Citation Nr: 21072942 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 16-61 097 DATE: December 7, 2021 REMANDED The appeal regarding entitlement to service connection for a cervical spine disability is remanded. The appeal regarding entitlement to service connection for a low back disability is remanded. The appeal regarding entitlement to service connection for a right knee disability is remanded. The appeal regarding entitlement to service connection for a left knee disability is remanded. The appeal regarding entitlement to service connection for hypertension is remanded. REASONS FOR REMAND The Veteran had active service from June 1987 to June 1991. This matter comes before the Board of Veterans' Appeals (Board) from an August 2018 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in August 2021. A transcript is of record. During her Board hearing, the Veteran testified that she sought treatment at the Houston VA Medical Center (VAMC) shortly following separation from service. The file contains VA treatment records dating to June 1999. It is unclear whether there are records of VA treatment prior to this date. Remand is required to determine whether there are earlier outstanding records, and if so, to obtain them. The Board concludes that adjudication of the issues on appeal cannot proceed pending clarification as to whether there are earlier records and if so, their receipt. However, the necessity for specific development of some issues on appeal has also been identified by the Board's review of the record. Such is set forth under the appropriate headings below. Service connection for a cervical spine disability Service connection for a low back disability The Veteran asserts that she has cervical spine and low back disabilities that are related to an incident in service. Service treatment records indicate that she complained of low back pain in June 1990 after riding in a speed boat in choppy water and being bounced around. Treatment included physical therapy. The Veteran maintains that she has experienced neck and low back symptoms since this incident. She reported a history of back pain on separation examination in June 1991. The examiner determined that the Veteran's low back pain was not considered disabling and concluded that she was fit for release from active duty. VA treatment records include April 2016 imaging showing degenerative changes and narrowing of the disc space at C5-6, and hypertrophic changes of the right sided L5-S1 facets. The Veteran has not been afforded a VA cervical spine examination. Considering the documented injury during service, her assertion that she had neck symptoms immediately following the June 1990 incident, and the current diagnosis referable to the Veteran's cervical spine, the Board concludes that an examination is necessary. On VA thoracolumbar spine examination in August 2016, the diagnosis was lumbosacral strain. The examiner concluded that it was not related to service. He reasoned, in part, that there were no records showing ongoing progression, chronicity, or repeated treatment for the condition. This opinion does not adequately consider the Veteran's competent reports of continuous symptoms since the in-service injury. An additional examination is required. Service connection for a right knee disability Service connection for a left knee disability During the August 2021 hearing, the Veteran testified that she was treated for shin splints during basic training and that she experienced knee pain during service and in the years following service. She related that she had been diagnosed with arthritis of the knees in approximately 2016, and attributed that diagnosis to wear and tear during service, such as running in combat boots. Considering the Veteran's competent description of symptoms during service and since, the Board concludes that an examination is necessary to determine whether the Veteran has a disability of either knee that is related to service. Service connection for hypertension The Veteran asserts that her hypertension is related to stressors in service. She testified in August 2021 that she was often verbally and physically harassed. The Veteran has indicated that she has been on medication for hypertension for more than 30 years. She testified that VA prescribed blood pressure medication in the early 1990s, shortly following her separation from service. As noted, remand is required to determine whether there are VA treatment records dated prior to June 1999. Any such records might confirm the Veteran's assertion that she was diagnosed with hypertension shortly following service. Additionally, considering the Veteran's testimony, the Board finds that an examination is warranted to determine the nature and etiology of her hypertension. The matters are REMANDED for the following action: 1. Obtain relevant treatment records from the Houston VAMC for the period from June 1991 to June 1999. All inquiries in this regard should be documented for the record. 2. Thereafter, schedule the Veteran for an examination to determine the nature and etiology of her cervical and thoracolumbar spine disabilities. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all relevant conditions referable to the Veteran's cervical and thoracolumbar spine. The examiner should provide an opinion regarding whether it is at least as likely as not that any such condition was incurred in, or is otherwise related to active service. In rendering this opinion, the examiner is directed to service treatment records documenting injury in June 1990. The examiner is also directed to the Veteran's report that she experienced neck and back pain immediately following the incident and in the years thereafter. The examiner is advised that the Veteran is competent to report her symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the development requested in #1 above is completed, schedule the Veteran for an examination to determine the nature and etiology of her claimed right and left knee disabilities. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all relevant conditions referable to the Veteran's knees. The examiner should provide an opinion regarding whether it is at least as likely as not that any such condition was incurred in, or is otherwise related to active service. In rendering this opinion, the examiner is directed to the Veteran's report that she was treated for shin splints during service and had knee pain throughout service and in the years following service. The examiner should also consider the Veteran's reports of extensive physical training in service, including running in combat boots. The examiner advised that the Veteran is competent to report her symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 4. After the development requested in #1 above is completed, schedule the Veteran for an examination to determine the nature and etiology of her hypertension. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should provide an opinion regarding whether it is at least as likely as not that the Veteran's hypertension was incurred in, or is otherwise related to active service. The examiner should consider the Veteran's reports that the stress of service led to her hypertension. In rendering this opinion, the examiner advised that the Veteran is competent to report her symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) 5. Then, readjudicate the Veteran's claims. If the decision remains adverse to the Veteran, she and her representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.