Citation Nr: 21070874 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 18-45 622 DATE: November 26, 2021 REMANDED Entitlement to service connection for a right ankle 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 July 1980 to March 1986, from December 1990 to May 1991 and from February 2003 to May 2004. The Veteran has additional service in the National Guard. The Veteran testified at a hearing before the Board in January 2021. A transcript of the hearing is associated with the record. 1. Entitlement to service connection for a right ankle disability is remanded. The claim must be remanded because the July 2016 VA examination is inadequate because the examiner did not consider the Veteran's statements of continuity of symptoms since active service. At the Board hearing, the Veteran testified that although he initially sought and received treatment for his right ankle during service, he self-treated his right ankle with other-the-counter (OTC) medications during and after his active service which is why there are no medical records documenting treatment after his active service. The Veteran also testified that he has continually had issues with and continued to self-treat his right ankle disability until recently in which he now uses a VA medical facility for treatment. On remand, a new VA examination is necessary for the examiner to interview the Veteran to identify whether the current symptoms he experienced since service are related to the injury incurred during active service. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. The claims must be remanded for additional development. The record shows the Veteran sought treatment for both knees during service. His VA treatment records show he has current bilateral knee pain from patella femoral syndrome. However, no VA examination was completed to opine whether there is a nexus between the Veteran's current knee disability and his service. An examination and opinion must be obtained on remand. 38 C.F.R. § 3.159 (c)(4). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination (or tele-health interview, review of the record, etc., if an in-person examination is not feasible) with an appropriate VA examiner, to determine the likely etiology of his right ankle condition. Copies of all pertinent records must be made available to the examiner. The examiner is asked to answer the following questions: Is it at least as likely as not (50 percent probability) that any currently diagnosed right ankle condition was incurred in or is otherwise related to service? The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. The examiner is asked to review and discuss any statements made by the Veteran, to include his January 2021 Board hearing testimony that he self-treated his right ankle with OTC medications after initially seeking treatment during active service. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 2. Schedule the Veteran for a VA examination (or tele-health interview, review of the record, etc., if an in-person examination is not feasible) with an appropriate VA examiner, to determine the likely etiology of any diagnosed knee disability. Copies of all pertinent records must be made available to the examiner. The examiner is asked to answer the following questions: (a) Identify all currently diagnosed knee disabilities. (b) Is it at least as likely as not (50 percent probability) that any currently diagnosed knee condition was incurred in or is otherwise related to service? The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. The examiner is asked to review and discuss any statements made by the Veteran, to include his January 2021 Board hearing testimony that he self-treated his knees with OTC medications after initially seeking treatment during active service. (b) If (a) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed knee condition has been caused by any of service-connected disabilities, to include his service-connected back disability? (c) If (b) is answered no, is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed knee condition has been aggravated by any his service-connected disabilities, to include his service-connected back disability? The examiner is informed that aggravation here is defined as any increase in disability. If aggravation is present, the clinician should indicate, to the extent possible, the approximate level of disability (baseline) before the onset of the aggravation. A complete rationale must be provided for all opinions. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge; the examiner's own expertise, or; whether additional facts are required and note what, if any, additional evidence would permit such an opinion to be made. 3. Confirm that the VA medical opinions provided comports with this remand, specifically that the standard for the secondary aggravation opinion is any increase in disability, not the standard of beyond the natural progression as noted on the examination form itself. If not, get an addendum. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.