Citation Nr: 21072959 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-43 010 DATE: December 7, 2021 REMANDED Entitlement to service connection for a hiatal hernia is remanded. Entitlement to service connection for bilateral carpal and cubital tunnel syndrome is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1971 to August 1975. In September 2019, the Veteran had a hearing before the undersigned at the Regional Office in St. Petersburg, Florida. These issues were then remanded. 1. Entitlement to service connection for a hiatal hernia is remanded. In October 2020, the Board remanded this issue in part to obtain an opinion as to whether it is at least as likely as not that any diagnosed gastrointestinal disabilities, to include hiatal hernia, began during, or was caused by, his service. The examiner was specifically asked to consider whether the Veteran's hiatal hernia or any other gastrointestinal disabilities are related to vomiting from his in-service paratyphoid fever due to salmonella paratyphi. In a June 2021 Esophageal Conditions Disability Benefits Questionnaire (DBQ), the Veteran was noted as having gastroesophageal reflux disease (GERD), hernia hiatal, and esophagitis along "with possible Barrett's". In a June 2021 VA medical opinion, the examiner noted that the Veteran had an isolated episode of paratyphoid fever in 1974. At this time, he also had epigastric burning pain and was diagnosed with a hiatal hernia. This was confirmed on a 2014 esophagogastroduodenoscopy (EGD). Other EGDs have also showed mild gastritis and duodenitis. His ongoing GERD and the epigastric pain from his gastritis is not caused by or related to the salmonella paratyphoid fever in the service. This is physiologically impossible. The paratyphoid fever was an isolated episode which was treated and resolved. His GERD and stomach issues are separate conditions and not related in any way to his paratyphoid fever. The examiner further determined that a hiatal hernia cannot be caused by emesis-physiologically impossible. The Board finds this opinion is inadequate. While the VA examiner found that the Veteran's GERD and stomach issues were not related to his paratyphoid fever and that his hiatal hernia is not related to emesis, the examiner did not address whether his GERD and other stomach issues are related to his in-service gastrointestinal complaints. Specifically, the Veteran was noted as having alcoholic gastritis in September 1973 and stomach pain in November 1973. Upon separation from service, the Veteran reported frequent indigestion with frequent belching and abdominal pain. Moreover, the June 2021 Esophageal Conditions DBQ noted that the Veteran had GERD with an onset date of 1972. As such, the Board finds that a new VA opinion must be obtained on this matter addressing whether the Veteran's GERD, hiatal hernia, or other stomach issues could be related to his in-service abdominal/stomach pain, indigestion, and belching. Additionally, the Board notes that the Veteran recently submitted an October 2021 private medical record from Dr. Kuhn confirming a diagnosis of Barrett's esophagus and suggesting that the Veteran's gastrointestinal problems could be related to his service. The examiner should specifically discuss this medical record in rendering the requested opinion. 2. Entitlement to service connection for bilateral carpal and cubital tunnel syndrome is remanded. In October 2020, the Board remanded this issue in part to obtain a VA medical opinion as to whether it is at least as likely as not that any diagnosed wrist disability, to include bilateral carpal or cubital tunnel syndrome, began during, or was caused by, his service. In a June 2021 VA medical opinion, the examiner noted that the Veteran's claims cramping his hands in the service. He later developed paresthesia in his fingers, and a December 31, 2013, electromyography (EMG)/nerve conduction study (NCS) confirmed right carpal tunnel and cubital tunnel syndrome but nothing on the left. There is no nexus after discharge until this EMG study in 2013. The examiner concluded that, therefore, his current right carpal and cubital tunnel syndrome is not related to service, and there is no left carpal or cubital tunnel condition. The Board finds this opinion is inadequate, as the examiner did not provide a sufficient rationale. While the examiner found that there is no nexus after discharge until the 2013 EMG, the Board notes that a lack of continuity of symptoms since service does not necessarily mean that a post-service disability could not be related to service. As such, the Board finds that a new VA opinion must be obtained on this matter addressing whether the Veteran has a current diagnosed wrist disability of any kind, to include bilateral carpal or cubital tunnel syndrome, that could be related to his reports of lifting a lot of heavy equipment while working as a flight facilities equipment repairman and injuring himself by hitting his elbows on the back of trucks while unloading equipment in service. See Hearing Transcript, September 2019; notice of disagreement (NOD), July 2015. 3. Entitlement to service connection for a right knee disability is remanded. In October 2020, the Board remanded this issue in part to obtain a VA medical opinion as to whether it is at least as likely as not that any diagnosed right knee disability began during, or was caused by, his service. The examiner was specifically asked to address the in-service diagnosis of chondromalacia patella. In a June 2021 VA medical opinion, the examiner noted that the Veteran claims right knee pain in the service but that the Veteran's service records are silent for any ongoing right knee condition. The examiner stated that there is no nexus after discharge. By history, his pain increased in 2012, and he was diagnosed with a torn meniscus. The examiner noted that he did not have the report for this. Based upon this history, the examiner found that his current right knee condition was not incurred while in service. The examiner further stated that the Veteran's in-service diagnosis of chondromalacia patella is no longer present based on examination and history-so this is not relevant. The Board finds this opinion is inadequate. While the examiner determined that the Veteran's in-service diagnosis of chondromalacia patella is no longer present based on examination and history, the examiner failed to address whether the Veteran's current right knee disability could be related to his in-service complaints/diagnosis or his reports that he hurt his right knee jumping in and out of trucks during service and running in boots on tar roads. See NOD, July 2015; Hearing Transcript, September 2019. The examiner found that the service records are silent for any ongoing right knee condition but failed to address the fact that the service treatment records document knee complaints in 1973 and 1975. As such, the Board finds that a new VA opinion must be obtained on this matter addressing whether the Veteran's current knee disability could be related to his in-service complaints/diagnosis or his reports that he hurt his right knee jumping in and out of trucks during service and running in boots on tar roads. Additionally, VA treatment records reflect that the Veteran underwent magnetic resonance imaging (MRI) at a Miami VA facility in 2012. See VA treatment record, July 2013. These records must be obtained on remand, as well as any other recent, outstanding VA treatment records. The matters are REMANDED for the following action: 1. Associate the following with the claims file: (a.) All available records from the Miami VA Healthcare System and associated outpatient clinics from March 2010 to the present; (b.) All available records from the North Florida/South Georgia Veterans Health System and associated outpatient clinics from April 2021 to the present; and (c.) All available records from the West Palm Beach VA Medical Center (VAMC) and associated outpatient clinics from November 2018 to the present. 2. Return the claims file to the VA examiner who provided the June 2021 VA right knee disability opinion so that an addendum opinion may be obtained. If the same examiner is not available, an opinion can be provided by another VA examiner. The examiner should render an opinion as to whether it is at least as likely as not that any diagnosed right knee disability began during, or was caused by, his service, to include his in-service knee complaints/diagnosis or his reports that he hurt his right knee jumping in and out of trucks during service and running in boots on tar roads The examiner should provide a complete rationale for any opinions provided. If additional examination is needed to render the above-requested opinion, such should be provided. 3. Return the claims file to the VA examiner who provided the June 2021 VA wrist disability opinion so that an addendum opinion may be obtained. If the same examiner is not available, an opinion can be provided by another VA examiner. The examiner should render an opinion as to whether it is at least as likely as not that any diagnosed wrist disability, to include bilateral carpal or cubital tunnel syndrome, began during, or was caused by, his service. In rendering any opinions, the examiner is advised that a lack of continuity of symptoms since service does not necessarily mean that a post-service disability could not be related to service. The examiner should specifically consider the Veteran's reports that he lifted a lot of heavy equipment while working as a flight facilities equipment repairman in service and injuring himself by hitting his elbows on the back of trucks while unloading equipment in service. The examiner should provide a complete rationale for any opinions provided. If additional examination is needed to render the above-requested opinion, such should be provided. 4. Return the claims file to the VA examiner who provided the June 2021 VA hiatal hernia opinion so that an addendum opinion may be obtained. If the same examiner is not available, an opinion can be provided by another VA examiner. The examiner should render an opinion as to whether it is at least as likely as not that any diagnosed gastrointestinal disabilities, to include hiatal hernia, GERD, esophagitis, Barrett's esophagus, gastritis, or duodenitis began during, or was caused by, his service, to specifically include his in-service abdominal/stomach pain, indigestion, and belching. In rendering an opinion, the examiner is specifically asked to discuss the October 2021 private medical record from Dr. Kuhn suggesting that the Veteran's gastrointestinal problems could be related to his service. The examiner should provide a complete rationale for any opinions provided. If additional examination is needed to render the above-requested opinion, such should be provided. MICHELLE L. KANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Durham, 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.