Citation Nr: 21070794 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 18-27 473 DATE: November 26, 2021 ORDER Service connection for a right knee disorder is granted. REMANDED The issue of service connection for a gastrointestinal disorder is remanded. FINDING OF FACT The Veteran's right knee disorder was caused by his service. CONCLUSION OF LAW The criteria for entitlement to service connection for a right knee disorder have been met. 38 U.S.C. § 1110, 1154(a); 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from August 1977 to August 1981. As an initial matter, the Veteran reported post-service treatment for his gastrointestinal disorder at Valley Gastroenterology Clinic when he underwent esophageal surgery in 1986. VA attempted to obtain these records. However, VA was notified that the records were not found. In September 2021, the Veteran notified VA that he was unable to obtain the records. VA has satisfied its duty to assist as to these records. Service connection for a right knee disorder will be granted because the evidence shows that disorder was caused by the Veteran's service. The issue of service connection for a gastrointestinal disorder will be remanded for a VA examination to determine the etiology of the disorder. Service Connection Generally, to establish service connection, a claimant must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. See 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303; see also Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection for a right knee disorder is granted. The Veteran contends that his current right knee disorder is related to his service. For the following reasons, service connection is warranted, and the claim is granted. The Veteran has a current diagnosis of right knee osteoarthritis and meniscal tear. The Veteran reported that his right knee pain onset in-service because of his duties as a helicopter mechanic and physical training with backpacks. The Veteran's service treatment records (STRs) do not identify any complaints, treatment, or diagnoses of any knee disorders. However, the Board will afford him the benefit of the doubt. The Board finds that his reports of in-service right knee injury and overuse, combined with his postings to aircraft-bearing vessels are consistent with the circumstances of his service. 38 U.S.C. § 1154(a). Thus, the second element of service connection is established. Regarding the third element of service connection, in December 2018, Dr. S.J.M., stated that the Veteran has been in his care for a right knee disorder and that he performed a partial right knee meniscectomy in June 2018. Dr. S.J.M. opined that the Veteran's years of service have contributed to the degenerative changes observed in his right knee. In July 2021, Dr. H.S.E. stated that the Veteran has been in his care for right knee pain since June 2020. Dr. H.S.E. opined that the Veteran's history, examination, and imaging studies are consistent with early degenerative joint disease of the right knee that is likely caused by his years of service and the physical nature of his in-service duties. Accordingly, all necessary elements are met, and service connection for a right knee disorder is warranted. The claim is granted. REASONS FOR REMAND The issue of service connection for a gastrointestinal disorder is remanded. The matter is REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: The Veteran contends that his gastrointestinal disorder resulted from drinking contaminated water at Camp Lejeune and his military personnel records reflect that he was stationed in Camp Lejeune during service. STRs show several reports of abdominal pain in-service and post-service VA treatment records reflect several diagnoses of gastrointestinal disorders. The Veteran's post-service VA treatment records reflect diagnoses of gastroesophageal reflux disease with esophagitis, chronic esophageal scar, gastritis, and peritoneum adhesions. He was afforded a VA examination in October 2017 when the examiner opined that his abdominal pain was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. However, the examiner did not provide any rationale for the opinion. Thus, the October 2017 VA opinion is not adequate. Therefore, remand is required to afford the Veteran with a new, adequate, VA examination. Barr v. Nicholson, 21 Vet. App. 303 (2007). THE REMAND DIRECTIVES FOLLOW. 2. Advise the Veteran that he may submit any additional medical and non-medical evidence relating to his gastrointestinal disorder that is not already in VA's possession. Assist the Veteran in obtaining any evidence cited. 3. Schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of his gastrointestinal disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical and non-medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. Based upon a review of the relevant evidence of record, history provided by the Veteran, and sound medical principles, the VA examiner MUST provide the following opinions: (a.) THE EXAMINER IS ADVISED THAT THE VETERAN WAS STATIONED IN CAMP LEJEUNE DURING HIS PERIOD OF SERVICE AND IS PRESUMED TO HAVE BEEN EXPOSED TO CONTAMINATED WATER. (b.) Identify all currently diagnosed gastrointestinal disorders. (c.) Provide an opinion as to whether any currently diagnosed gastrointestinal disorder was incurred in-service or caused by or aggravated by an in-service injury, event, or illness, to include in-service complaints of abdominal pain, as due to PRESUMED in-service exposure to contaminated water at Camp Lejeune. (d.) The examiner MUST specifically discuss in-service complaints of abdominal pain and any potential relationship between those complaints and his current gastrointestinal disorder. (e.) The examiner MUST also specifically discuss the Veteran's report of having gastrointestinal symptoms since his service. (f.) THE EXAMINER MUST ALSO EXPRESS AN OPINION OF WHETHER THE VETERAN'S ACCOUNT OF THE DEVELOPMENT OF THE DISORDER IS CONSISTENT WITH THE MEDICAL EVIDENCE AND THE EXAMINER'S KNOWLEDGE AND PRACTICE EXPERIENCE. (g.) If the examiner determines that any currently diagnosed gastrointestinal disorder was not incurred in-service or caused by or aggravated by an in-service injury, event, or illness, to include in-service complaints of abdominal pain, as due to PRESUMED in-service exposure to contaminated water at Camp Lejeune, to the extent possible, provide an opinion as to the likely etiology of the disorder(s). (h.) The examiner MUST provide a complete and full explanation for the opinions provided. (i.) The examiner is ADVISED that an opinion without a complete and full explanation is not adequate. The examiner must review the entire record in conjunction with rendering the requested opinions. In addition to any records that are generated because of this Remand, the VA examiner's attention is drawn to the following: * The Veteran's post-service medical records show diagnoses of gastroesophageal reflux disease with esophagitis, chronic esophageal scar, gastritis, and peritoneum adhesions. * The May 1978 STR showing complaints of abdominal pain. * The December 1978 STR showing chest pain that radiates to the abdomen. * The February 1980 STR showing an evaluation of an abdominal disorder. * The March 1981 STR showing complaints of abdominal pain. * The November 1981 VA examination. * In August 2017, a long-time friend of the Veteran reported that the Veteran was unable to digest his food before he had surgery. * The October 2017 VA examination. * The September 2019 private Disability Benefits Questionnaire. * During the August 2021 Board hearing, the Veteran testified that he had esophageal cancer surgery in 1986. However, records of the surgery were not able to be obtained. He also testified that he has had acid reflux since service. * In September 2021, the Veteran's brother reported that since his service, the Veteran has been unable to keep any food or liquids down, and that he will gag when eating. A thorough explanation must be provided for the opinions rendered. If the examiner cannot provide the requested opinions without resorting to speculation, s/he should expressly indicate this and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. The examiner is advised that by law, the mere statement that the claims folder was reviewed, and/or the examiner has expertise is not sufficient to find the examination/opinion sufficient. 4. Following the review and any additional development deemed necessary, re-adjudicate the claim. Should the claim not be granted in its entirety, issue an appropriate supplemental statement of the case (SSOC) and forward the claim to the Board for adjudication. The Veteran has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Timothy T. Emmart The Board's action is binding only in this case. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.