Does the Veteran have a low back condition which is at least as likely as not related to service, including a fall with full gear during service? The examiner must discuss the relevance, if any, of the December 2013 x-ray noting "Minimal decrease in height of T11, T12, L1, L2, consistent with old process." Does the Veteran have arthritis of the left knee which at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? In providing the requested opinion, consider the Veteran's description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injury and symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? The examiner is advised that, in this Veteran's case, the lack of in-service medical documentation is not evidence for or against the Veteran's claim. The Veteran's entire record of in-service medical treatment has been lost. The Board finds the Veteran's report of his fall during service, confirmed by lay statement of an independent witness, to be credible. For purposes of this opinion, the examiner should assume that the Veteran fell while carrying full gear on Mt. Fuji as he has described. Provide a rationale to support these opinions. Only if the required opinions cannot be provided based on the evidence of record, schedule the Veteran for an in-person examination. 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Zimmerman, Micah 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.