Citation Nr: 21063361 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 17-56 194A DATE: October 14, 2021 REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for diverticulitis is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for coronary artery disease is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for obstructive sleep apnea is remanded. Entitlement to service connection for benign prostate hypertrophy is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1969 to February 1973, with additional service as an Air Reserve Technician (ART), from May 1975 to March 2003. This matter was previously remanded by the Board in December 2019 for evidentiary development. 1. Entitlement to service connection for a left knee disorder is remanded. 2. Entitlement to service connection for a right knee disorder is remanded. The Veteran's primary contention is that his knee disorders are directly due to his service as an ART, and that the other claimed disorders are secondary to his knee disorders. The Veteran contends that his ART service should be considered ACDTURA as it was on "orders." As a preliminary matter, the Board notes that ART employment is considered civilian employment by the Department of Defense, and the Court of Appeals for Veterans Claims has held that there is no legal basis upon which to establish service connection for diseases or injuries incurred during civilian employment. See Venturella v. Gober, 10 Vet. App. 340 (1997). The Court of Appeals for the Federal Circuit has held the same. See Jeffries v. Dep't of the Air Force, 999 F.2d 529, 529-30 (Fed.Cir.1993). However, as noted in the Board's December 2019 Remand, the record indicates that the Veteran has periods of ACDUTRA during his time as an ART. As such, the Board remanded for the RO to (1) obtain the Veteran's personnel records to confirm periods of ACDUTRA and INACDUTRA, (2) obtain medical opinions regarding the etiology of his claimed disorders, and (3) provide the examiner(s) with a list of active duty service dates, to include ACDUTRA and INACDUTRA. The Veteran was afforded a November 2020 VA examination to determine the etiology of his bilateral knee disorders. A May 2021 addendum opinion was issued as well. It is unclear to the Board that the examiner was provided the dates of ACDUTRA or INACDUTRA, thus failing to comply with the December 2019 Remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). In addition, the November 2020 opinion and May 2021 addendum opinion do not provide a sufficient rationale to support the examiner's determination that the knee disorders are less likely than not related to service. The November 2020 opinion simply states: "arthroscopic surgery 01/2001 from note 02/02/2002." The May 2021 addendum opinion does no better: "there is documentation from a 02/020/2002 note that this Veteran had arthroscopic left knee surgery." The Board notes that there are treatment records indicating treatment for knee pain as early as 1990. A new medical opinion that provides an adequate rationale is necessary. When VA provides a medical examination or opinion, it must ensure that such is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). 3. Entitlement to service connection for diverticulitis is remanded. 4. Entitlement to service connection for hypertension is remanded. 5. Entitlement to service connection for coronary artery disease is remanded. 6. Entitlement to service connection for diabetes mellitus is remanded. 7. Entitlement to service connection for obstructive sleep apnea is remanded. 8. Entitlement to service connection for benign prostate hypertrophy is remanded. The Board remand ordered medical opinions as to whether the Veteran's bilateral knee disorders aggravated diverticulitis, hypertension, coronary artery disease, diabetes, obstructive sleep apnea, and benign prostate hypertrophy pursuant to 38 C.F.R. § 3.310. The November 2020 examiner provides opinions regarding causation under section 3.310 but did not provide opinions regarding aggravation under section 3.310 (b). These opinions need to be obtained to ensure compliance with the Remand directives. Stegall, supra. The Board also notes inconsistencies with the rationales provided regarding direct service connection for hypertension, sleep apnea, BPH, and diverticulitis. The November 2020 medical opinions indicate that these disorders began in 1982, 1998, 1998, and 1992, respectively. The May 2021 addendum opinions indicate that there is no documentation of treatment for such disorders during the period from February 1973 to May 2003. It is not clear if the examiner is referring specifically to reserve treatment records. Regardless, a more elaborate rationale must be provided. In addition, it is unclear to the Board that the examiner was provided the dates of ACDUTRA or INACDUTRA for the direct service connection opinion. The matters are REMANDED for the following action: 1. Return the claims file to an examiner(s) of appropriate knowledge and expertise to issue the requested opinions regarding the etiology of the Veteran's claimed disorders. Provide the examiner(s) with the dates of ACDUTRA and INACDUTRA, in accordance with the December 2019 Remand directives. Based on a review of the record, the examiner(s) should: (a) Provide opinions as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran's bilateral knee disorder is related to the Veteran's active service, to include any period of ACDUTRA or INADCUTRA. (b) Provide opinions as to whether it is at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran's (1) diverticulitis, (2) hypertension, (3) coronary artery disease, (4) diabetes, (5) obstructive sleep apnea, or (6) benign prostate hypertrophy is related to the Veteran's active service, to include any period of ACDUTRA or INADCUTRA. (c) Provide opinions as to whether it is at least as likely as not (i.e., a probability of 50 percent or greater) that (1) diverticulitis, (2) hypertension, (3) coronary artery disease, (4) diabetes, (5) obstructive sleep apnea, or (6) benign prostate hypertrophy is aggravated by the Veteran's bilateral knee disorders. If the bilateral knee disorders aggravate (1) diverticulitis, (2) hypertension, (3) coronary artery disease, (4) diabetes, (5) obstructive sleep apnea, or (6) benign prostate hypertrophy, the examiner(s) should identify the percentage of disability which is attributable to the aggravation. 38 C.F.R. § 3.310. A complete rationale for any opinion expressed should be provided in a report. The Veteran is competent to report symptoms and treatment, and his reports must be taken into account, along with the other evidence of record. H. N. SCHWARTZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board W. R. Stephens, 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.