Citation Nr: 21071658 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 17-17 402 DATE: December 1, 2021 REMANDED Service connection for a disability of the left upper extremity (also claimed as "elbow, wrist, shoulder, left upper extremity") is remanded. Service connection for plantar fasciitis is remanded. Service connection for a right hip condition is remanded. Service connection for a left hip condition is remanded. Service connection for a left knee condition is remanded. Service connection for a right knee condition is remanded. Service connection for a right leg condition is remanded. Service connection for a left leg condition is remanded. Service connection for bilateral hearing loss is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1982 to March 1982, November 1985 to December 1989 and from May 2009 to November 2010. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. The Veteran testified at a Board hearing before the undersigned Veterans Law Judge in August 2021. A transcript of the hearing is of record. The Veteran testified at the Board hearing that his musculoskeletal injuries were the result of an incident in 2009 when he was injured while driving a truck in Iraq. According to the Veteran, he was hit in the head with a large metal plate while driving and fell while attempting to get out of the truck. The Veteran also attributed his musculoskeletal injuries to the wear and tear caused by physical training throughout active duty and his activities while on missions in full body armor while deployed. The Veteran was afforded VA examinations in March 2014 for his musculoskeletal conditions and, while the VA examiners noted the Veteran's complaints of pain, they concluded that he did not have any diagnosed disabilities. The Board finds these examinations inadequate as pain alone, when causing functional impairment, may constitute a disability for VA compensation purposes, even without an accompanying diagnosis. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Accordingly, remand is required to afford the Veteran adequate VA examinations for his claimed musculoskeletal disabilities. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion it must ensure that the examination or opinion is adequate.) The Board also finds that remand is warranted to provide the Veteran with an adequate examination for his claim for service connection for bilateral hearing loss. A March 2014 VA examination for ear conditions does not contain an audiogram and, although the Veteran submitted a May 2014 private opinion relating his hearing loss to service, the private physician did not perform or refer to any audiogram reflecting hearing loss for VA disability purposes. See 38 C.F.R. § 3.385. Accordingly, remand is warranted to provide the Veteran with an adequate VA examination for his claimed bilateral hearing loss, including an audiogram to determine if the Veteran has hearing loss for VA disability purposes. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records and associate them with the claims file. 2. After completing the development in item 1, schedule the Veteran for VA examinations with appropriate clinicians to determine the nature and etiology of the Veteran's disabilities, if any of his upper left extremity, bilateral feet, bilateral hips, bilateral knees, bilateral lower extremities and bilateral hearing loss. A copy of the claims file (including this remand) should be made available to and be reviewed by the examiner. All necessary tests should be conducted. If musculoskeletal diagnoses cannot be provided but the Veteran's conditions manifest in signs or symptoms that cause functional impairment, the examiners should consider them disabilities for purposes of providing the requested opinions. The examiners are asked to opine: (a.) Whether it is at least as likely as not that any currently diagnosed left upper extremity condition was incurred in or is otherwise related to service. (b.) Whether it is at least as likely as not that any currently diagnosed bilateral foot condition was incurred in service or is otherwise related to service. (c.) Whether it is at least as likely as not that any currently diagnosed bilateral hip condition was incurred in service or is otherwise related to service. (d.) Whether it is at least as likely as not that any currently diagnosed bilateral knee condition was incurred in service or is otherwise related to service. (e.) Whether it is at least as likely as not that any currently diagnosed bilateral lower extremity condition was incurred in service or is otherwise related to service. In providing an opinion, the examiner should specifically address whether the Veteran has lower extremity conditions separate and distinct from his service-connected lower extremity radiculopathy, including whether the Veteran has separate and distinct ankle disabilities that are related to service. (f.) Whether it is at least as likely as not that any bilateral hearing loss was incurred in service or is otherwise related to service. The examiners should specifically consider the Veteran's lay statements regarding his injuries and duties in active service in formulating the requested opinions. A complete rationale for the examiner's opinions should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide opinions 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 (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Snyder, Associate 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.