Citation Nr: 21073785 Decision Date: 12/10/21 Archive Date: 12/10/21 DOCKET NO. 16-00 001A DATE: December 10, 2021 REMAND Entitlement to service connection for a bilateral knee disability is remanded. Entitlement to service connection for a neurological disability of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1979 to October 1979 and February 1982 to February 1987. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2012 Decision Letter by the Department of Veterans Affairs (VA) Regional Office (RO) in Decatur, Georgia. These claims twice have been remanded by the Board: in January of 2019 and 2021. Each time, the Board instructed the AOJ to obtain various outstanding records and examinations/opinions. If further evidence, clarification of the evidence, correction of a procedural defect, or any other action is essential for a proper appellate decision, a Veterans Law Judge (VLJ) shall remand the case to the agency of original jurisdiction (AOJ), specifying the action to be undertaken. 38 C.F.R. § 20.904(a). 1. Entitlement to service connection for a bilateral knee disability is remanded. The Veteran argues that his bilateral knee disability has been caused by the "constant climbing and jumping down off of Armored vehicles during field operations on a daily basis for over [four] years." March 9, 2011, Correspondence. In a December 2020 Written Brief Presentation, the Veteran's Representative cited medical literature for the proposition that veterans are more likely than their non-serving counterparts to develop arthritic conditions at an earlier age. None of the medical opinions obtained throughout this appeal have referenced or responded to this medical literature. Thus, remand is required for the AOJ to secure an addendum opinion. See 38 C.F.R. § 20.904(a). 2. Entitlement to service connection for a neurological disability of the bilateral lower extremities is remanded. When reviewing a claimant's appeal, the Board is required to discuss contentions regarding the case directly raised by the claimant and those reasonably raised by the record. Scott v. McDonald, 789 F.3d 1375, 1380 (Fed. Cir. 2015). The Veteran explicitly argues that his neuropathy is due to exposure to contaminated water at Camp Lejeune (CWCL). April 11, 2016, Correspondence. In a March 9, 2011, correspondence, he stated that he "has neuropathy" and that in "cold weather it is so painful." An April 1983 report of medical history in the Veteran's service treatment records (STRs) notes that the Veteran gets cramps in his legs when exposed to cold weather. While the Board previously requested a medical opinion to respond to the Veteran's theory of CWCL exposure, it overlooked the fact that no examiner has opined as to whether the Veteran's neurological abnormalities could be related to his in-service complaints of leg cramping in cold weather. Thus, remand is required to secure an addendum opinion. See Scott, 789 F.3d at 1380; 38 C.F.R. § 20.904(a). The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion for the Veteran's bilateral knee claim. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran's bilateral knee disabilities occurred in, or is the result of, his period of active duty service, to include the general rigors of service? In answering this question, the examiner must respond to the Veteran's cited medical literature found at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6375463/; https://onlinelibrary.wiley.com/doi/full/10.1002/art.30498; https://www.arthritis.org/getmedia/e1256607-fa87-4593-aa8a-8db4f291072a/2019-abtn-final-march-2019.pdf 2. Obtain an addendum medical opinion for the Veteran's bilateral neurological claim. The addendum shall answer the following: Is it at least as likely as not (a fifty percent probability or greater) that the Veteran's neurological disabilities of the bilateral lower extremities occurred in, or is the result of, his period of active duty service, to include his 1983 in-service complaints of leg cramping in cold weather? Note: The examiner is reminded that the term "as likely as not" does not mean "within the realm of medical possibility," but rather that the evidence of record is so evenly divided that, in the examiner's expert opinion, it is as medically sound to find in favor of the proposition as against it. A detailed rationale supporting the examiner's opinions must be provided. The lack of documented treatment in service, while probative, cannot serve as the sole basis for a negative finding. If an opinion cannot be made without resort to speculation, the examiner should so state and provide reasoning as to why a conclusion would be so outside the norm that such an opinion is not possible. 3. Conduct any other development deemed necessary and then readjudicate the Veteran's claim. The Veteran has the right to submit additional evidence and argument on the matter that the Board has remanded. See Kutscherousky v. West, 12 Vet. App. 369, 372 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded for additional development or other appropriate action by the Board or United States Court of Appeals for Veterans Claims must be handled in an expeditious manner. 38 U.S.C. §§ 5109B, 7112. LLOYD MASON CRAMP Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Trevor T. Bernard, 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.