Citation Nr: 21068722 Decision Date: 11/12/21 Archive Date: 11/12/21 DOCKET NO. 18-01 462 DATE: November 12, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1974 to August 1976. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an October 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office. In October 2020, the Veteran testified before the Board at a virtual hearing. A transcript of the hearing is of record. The Veteran testified that he injured his back in service while moving equipment. He said that he slipped and fell on a water valve and it felt as if a lightning bolt had gone through his head. His service treatment records do not document a back injury nor does the Veteran assert that he received treatment in service for this injury. Rather, he explained that he was taught to be tough, and he just dealt with the pain which has been ongoing. Private treatment records beginning in 2012 note that the Veteran had a long history of chronic back pain. His private orthopedic physician, Dr. Smith, reported in August 2012 that the Veteran underwent two local decompressions for stenosis, one on the right and one on the left. Dr. Smith subsequently reported on an October 2012 operative report for L3-S1 posterior instrumented fusion with iliac crest bone graft, and L4-L5 laminectomy and decompression that the Veteran had previously undergone "multiple surgeries". Notably, there are no treatment or surgical records on file for back problems prior to 2012. Thus, to make a fully informed decision in this appeal, VA must attempt to obtain all outstanding identified treatment and surgical records for the Veteran's back disability prior to August 2012. 38 U.S.C. §5103A(b); 38 C.F.R. §3.159. The Veteran has not been afforded a VA examination for his claimed back disability. VA is obliged to provide an examination or obtain a medical opinion in a claim for service connection when the record contains competent evidence that the claimant has a current disability or persistent or recurrent symptoms of disability, the record indicates that the disability or symptoms of disability may be associated with active service, and the record does not contain sufficient information to decide on the claim. 38 U.S.C.A. § 5103A(d) (West 2014); McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). The threshold for determining whether the record "indicates" that there "may" be a nexus between a current disability and an in-service event, injury, or disease is a low one. See McLendon, 20 Vet. App. at 83. As noted, the Veteran testified in October 2020 that his chronic back problems began in service when he fell on a valve while carrying heavy equipment. He also testified that his private orthopedic doctor, Dr. Smith, told him that test findings were consistent with old fractures. Notably, the record contains an August 2012 record from Dr. Smith who reported that he thought that the Veteran had a spondylolysis at L4 "probably caused by his injury as a young man". In consideration of this evidence, the Board finds that the requirements for affording the Veteran a VA examination have been satisfied. McLendon, 20 Vet. App. at 81. Accordingly, on remand, the Veteran should be scheduled for a VA spine examination. The Veteran also testified that his right and left knee disabilities are a result of his back disability. He explained that his back condition has caused him to lean forward putting pressure on his knees. Treatment records show that he has a long history of chronic bilateral knee pain and that he underwent left total knee arthroplasty in January 2015 and right total knee arthroplasty in March 2015. Notably, there are no medical records on file with respect to the Veteran's knees prior to 2012. Accordingly, an attempt should be made to obtain all outstanding pertinent medical records. 38 U.S.C. §5103A(b); 38 C.F.R. §3.159. Moreover, the Veteran's service connection claims for right and left knee disabilities are inextricably intertwined with his claim for service connection for a back disability and a decision regarding his knee claims must be deferred pending resolution of his back claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private medical facility/provider that he saw for his back and knee conditions since service. This should include all surgeries that were performed as well as treatment to include chiropractic, physical therapy, and osteopathic manipulation. Make two requests for the authorized records from each facility/provider unless it is clear after the first request that a second request would be futile. 2. Schedule the Veteran for a VA examination for his claimed back disability. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: Does the Veteran have a back disability that is at least as likely as not (50% degree of probability or higher) related to service? In providing the requested opinion, consider the Veteran's description of his/her in-service injury reported where he fell onto a valve while carrying heavy equipment. Also consider the Veteran's reported symptoms as well as his post-service symptoms. Stated another way, do the Veteran's reports about his back symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? Is it at least as likely as not that the degenerative disease of the spine (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Provide a rationale to support the opinion(s). 3. Then, readjudicate the appeal. if the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for a response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Shawkey, 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.