Citation Nr: 21065899 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 18-32 261 DATE: October 27, 2021 REMANDED Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for a right knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1985 to May 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans' Law Judge (VLJ) via a virtual hearing in July 2021; a transcript is of record. As a preliminary matter, the Board notes that the Veteran has been diagnosed with various cervical spine and right knee conditions throughout the period on appeal. See December 2008 VA Internal Medicine Note; February 2009 VA Physical Medicine Rehab Note; February 2009 VA Physical Therapy Consult; December 2008 VA Imaging Findings for Cervical Spine and Right Knee. Consequently, the Board finds that it is more appropriate to characterize the Veteran's claims broadly, as entitlement to service connection for a cervical spine condition and a right knee condition. Clemons v. Shinseki, 23 Vet. App. 1 (2009). 1. Cervical Spine Condition 2. Right Knee Condition First, the Board acknowledges receipt of additional medical records from the Veteran regarding her neck disability and the possibility and probability that she sought additional private medical treatment for her cervical spine and right knee disorders. Thus, the Board requests that any and all additional private medical records related to her conditions be obtained and associated with the claims file. The RO should also obtain the Veteran's updated VA medical records. The Board also notes receipt of opinions from the Veteran's provider concluding that her cervical spine and right knee conditions are more likely than not etiologically related to her active duty service. See January 2016 Opinion by M.C.P., M.D.; April 2016 Opinion by M.C.P., M.D. However, the Veteran's physician did not provide a rationale explaining his opinions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). Consequently, the private opinions of record are inadequate to determine the nature and cause of the Veteran's cervical spine and right knee disabilities. To date, the Veteran has not been examined by VA for her above-mentioned disorders. An examination must be obtained in conjunction with a claim if there is competent evidence of a current disability, evidence of an in-service injury, event, or disease, an indication that the current disability may be associated with the Veteran's service or another service-connected disability, and there is otherwise insufficient competent medical evidence to decide on the claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Because the Veteran has presented evidence that her conditions could be related to her in-service training, the Board finds that an examination and opinion should be obtained to determine the natures and etiologies of her cervical spine and right knee conditions. Finally, the Board notes that the Veteran testified that her neck pain's severity increases with migraines; she is service connected for migraine headaches. See July 2021 Hearing Transcript; May 2018 Rating Decision. Accordingly, the Board finds that there is a question as to whether the Veteran's service-connected headaches cause or aggravate her neck condition. This question should also be answered on remand. The matters are REMANDED for the following action: 1. The RO should request the Veteran to identify any and all outstanding and/or updated VA and/or private medical records related to her cervical spine and right knee conditions. Appropriate efforts must be made to obtain these records if she has adequately identified them and authorized their release (with respect to private medical records). She should also be invited to submit these records herself. All actions to obtain the requested records should be fully documented in the claims file. If they cannot be located or no such records exist, the Veteran and her representative should be so notified in writing. 2. After completing the foregoing, schedule the Veteran for an appropriate examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of any and all cervical spine condition(s) attributable to the Veteran. The entire claims file, including a copy of this remand, must be made available to the examiner, who must note its review. (a) The examiner should identify any and all cervical spine condition(s) attributable to the Veteran throughout the period on appeal. (b) For each condition so identified, the examiner should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's condition manifested during, or is the result of, her active duty service. (c) For each condition so identified, the examiner should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's condition was either (i) caused or (ii) aggravated by her service-connected headaches. NOTE: With respect to the question concerning aggravation, the examiner is advised that aggravation under 38 C.F.R. § 3.310(b) does not require "permanent worsening" of the nonservice-connected disability. If aggravation is found, the examiner should attempt to determine the baseline level of severity of disability prior to such aggravation. In formulating his or her opinions, the examiner should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran's service treatment records; (ii) The Veteran's post-service medical records; (iii) The Veteran's competent lay statements regarding her first-hand in-service experiences and the onset and continuity of her symptomatology, including her July 2021 hearing testimony and statements submitted with her June 2018 VA Form 9; (iv) Injury Prevention Program, Foot Marching, Load Carriage, and Injury Risk, TECHNICAL INFORMATION PAPER NO. 12-05400616 (May 2016) (submitted with Veteran's June 2018 VA Form 9); and (v) Veneria Johnson, et. al., Load Carriage and the Female Soldier, J. OF MILITARY AND VETERANS' HEALTH, VOL. 19 NO. 3 (Dec. 2011) (submitted with Veteran's June 2018 VA Form 9). If the examiner determines that the Veteran's cervical spine condition(s) is/are less likely than not due to her active duty military service and/or caused and/or aggravated by her service-connected headaches, the examiner should discuss what other factor(s) caused the disorder(s). In other words, the examiner should ascertain the most likely etiology of the Veteran's cervical spine condition(s). The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. 3. Schedule the Veteran for an appropriate examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of any and all right knee condition(s) attributable to the Veteran. The entire claims file, including a copy of this remand, must be made available to the examiner, who must note its review. (a) The examiner should identify any and all right knee condition(s) attributable to the Veteran throughout the period on appeal. (b) For each condition so identified, the examiner should opine as to whether it is at least as likely as not (probability of about 50 percent) that the Veteran's condition manifested during, or is the result of, her active duty service. In formulating his or her opinion, the examiner should consider and address the competent medical and lay evidence of record, including but not limited to: (i) The Veteran's service treatment records; (ii) The Veteran's post-service medical records; (iii) The Veteran's competent lay statements regarding her first-hand in-service experiences and the onset and continuity of her symptomatology, including her July 2021 hearing testimony and statements submitted with her June 2018 VA Form 9; (iv) Injury Prevention Program, Foot Marching, Load Carriage, and Injury Risk, TECHNICAL INFORMATION PAPER NO. 12-05400616 (May 2016) (submitted with Veteran's June 2018 VA Form 9); and (v) Veneria Johnson, et. al., Load Carriage and the Female Soldier, J. OF MILITARY AND VETERANS' HEALTH, VOL. 19 NO. 3 (Dec. 2011) (submitted with Veteran's June 2018 VA Form 9). If the examiner determines that the Veteran's right knee condition(s) is/are less likely than not due to her active duty military service, the examiner should discuss what other factor(s) caused the disorder(s). In other words, the examiner should ascertain the most likely etiology of the Veteran's right knee condition(s). The examiner must provide a comprehensive report that includes a complete rationale for all opinions and conclusions reached. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoffman 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.