Citation Nr: 21064152 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 17-37 637 DATE: October 19, 2021 REMANDED Service connection for a right knee disorder. Service connection for a left knee disorder. Service connection based on service aggravation of a right shoulder disorder. Service connection for a left shoulder disorder. Service connection for a right elbow disorder. Service connection for a left elbow disorder. REASONS FOR REMAND The Veteran served on active duty from November 1989 to August 1992. The case is on appeal from a January 2015 rating decision. In October 2019, the Board denied service connection for peripheral neuropathy of the torso and upper and lower extremities. At that time, the Board also remanded the issues of service connection for sleep apnea, and right and left knee, shoulder, and elbow disorders were remanded for additional development. By rating decision in July 2020, service connection for sleep apnea was granted. This represents a full grant of the benefit sought with respect to that issue. Thus, that issue is no longer on appeal. 1. Service connection for a right knee disorder. 2. Service connection for a left knee disorder. Pursuant to the Board's October 2019 remand, the Veteran was afforded a VA knee examination in December 2019. The examiner diagnosed bilateral knee strain, noting that in-service knee injuries, to include ligament strain, were acute and without continuity of symptomatology after service. However, the examiner reported that the Veteran's history of right knee surgery at Corry Station in Pensacola, Florida, during service was corroborated by a surgical-linear scar of the right knee. As such, remand is warranted to attempt to obtain the right knee surgery records. The Board notes that an ABSTRACT OF SERVICE AND MEDICAL HISTORY reflects the Veteran was stationed at Corry Station from January 1990 to March 1991; served at the NSGA (Naval Security Group Activity) Naples IT. from April 1991 to May 1991; and was seen at the NAVAL TRAINING CENTER BRANCH MEDICAL CLINIC in San Diego, California, on June 23, 1992. See March 2014 service treatment records (STRs). In addition, the record indicates that the Veteran was released from active duty upon commencing a Naval Reserve Officer Training Corps (NROTC) scholarship with Marquette University and appointment as a midshipman in the NROTC, during which time his health record was noted to be located at the NROTC UNIT, MARQUETTE UNIVERSITY, MILWAUKEE, WI. See March 2014 STRs. Further, a NROTC record notes summer travel completed while enrolled in the NROTC program as: CORTRAMID WEST JULY 24, 1993-AUGUST 21, 1993, SAN DIEGO, CA; USS SLIDES (FFG14) JUNE 6, 1994-JUNE 20, 1994; AND USS FLATLEY (FFG21) MAY 31, 1995-JUNE 23, 1995. See September 2013 Correspondence. In addition, a February 1995 record from the Marquette University Student Health Services notes no weight bearing exercise for one week. See July 2017 Medical Treatment Record Government Facility. Moreover, a July 2021 VA fibromyalgia examination report noting joint pain secondary to depression raises a theory of secondary service connection. In that respect, the Veteran's 70 percent rating for service-connected posttraumatic stress disorder (PTSD) contemplates depression. Thus, remand is also warranted to obtain an opinion as to whether a right or left knee disorder is caused by or aggravated by service-connected PTSD. 3. Service connection based on service aggravation of a right shoulder disorder. Pursuant to the Board's October 2019 remand, the Veteran was afforded a VA shoulder examination in December 2019. The examiner diagnosed right shoulder strain, noting that a right shoulder disorder existed prior to service entrance. However, the examiner did not provide an opinion in this regard. The Board notes that the July 1989 service entrance examination report notes a probable old mild right shoulder acromioclavicular joint separation. See July 2017 STRs. In August 1991, rhomboid strain was noted. See March 2014 STRs. As such the VA opinion is not completely adequate. Thus, remand for an opinion with respect to service aggravation is warranted. 4. Service connection for a left shoulder disorder. 5. Service connection for a right elbow disorder. 6. Service connection for a left elbow disorder. Pursuant to the prior remand, the Veteran was afforded VA shoulder and elbow examinations in December 2019. Although negative opinions were provided, as noted above, a subsequent July 2021 VA fibromyalgia examination report raises secondary service connection for a left shoulder and right and left elbow disorders. In that respect, the examination report notes pain in multiple joints secondary to depression and the Veteran's 70 percent rating for service-connected PTSD contemplates depression. Thus, remand is warranted to obtain an opinion as to whether a left shoulder disorder or a right or left elbow disorder is caused by or aggravated by service-connected PTSD. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records dated since September 2021. 2. Attempt to obtain right knee surgery records, to include from Corry Station in Pensacola, Florida, Marquette University, Milwaukee, Wisconsin, including the NROTC Unit and/or Student Health Services, or any other appropriate repositories of records. Such efforts should continue until the records are obtained or it is reasonably certain that they no longer exist or that further efforts to obtain them would be futile. If unable to obtain any identified records, notify the Veteran and his representative in accordance with 38 C.F.R. § 3.159(e). 3. After completion of the above, return the claims file to the VA examiner who conducted the December 2019 knee examination. If the December 2019 examiner is not available, the claims file should be provided to an appropriate medical professional to render the requested opinion. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The claims file must be made available to and reviewed by the clinician. The clinician should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that a right or left knee disorder had its onset during or within the initial year after service or is otherwise related to an in-service injury, event, or disease, or is caused by or aggravated by service-connected PTSD. Aggravation is an increase in severity beyond the natural progress of the disease. For any aggravation found, the clinician should state, to the extent possible, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. Rationale for all opinions expressed should be provided. If the clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation 4. Return the claims file to the VA examiner who conducted the December 2019 right shoulder examination. If the December 2019 examiner is not available, the claims file should be provided to an appropriate medical professional to render the requested opinion. The need for another examination is left to the discretion of the medical professional offering the addendum opinion. The examiner should opine whether it is at least as likely as not that the right shoulder disorder noted at service entrance in July 1989 increased in severity during service. If so, the examiner should opine whether it is medically undebatable that the increase in severity was due to the natural progress of the disease. The examiner should also comment on whether the current right shoulder strain is the same disease process as from service noted as probable old right acromioclavicular separation at service entrance and/or rhomboid strain in August 1991. Rationale for all opinions expressed should be provided. If the reviewing clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. 5. Return the claims file to the VA examiner who conducted the December 2019 left shoulder and elbow examinations. If the December 2019 examiner is not available, the claims file should be provided to an appropriate medical professional to render the requested opinions. The need for another examination is left to the discretion of the medical professional offering the addendum opinions. The examiner should opine as to whether it is at least as likely as not (50 percent or greater probability) that a left shoulder, right elbow, or left elbow disorder is caused by or aggravated by service-connected PTSD. Aggravation is an increase in severity beyond the natural progress of the disease. For any aggravation found, the clinician should state, to the extent possible, the baseline of symptomatology and the amount, quantified if possible, of aggravation beyond the baseline symptomatology by the aggravation. Rationale for all opinions expressed should be provided. If the reviewing clinician is unable to provide the requested opinions without resort to speculation, it must be so stated, and he or she must provide the reasons why an opinion would require speculation. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Taylor 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.