Citation Nr: 21072282 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 16-25 454 DATE: December 2, 2021 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a left knee condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the Navy from June 1975 to January 2003. This matter is before the Board of Veterans' Appeals (Board) on appeal from a March 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, a hearing was held before the undersigned. A transcript of the hearing is of record. The case was previously before the Board in December 2018 and May 2020 when it was remanded for further development. 1. Entitlement to service connection for a low back disability is remanded. Unfortunately, the Board finds that the claim must be remanded for a new VA opinion. In May 2020, the Board remanded the issue of entitlement to service connection for a low back disability to obtain a new VA opinion addressing the etiology of the Veteran's low back disability. The Board instructed the examiner to consider the July 1976 service treatment record noting recurrent low back pain and the Veteran's report that he was told that he had a recurring back strain in service. A VA examination and opinion were obtained in December 2020. The examination report specifically noted that the Veteran had a diagnosis of lumbosacral strain and did not have arthritis. The examiner opined that the low back disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. An addendum opinion was obtained in January 2021. The examiner found that it is less likely than not that the Veteran's current back condition is due to a strain condition during active duty. The examiner stated that the Veteran's in-service injuries would be considered acute for the time of occurrence then resolution could be expected without progression to degeneration. The examiner stated that symptoms related to the arthritis would be expected to be more persistent and more subject to flares in most cases than sprains. The VA examiner's rationale in both the December 2020 and January 2021 opinions addressed arthritis of the thoracolumbar spine, which is inconsistent with the December 2020 VA examination report's finding that the Veteran had lumbosacral strain and did not have arthritis of the thoracolumbar spine. The examiner also failed to fully address the service treatment records and the Veteran's testimony as requested in the May 2020 remand. As the December 2020 and January 2021 opinions are inadequate, the claim must be remanded for a new opinion. See Stegall v. West, 11 Vet. App. 268, 271 (1998). The Board also notes that an October 2013 VA examination report indicated the Veteran had mild degenerative disc disease at L5-S1 and within the sacroiliac joints. On remand, the examiner should clarify the Veteran's low back disability diagnosis. 2. Entitlement to service connection for a right knee condition is remanded. 3. Entitlement to service connection for a left knee condition is remanded. In the May 2020 remand, the Board remanded the claims for service connection for right and left knee conditions to obtain a VA opinion addressing the etiology of his knee conditions. The examiner was instructed to address the Veteran's June 2018 Board testimony concerning his frequent use of ladders in service and his statement that he avoided reporting to sick call despite his knee trouble. A December 2020 VA examination report noted that the Veteran had degenerative arthritis of both knees, diagnosed in 2010. In the December 2020 VA opinion, the examiner stated that it is likely that the use of the ship's ladders did result in strain conditions. However, it is less likely than not related to the Veteran's current conditions as not all strains progress to degenerative changes as well as the time elapsed since active duty making it more likely due to post-service activities. The examiner stated that the first evidence to support degenerative changes was well past discharge per X-ray findings. In the January 2021 addendum opinion, the examiner stated symptoms related to the arthritis would be expected to be more persistent and more subject to flares in most cases than sprains. Although the opinions addressed the Veteran's testimony regarding his frequent use of ladders, the opinions did not address his statement that he avoided reporting to sick call despite his knee trouble, as instructed in the May 2020 remand. The rationale stated that arthritis symptoms are persistent to some degree, but the examiner did not address the Veteran's statements indicating that he had experienced knee pain since the 1990s. See December 2020 VA examination report; March 2019VA treatment record. The December 2020 VA examination report stated that the Veteran was diagnosed with degenerative arthritis of the knees in 2010. However, an October 2007 VA X-ray indicated that the Veteran had mild degenerative changes primarily involving the patellofemoral joint spaces of both knees. As the examiner relied on the time elapsed between the Veteran's service and the diagnosis of arthritis, but cited the incorrect date of diagnosis, and did not address the Veteran's statements regarding his knee symptoms since service, the opinions are inadequate, and the claims must be remanded for a new VA opinion. Evidence indicates that the Veteran has continued to receive VA treatment for the disabilities on appeal. Therefore, on remand, his VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from March 2021 to the present. 2. After obtaining the additional records, obtain an opinion from an appropriate clinician to determine the etiology of the Veteran's low back disability. The claims file must be made available to the clinician in conjunction with the request. It is left to the discretion of the reviewing clinician as to whether an examination of the Veteran is needed. The reviewing clinician should respond to the following: a) Clarify the Veteran's low back disability diagnosis. The clinician should address the December 2020 VA examination report indicating the Veteran had a diagnosis of lumbosacral strain and October 2013 VA examination report indicating he had mild degenerative disc disease at L5-S1 and within the sacroiliac joints. b) Is it at least as likely as not that the Veteran's low back disability is related to an in-service injury, event, or disease? The clinician should consider the July 1976 service treatment record of low back pain due to lifting weapons and service treatment records showing low back pain in May and June 1981, and after falling downstairs in May 1996, and recurrent back pain in February 1997, low back pain in July 2002, and recurrent back pain again in October 2002. Additionally, the clinician should consider the Veteran's June 2018 Board testimony that he first injured his back in 1977 or 1978 unloading items from a boat and that he later reinjured his back and that he was told that he had a recurring back strain. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. After obtaining any additional records, obtain an opinion from an appropriate clinician to determine the etiology of the Veteran's knee conditions. The claims file must be made available to the clinician in conjunction with the request. It is left to the discretion of the reviewing clinician as to whether an examination of the Veteran is needed. The reviewing clinician should respond to the following: Is it at least as likely as not that the Veteran's right and left knee disabilities are related to an in-service injury, event, or disease, including the frequent climbing of ladders while in service? In responding to this question, the clinician should note that an October 2007 VA X-ray indicated that the Veteran had mild degenerative change primarily involving the patellofemoral joint spaces of both knees. The examiner should address the Veteran's June 2018 Board testimony concerning his frequent use of ladders while in service and his statement that he avoided reporting to sick call despite his knee trouble. The clinician should also address the Veteran's statements indicating that he had experienced knee pain since the 1990s in the December 2020 VA examination report. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Marenna, 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.