Citation Nr: 21065197 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 17-09 069 DATE: October 25, 2021 REMANDED Entitlement to service connection for a left hip disability, to include as secondary to service-connected residuals of a right knee injury, is remanded. Entitlement to service connection for a right hip disability, to include as secondary to service-connected residuals of a right knee injury, is remanded. Entitlement to service connection for residuals of a left wrist injury is remanded. Entitlement to service connection for a back disability, claimed as mild dextroscoliosis, to include as secondary to service-connected residuals of a right knee injury, is remanded. Entitlement to an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and depressive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from September 1989 to February 1994. In February 2020, the Veteran testified at a Board of Veterans' Appeals (Board) hearing before the undersigned, and a transcript of that hearing is of record. In July 2020, the Board remanded the Veteran's claim to the Agency of Original Jurisdiction (AOJ) for additional development. The claim has since been returned to the Board for further appellate action. Although the Board regrets the additional delay, a remand is again required. 1. Entitlement to service connection for residuals of a left wrist injury The Veteran testified at his Board hearing that he injured his left wrist in service in a motorcycle accident, then had surgery on it in the late 1990s after separating from service at a university hospital. In a February 2020 letter, the Veteran's representative stated that the Veteran's surgery was in 1998 at Lakeland Regional Hospital, but that the surgery records are not a part of the Veteran's claims file. In its July 2020 remand, the Board ordered that the Veteran be requested to submit relevant private medical records, including records of his left wrist surgery, or submit an authorization for release to allow the VA to obtain those records on his behalf. In November 2020, the VA sent a letter to the Veteran soliciting private treatment records but did not specifically mention the records of his left wrist surgery. On remand, the Board finds that the Veteran should be given an additional chance to submit or identify specifically the left wrist surgery records. The Board notes that the Veteran did submit in October 2020 a letter from his mother recalling that in "1989" the Veteran had surgery on his left wrist due to injuries from a motorcycle accident. The Board further notes that the Veteran has submitted a May 2021 private opinion that the Veteran's current left wrist chronic pain was incurred in and caused by service. As rationale, the examiner noted the Veteran's in-service vehicle crashes and stated that he subsequently had back pain. There was no discussion of wrist pain with respect to the vehicle crashes. The private examiner then stated that studies show wrist pain is highly prevalent in groups who partake in physically demanding activities from day to day, noting that the Veteran was on active duty for four years after his initial complaint, but including no discussion of any specific activities this specific Veteran engaged in during his active duty service. The Board finds that the deficiencies in the private examiner's rationale limit the probative value of his opinion. A VA opinion has not been obtained since June 2012. That opinion was that the Veteran's current left wrist disability is less likely as not incurred in or caused by left wrist pain related to his in-service auto accident. The Board notes that in addition to records noting a December 1990 motor vehicle accident, the Veteran's service treatment records additionally contain a January 1994 record of the Veteran reporting pain in his left hand and wrist after falling on it one week prior. The Board finds that a new VA examination opinion should be obtained that includes discussion on the May 2021 private opinion as well as the 1994 service treatment record. 2. Entitlement to service connection for a left hip disability, to include as secondary to service-connected residuals of a right knee injury 3. Entitlement to service connection for a right hip disability, to include as secondary to service-connected residuals of a right knee injury In July 2020, the Board ordered that on remand a VA opinion be obtained as to whether it is at least as likely as not that the Veteran's right and/or left hip disability was caused or aggravated by the Veteran's service-connected right knee disability. A VA opinion was obtained in February 2021. Subsequently, the Veteran submitted a private opinion in May 2021. The private reviewer opined, in part, that the Veteran's ongoing service-connected bilateral knee condition has worsened his chronic hip pain and arthritis beyond its natural progression. The Board notes that another VA opinion was obtained in August 2021, which has not yet been considered by the AOJ. Neither VA opinion discusses the May 2021 private opinion. With respect to the private opinion, the Board notes that the Veteran is only service-connected for his right knee disability, not his left. However, the Board finds that as it discusses a rationale for how a knee disability could cause or aggravate a hip disability, a remand is needed for a VA examiner to consider the opinion. On remand, an addendum opinion should be obtained. The VA opinion should discuss the May 2021 private opinion. 4. Entitlement to service connection for a back disability, claimed as mild dextroscoliosis, to include as secondary to service-connected residuals of a right knee injury In July 2020, the Board ordered that on remand a VA opinion be obtained as to whether it is at least as likely as not that the Veteran's back disability was caused or aggravated by the Veteran's service-connected right knee disability. A VA opinion was obtained in February 2021 that addressed only service connection secondary to the Veteran's service-connected right knee disability. Already of record was a June 2012 VA opinion that the Veteran's current back disability is not directly related to service, to include his in-service vehicle crashes. In May 2021, the Veteran submitted a private opinion. The private reviewer opined that the Veteran's thoracolumbar spine arthritis with degenerative disc disease was incurred in and caused by service and is additionally aggravated beyond the normal degree of worsening by the Veteran's service-connected right knee arthritis. As rationale, the private reviewer noted that the Veteran was in both a motorcycle and motor vehicle crash during service and stated that it would "be reasonable to think that the trauma from the impact of a crash contributed to the current condition." The private reviewer cited medical studies supporting that there is an increased risk of low back pain in individuals who have been injured in a motor vehicle collision. The private reviewer also opined that the Veteran's "ongoing left knee instability and altered gait" had worsened the Veteran's chronic back strain. The Board finds that a new VA opinion should be obtained that considers the May 2021 private opinion. 5. Entitlement to an acquired psychiatric disorder, to include PTSD and depressive disorder, is remanded. As an initial matter, the Board notes that the claim on appeal is for entitlement to an acquired psychiatric disorder, which includes, but is not limited to PTSD. The scope of a mental health disability claim includes any mental disability that may reasonably be encompassed by the claimant's description of the claim, reported symptoms, and the other information of record. Clemons v. Shinseki, 23 Vet. App. 1 (2009). In its July 2020 remand, the Board ordered that a VA opinion be obtained as to the etiology of the Veteran's psychiatric disorder(s). A VA opinion was obtained in January 2021, and the AOJ issued a supplemental statement of the case in February 2021. The Veteran subsequently filed a claim form specifically listing depressive disorder, which the AOJ denied in a June 2021 rating decision. The Veteran filed a supplemental claim, and in July 2021 the AOJ arranged for him to undergo another VA mental health examination. The AOJ has not issued either a rating decision or SSOC considering that July 2021 VA examination. As the July 2021 VA examination is relevant to the issue on appeal and has not been considered in the first instance by the AOJ, and as the file indicates that the AOJ is continuing development of the issue of entitlement to service connection for an acquired psychiatric condition, the Board finds that remand is warranted. The matters are REMANDED for the following action: 1. Contact the Veteran and request that he provide sufficient information, and if necessary, authorization to enable the AOJ to obtain any relevant outstanding non-VA treatment records, to include treatment records from the left wrist surgery in 1998. The AOJ should make an attempt to obtain any treatment records identified by the Veteran that are not currently associated with the claims file. 2. Thereafter, obtain a VA opinion with respect to the Veteran's claim for service connection for a left wrist disability. The VA reviewer/examiner should opine whether it is at least as likely as not that Veteran's current left wrist disability onset in or is causally related to his service. A thorough rationale should be provided for all opinions expressed. The examiner should specifically discuss the May 2021 private opinion, the 1990 and 1994 service treatment records regarding the Veteran's wrist, and the Veteran's statements with respect to having wrist surgery in 1998. 3. Obtain a VA opinion with respect to the Veteran's claim for service connection for a right and left hip disability. The VA reviewer/examiner should opine as to the following: (a.) Whether it is at least as likely as not that the Veteran's current right and/or left hip disability onset in or is causally related to his service. (b.) Whether it is at least as likely as not that the Veteran's current right and/or left hip disability was caused or aggravated by his service-connected right knee disability. A thorough rationale should be provided for all opinions expressed. The examiner should specifically discuss the May 2021 private opinion. 4. Obtain a VA opinion with respect to the Veteran's claim for service connection for a back disability. The VA reviewer/examiner should opine as to the following: (a.) Whether it is at least as likely as not that the Veteran's current back disability onset in or is causally related to his service. (b.) Whether it is at least as likely as not that the Veteran's current back disability was caused or aggravated by his service-connected right knee disability. A thorough rationale should be provided for all opinions expressed. The examiner should specifically discuss the May 2021 private opinion. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Christensen 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.