Citation Nr: 21064894 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 19-07 286 DATE: October 21, 2021 REMANDED Entitlement to service connection for a right elbow disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2013 to April 2017. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision issued in June 2018 by a Department of Veterans Affairs (VA) Regional Office (RO). In September 2020, the Veteran testified at a hearing before the undersigned Veteran's Law Judge. A transcript of the hearing is associated with the record. At such time, the undersigned held the record open for 60 days for the receipt of additional evidence; however, none has been received to date. 1. Entitlement to service connection for a right elbow disorder. 2. Entitlement to service connection for a right ankle disorder. 3. Entitlement to service connection for a right knee disorder. The Veteran contends that he has right elbow, right ankle, and right knee disorders as a result of in-service injuries and/or the performance rigorous physical duties. As pertinent to his claimed right elbow disorder, the Veteran's service treatment records (STRs) reflect that, in February 2015, he was treated for a right arm injury that occurred when a mortar tube recoiled and struck the back of his elbow. At such time, it was noted that the injury was a direct blow to the elbow without dislocation. While an assessment of radial head fracture was noted, an X-ray from the following day only showed irregularity to the superficial skin and the soft tissues posterior to the distal humerus, without any underlying osseous abnormality of the right humerus or elbow or fracture. Subsequent STRs dated through March 2015 reflect follow up treatment for right blunt trauma to the elbow; however, approximately a month after the initial injury, the Veteran reported that he had full function with no limitations. At such time, it was noted that his elbow was stable with no tenderness to palpation, but there was a small hematoma near the triceps insertion. In regard to the Veteran's reported right ankle disorder, his STRs reflect that, in September 2014, he complained of ankle joint pain from rolling his ankle two weeks ago. However, there was no deformity to the injured site, and the Veteran could perform normal duties. In December 2014, the Veteran reported right ankle pain following a sprain that occurred when he inverted his ankle while running. He also indicated that he had previously sprained his ankle four times. In December 2015, the Veteran complained of right foot pain for 10 days after doing a 10 kilometer run. He further indicated that he rolled his ankle a lot of times, but he never experienced such issue. As pertinent to his claimed right knee disorder, the Veteran's STRs reflect that he complained of pain in the right knee for the prior two months that started after a 20 mile ruck march, which was gradually getting worse, in April 2016. A couple of weeks later, the Veteran again reported experiencing right knee, popping, and limited range of motion. In May 2016, he reported that, while his right knee improved while he was on profile, it stated getting worse when he returned to running. A week later, the Veteran again complained of right knee pain that was aggravated with running and lifting heavy weight. The Veteran's STRs further reflect that he underwent physical therapy related to chronic anterior knee pain and ankle instability in May, June, and July 2016. The Veteran's post-service treatment records reflect complaints of joint pain, to include elbow, ankle, and knee pain, in August 2017, a report of difficulty moving the right arm in May 2018, and ankle pain in October 2018. However, no diagnosis pertinent to the right elbow or right ankle were noted. In regard to the Veteran's right knee, despite reports of pain in August 2017, June 2018, August 2018, October 2018, and November 2018, X-rays performed in August 2017 were normal and all related physical examinations showed full range of motion. Nonetheless, in August 2018, an assessment of patellofemoral pain syndrome was rendered and, in November 2018, it was indicated that he had suspected right patellar tendinopathy. Furthermore, at March 2018 VA examinations, the VA examiner found that the Veteran did not have right elbow, right ankle, or right knee disorders. In this regard, physical examination of each joint was normal, and he noted that the August 2017 X-rays of the right knee were normal. However, the examiner did not comment on whether the Veteran's reported symptoms resulted in functional impairment. Furthermore, since such time, an assessment of patellofemoral pain syndrome was rendered in August 2018, and suspected right patellar tendinopathy was noted in November 2018. Additionally, the Veteran has reported ongoing symptomatology related to his claimed disorders, to include pain, decreased strength in his elbow, and functional limitations that affect his ability to perform his job as an electrician, to include physical limitations and the need for multiple breaks. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (the term "disability" as used in 38 U.S.C. § 1110 "refers to the functional impairment of earning capacity, not the underlying cause of said disability," and held that "pain alone can serve as a functional impairment and therefore qualify as a disability"). Consequently, in light of the assessments pertinent to the Veteran's right knee disorder and his reported functional impairment associated with his claimed disorders, the Board finds that a remand is necessary in order to afford the Veteran new VA examinations so as to determine the nature and etiology of his claimed right elbow, right ankle, and right knee disorders. The Board further finds that a remand is necessary in order to obtain outstanding VA and private treatment records as the Veteran reported receiving an MRI and physical therapy for his right knee from New Mexico Orthopedics, and the record reflects that he has received ongoing treatment through VA and Tricare Prime. Accordingly, the matters are REMANDED for the following actions: 1. The Veteran should be given an opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, obtain all outstanding records, to include those from New Mexico Orthopedics and Tricare Prime, and updated VA treatment records dated from November 2018 to the present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Thereafter, afford the Veteran appropriate VA examination(s) so as to determine the nature and etiology of his claimed right elbow, right ankle, and right knee disorders. Following a review of the record and conducting all indicated testing, the examiner should address the below inquiries. (A) Identify all right elbow, right ankle, and right knee disorders that have been present at any time proximate to the Veteran's January 2018 claim, even if such is asymptomatic or has since resolved. In addressing such matter in regard to the Veteran's claimed right knee disorder, the examiner should consider the assessment of patellofemoral pain syndrome in August 2018, and suspected right patellar tendinopathy in November 2018. If the examiner finds that the Veteran does not have a current diagnosed disorder of the right elbow, right ankle, and/or right knee, he or she should offer an opinion as to whether his reported symptomatology results in functional impairment of earning capacity. If so, the examiner should accept that the Veteran has a current disability for VA purposes. In addressing such matter, he or she should consider the Veteran's report that his symptomatology affects his ability to perform his job as an electrician, to include physical limitations and the need for multiple breaks. (B) For each right elbow disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his military service, to include the documented in-service injury that occurred when a mortar tube recoiled and struck the back of his elbow in February 2015 and/or the performance of rigorous physical duties. (C) For each right ankle disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his military service, to include his documented in-service right ankle sprains in September 2014 and December 2014 and/or the performance of rigorous physical duties. (D) For each right knee disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such had its onset in, or is otherwise related to, his military service, to include his documented in-service complaints of right knee pain in April 2016 and May 2016 and/or the performance of rigorous physical duties. In offering such opinions, the examiner should consider the Veteran's report of the onset of his claimed disorders in service and a continuity of symptomatology thereafter. The examiner is advised that a lack of post-service treatment records demonstrating a continuity of care cannot form the sole basis of a negative opinion. A rationale for any opinion offered should be provided. A. JAEGER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.