Citation Nr: 21073622 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 18-14 572 DATE: December 9, 2021 REMANDED Entitlement to service connection for a left knee injury is remanded. Entitlement to service connection for tinnitus is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from July 1993 to August 1997. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office. In August 2021, the Veteran testified before the undersigned at a hearing. A transcript of his testimony has been associated with the claims file. 1. Left knee The Veteran asserts that his current left knee arthritis is related to his service. More specifically, he contends that during service his left knee began hurting. Although he sought treatment for it, he reported that the pain in his knee has continued since that time. Service treatment records confirm that in October 1994 he reported to sick call while stationed on the U.S.S. Trenton with complaints of pain in his left knee. He reported pain in the left knee while walking up and down stairs and ladders for the past two months. The record reflects that he was instructed to take Motrin, apply ice the area in the evening, and elevate it while in bed. The Veteran underwent a VA examination with respect to the etiology of his left knee disability in September 2017. When VA undertakes to provide an examination or obtain a medical opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). If an examination report is inadequate or does not contain sufficient detail, the Board is required to return the report in a remand. See Bowling v. Principi, 15 Vet. App. 1, 12 (2001). Here, the September 2017 VA examination report indicates that he reported to the VA examiner that his knee pain had its onset while he was in the Navy and that it has worsened over the years. However, the VA examiner opined that it was less likely than not that his left knee condition was related to service, because there was "a lack of documentation needed to support a nexus" between his complaints of knee pain in 1994 and his present degenerative joint disease. An opinion that is conclusory or that does not provide a sufficiently detailed rationale is inadequate. Stefl v. Nicholson, 23 Vet. App. 320 (2007). Such is the case here. Indeed, the September 2017 VA examiner failed to provide a detailed rationale for his opinion beyond stating that there was a lack of other documentation. The Board notes, however, that a lack of contemporaneous medical records alone is not a permissible reason to deny entitlement to service connection. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (Fed. Cir. 2006). Moreover, the VA examiner failed to address the Veteran's reports that his pain had continued since that time. An opinion is inadequate if it does not consider all relevant evidence of record, including lay evidence. Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). As such, the September 2017 VA examiner's opinion is inadequate, and remand is warranted to obtain an addendum medica opinion. 2. Tinnitus The Veteran also asserts that he has tinnitus that is connected to his service. His service department records reflect that his primary military occupational specialty was infantry, gun crews, and seamanship specialist. This specialty carries a high probability of noise exposure. Indeed, he reported that he was often exposed to the noise of helicopters landing on the deck of the ship he was stationed on. The Veteran reported that he noticed that his tinnitus had its onset approximately five years following his discharge. In a September 2017 VA audiological examination report, a VA examiner opined that his tinnitus was less likely than not related to his military service. As rationale, the VA examiner explained that the Veteran experienced no permanent threshold shifts in hearing acuity during service, indicating that there were no noise injuries during service, despite exposure to noise while he was in the military. She also indicated that service treatment records were negative for any complaints, diagnosis, or treatment of tinnitus and that he had not reported tinnitus until around five years after service. Because the Veteran did not provide a clear nexus between his military service and his tinnitus, she opined that his current tinnitus was less likely than not a result of military noise exposure. The Board finds that remand is necessary to obtain an addendum medical opinion regarding the etiology of the Veteran's tinnitus as well. To that end, the Board observes that tinnitus is not necessarily linked to permanent threshold shifts in hearing acuity or in-service audiometric results. Moreover, the VA examiner did not adequately address the Veteran's contentions that his tinnitus could nonetheless have been related to his military noise exposure despite its delayed onset. As such, remand is necessary to obtain an addendum opinion. Accordingly, the matters are REMANDED for the following action: 1. After obtaining proper authorization, associate with the claims file any outstanding VA treatment records and any outstanding, relevant private treatment records. 2. After the development in step 1 is completed, obtain an addendum medical opinion from an appropriate VA examiner regarding the etiology of the Veteran's left knee disability. The Veteran's claims file and a copy of this remand should be furnished to the examiner, who should indicate in the examination report that he or she has reviewed the claims file in its entirety. After reviewing the claims file in its entirety, the examiner is asked to opine as to whether it is at least as likely as not (approximately 50 percent or greater probability) that the Veteran's left knee disability had its onset during or is otherwise related to his military service. A complete rationale is required for any opinion rendered by the examiner. All opinions should be based on examination findings, historical records, and medical principles. The examiner should fully articulate a sound reasoning for all conclusions made. In doing so, the examiner is directed to address the Veteran's lay statements regarding the onset of his left knee pain. If the requested opinion cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. If the examiner is unable to provide an addendum opinion without performing a physical examination of the Veteran, a new examination should be scheduled. 3. After the development in step 1 is completed, obtain an addendum medical opinion from an appropriate VA examiner regarding the etiology of the Veteran's tinnitus. After reviewing the claims file in its entirety, the examiner is asked to opine as to whether it is at least as likely as not (approximately 50 percent or greater probability) that the Veteran's tinnitus had its onset during or is otherwise related to his military service. A complete rationale is required for any opinion rendered by the examiner. All opinions should be based on examination findings, historical records, and medical principles. The examiner should fully articulate a sound reasoning for all conclusions made. In doing so, the examiner is directed to address the Veteran's lay statements regarding the delayed onset of his tinnitus approximately five years after service. If the requested opinion cannot be provided without resorting to mere speculation, the examiner should so state but, more importantly, explain why an opinion cannot be provided without resorting to speculation, as merely stating this will not suffice. If the examiner is unable to provide an addendum opinion without performing a physical examination of the Veteran, a new examination should be scheduled. M. Tenner Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Rademacher, 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.