Citation Nr: 21074271 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 16-42 796 DATE: December 14, 2021 ORDER Service connection for a neck disability is granted. Service connection for a throat disability, to include pharyngitis and deviated nasal septum, is granted. Service connection for a right knee disability is granted. Service connection for a left hip disability is granted. Service connection for a disability manifested by chest pain is dismissed. REMANDED Service connection for a lip papilloma is remanded. Service connection for a left toe disability is remanded. Service connection for a bilateral wrist disability is remanded. Service connection for hemorrhoids is remanded. FINDINGS OF FACT 1. The Board finds that the probative evidence of record, including the Veteran's competent and credible testimony, supports a finding that the Veteran's neck condition began during service and has persisted since that time. 2. The Board finds that the probative evidence of record, including a November 2020 medical examiner's opinion and competent and credible statements provided by the Veteran and his spouse, support a finding that the Veteran's throat disability began during service and has persisted since that time. 3. The Board finds that the probative evidence of record, including competent and credible statements provided by the Veteran and his spouse, support a finding that the Veteran's right knee condition began during service and has persisted since that time. 4. The Board finds that the probative evidence of record, including the Veteran's competent and credible testimony, supports a finding that the Veteran's left hip condition began during service and has persisted since that time. 5. In June 2021, prior to issuance of a Board decision, the Regional Office granted service connection for a disability manifested by chest pain. CONCLUSIONS OF LAW 1. The criteria have been met for service connection for a neck disability. 38 U.S.C. § 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria have been met for service connection for a throat disability. 38 U.S.C. § 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 3. The criteria have been met for service connection for a right knee disability. 38 U.S.C. § 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 4. The criteria have been met for service connection for a left hip disability. 38 U.S.C. § 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 5. The criteria for dismissal of a disability manifested by chest pain have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from March 1995 to October 2002. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a Board hearing via videoconference before a Veterans Law Judge no longer with the Board. A transcript of that hearing is associated with the record. In an August 2021 letter the Veteran was notified that he could request another hearing by a Veterans Law Judge. The letter indicated that if there was no response, it would be assumed that he did not want another hearing. There has been no response and the Board may proceed to adjudicate the claims. This matter was before the Board in December 2019 and was remanded for further development. SERVICE CONNECTION Legal Criteria Service connection may be granted for disability arising from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and (3) a relationship or nexus between the current disability and any injury or disease during service. 1. Service connection for a neck disability is granted. Factual Background The Veteran's service treatment records indicate that he reported that his neck had been bothering him on and off for several months. See July 1996 entry. The Veteran testified at the August 2019 Board hearing that he accidentally fell flat on his face onto a concrete tarmac during service. The Veteran explained that he has had chronic neck pain since then. The Veteran's spouse reported that the Veteran reported neck pain to her after his accidental fall during service. See buddy statement. A November 2020 medical examination indicates that the Veteran has a diagnosis of a cervical strain. However, the conducting physician opined that there was no evidence which shows that the Veteran's cervical strain is due to exposure to any material or chemical while in Southwest Asia. Analysis The evidence of record indicates that the Veteran has a current diagnosis of a neck condition. The Veteran's service treatment records indicate that he reported neck pain during service. The Veteran has provided competent and credible testimony that he experienced neck pain during service after an accidental fall. Layno v. Brown, 6 Vet. App. 465 (1994). What remains for consideration is whether the Veteran's neck pain is causally related to his service. The Board finds that the Veteran is competent and credible to testify that his neck pain began during service following his accident and has persisted since exiting service. Id. The Board also assigns probative value to the Veteran's spouse's statement that the Veteran reported neck pain to her after his accidental fall, as well as the contemporaneous July 1996 service treatment record showing a neck disorder in service. The Board cannot assign probative value to the November 2020 examiner's opinion indicating that the Veteran's neck condition was not causally related to service because the conducting physician limited the scope of their opinion to exposure to materials or chemicals in Southwest Asia. The examiner did not address the neck pain reported in the service treatment records or the statements provided by the Veteran and his spouse about chronic neck pain. Accordingly, the Board finds that the preponderance of the evidence supports a finding that the Veteran's neck condition began during service and has persisted since that time. As such, service connection is granted. 2. Service connection for a throat disability is granted. Factual Background The Veteran's service treatment records contain several entries detailing various sinus and throat issues. An October 1995 entry indicates that the Veteran had a deviated nasal septum and possible chronic sinusitis. The physician opined that if the Veteran's airway got to be more of a problem, he could be a candidate for nasal septal surgery. A November 1995 entry indicates that the Veteran had some deviation of the septum and a lot of drainage down his throat. The physician indicated that the Veteran's left maxillary sinus may have a little polyp in the floor of his sinus. A May 1997 entry indicates that the Veteran was diagnosed with pharyngitis. A November 1997 entry indicates that the Veteran reported congestion and a cough which produced phlegm. An October 1999 entry indicates that the Veteran was diagnosed with viral pharyngitis. An August 2001 entry indicates that the Veteran was coughing up yellow-green phlegm, had sinus congestion, and rhinorrhea. See service records. The Veteran's spouse reported that the Veteran was made to clean out an old, abandoned aircraft hangar without the use of any respiratory masks during which he had to breathe particulate, dust, and pigeon excrement. The Veteran's spouse reported that the Veteran came home wheezing and coughing followed by having chronic sinusitis. See buddy statement. The Veteran testified at the Board hearing that he began having bronchitis and problems with his lungs after working in a dusty aircraft hangar. The Veteran further testified that his throat disability has persisted since exiting from service. A November 2020 medical examination indicates that the Veteran has a diagnosis of pharyngitis, rhinitis, and sinusitis. The conducting physician noted that the Veteran had a history of throat and sinus issues during service. The physician opined that it was at least as likely as not that the Veteran's throat disability had its onset in service. Analysis The Board notes that the Veteran has a diagnosis of a throat disability per the results of the November 2020 examination. The Board further notes that the Veteran's service treatment records indicate that the Veteran reported throat and sinus issues on multiple occasions. The Board also finds the Veteran and his spouse competent to report that the Veteran was experiencing throat and sinus issues during service. See Layno supra. What remains for consideration is whether the Veteran's throat disability is causally related to his throat and sinus issues he had during service. The Board finds that the Veteran is competent and credible to testify that his throat disability began during service has persisted since exiting service. Id. The Board also assigns probative value to the Veteran's spouse's statement that the Veteran had throat and sinus issues after being assigned to clean out the hangar. Id. The Board likewise assigns probative value to the September 2016 and November 2020 examinations which indicate that the Veteran's throat disability had its onset during service. Accordingly, the Board finds that the preponderance of the evidence supports a finding that the Veteran's throat disability had its onset during service and has persisted since that time. As such, service connection for a throat disability is granted. 3. Service connection for a right knee disability is granted. Factual Background The Veteran testified at the Board hearing that during service, he would have to continually kneel under the aircraft for extended periods of time. The Veteran further testified that he attended a survival school during which he was left kneeling on gravel for about an hour. The Veteran also testified that his right knee began to swell, pop, and give out on him while walking which has continued since exiting from service. The Veteran's spouse reported that the Veteran informed her that he would spend many hours squatting, kneeling, and crawling under aircraft carriers. The Veteran's spouse explained that the Veteran reported having weakness in his knees. The Veteran's spouse further explained that after the Veteran returned from survival school, he would complain about his knees. See buddy statement. The Veteran was afforded a November 2020 medical examination during which the conducting physician opined that the Veteran has a diagnosis of a right knee strain. The conducting physician indicated that it was less likely than not that the Veteran's right knee condition was causally related to service. As a rationale, the physician explained that the Veteran's service treatment records are silent for a right knee condition and there is no evidence that his right knee strain is due to service. Analysis The Board notes that the Veteran has an evidence of a right knee strain. The Board also notes that the Veteran and his spouse provided competent and credible reports that the Veteran experienced right knee pain during service as a result of kneeling, squatting, and crawling. What remains for consideration is whether the Veteran's right knee condition is causally related to his service. The Board finds that the Veteran is competent and credible to testify that his right knee began during service as a result of crouching, squatting, and kneeling on gravel and has persisted since exiting service. Layno supra. The Board also assigns probative value to the Veteran's spouse's statement that the Veteran reported right knee pain during his time in service. Id. The Board observes that at the September 2016 VA knee examination that led to the Veteran receiving service connection for his left knee, the examiner reported that "although abnormal findings were found for the Veteran's non-claimed [right] extremity, they are outside the scope of the current examination request." The Board cannot assign probative value to the November 2020 medical examiner's opinion indicating that the Veteran's right knee condition was not causally related to service because the conducting physician indicated that there was no evidence that the Veteran's right knee strain was due to service without addressing the Veteran and his spouse's statements regarding right knee swelling, popping, and giving out during service. Accordingly, the Board finds that the preponderance of the evidence supports a finding that the Veteran's right knee condition began during service and has persisted since that time. As such, service connection is granted. 4. Service connection for a left hip disability is granted. Factual Background The Veteran's service treatment records indicate that he reported left hip pain which radiated to his lower back. See March 2002 entry. The Veteran testified at the Board hearing that he slipped on a step during service which subsequently led to pain and popping of his left hip. The Veteran further testified that his left hip pain is chronic and that it pops on a daily basis. The Veteran was afforded a November 2020 medical examination during which the conducting physician diagnosed the Veteran with a left hip strain. The physician opined that it was less likely than not that the Veteran's left hip strain was causally related to service. As a rationale, the physician explained that the Veteran's in-service report of hip pain was acute, there was no evidence of chronicity of care, and that the Veteran's symptoms were only subjective. Analysis The Board notes that the Veteran has a diagnosis of a left hip disability per the results of the November 2020 medical examination. The Board further notes that the Veteran's service treatment records indicate that the Veteran reported left hip pain during service. The Board also finds the Veteran competent to report that he was having left hip symptoms including pain and popping during service. See Layno, supra. The Board cannot assign probative value to the November 2020 medical examiner's opinion indicating that the Veteran's left hip condition was not causally related to service because the conducting physician relied on a lack of chronicity of care for his left hip condition. Dalton v. Nicholson, 21 Vet. App. 23 (2007). Accordingly, the Board finds that the preponderance of the evidence supports a finding that the Veteran's left hip condition began during service and has persisted since that time. As such, service connection is granted. 5. Service connection for a disability manifested by chest pain is dismissed. While the case was in remand status, the Veteran was granted service connection for a disability manifested by chest pain in a June 2021 rating decision. This rating decision was issued prior to the promulgation of a decision in the appeal by the Board. Therefore, there remain no statements of errors of fact or law for appellate consideration with regard to the claim of service connection for a disability manifested by chest pain. Accordingly, the Board does not have jurisdiction to review the appeal and it is dismissed. See 38 U.S.C. § 7105 (d)(5). REASONS FOR REMAND 1. Service connection for a lip papilloma, to include residuals, is remanded. The Veteran sought treatment during service for a growth on the inside of his lower lip which had been there a couple of weeks. The attending physician treated the Veteran's lip papilloma with silver nitrate. See service treatment records. An October 2016 VA DBQ indicates that the Veteran did not have any current residuals of his in-service treatment of lower lip papilloma with silver nitrate. The Veteran reported that his last lesion was in 1998. The Veteran testified at the Board hearing that after the silver nitrate was used to treat his papilloma, it left a "big knot" in his mouth that gets caught in his teeth. The Veteran testified that this knot in his mouth has been chronic and has not gone away since exiting service. The physician conducting a January 2021 VA DBQ indicated that the Veteran's claimed condition of lip papilloma has resolved. The Board finds this opinion to be inadequate because while the Veteran's papilloma may have resolved, the Veteran provided competent and credible testimony that the treatment of his papilloma left a painful residual which was extant during the pendency of his claim. Accordingly, this matter must be remanded again in order to provide the Veteran with an adequate examination. See Barr v. Nicholson, 21 Vet. App. 303 (2007). 2. Service connection for a left toe condition is remanded. The Veteran sought treatment during service for a left great toe contusion. See May 2000 entry. The Veteran testified at the Board hearing that his left toe injury resolved over time and that he has partial range of motion of the toe. The Veteran testified that his feet hurt a lot of the time which may be due to his back and knees. In accordance with the December 2019 Board remand instructions, the Veteran was provided a November 2020 medical examination during which the conducting physician opined that it was less likely than not that Veteran's left toe condition was causally related to service. As a rationale, the physician explained that the Veteran was diagnosed with bilateral plantar fasciitis and status post great toe contusion was rendered with symptoms of pain to both plantar, however the Veteran's in-service left toe contusion was only acute and there was no chronicity of care. The Board cannot assign probative value to the November 2020 medical examiner's opinion indicating that the Veteran's left toe condition was not causally related to service because the conducting physician relied on a lack of chronicity of care for his left toe condition. See Dalton supra. Additionally, the Veteran testified that his foot pain may be due to his back and knees which creates an indication that the Veteran's left condition may be causally related to, or aggravated by, his service-connected knee and back conditions. Accordingly, this matter must be remanded again in order for the Veteran to be provided an adequate examination to include whether the Veteran's left toe condition is causally related to, or aggravated by, his service-connected knee and back conditions. McLendon v. Nicholson, 20 Vet. App. 79 (2006) 3. Service connection for a wrist condition is remanded. The Veteran testified at the Board hearing that he would change airplane panels during military service which caused popping in his wrist. The Veteran testified that he noticed wrist pain eight years after exiting from service. Private treatment records reflect that he was diagnosed with tenosynovitis of the wrist. The Veteran was afforded a November 2020 medical examination during which the conducting physician diagnosed the Veteran with bilateral tendonitis of the wrist. The physician opined that it was less likely than not that the Veteran's wrist condition was causally related to service because the Veteran's service treatment records silent for a wrist condition. The Board does not assign probative value to the November 2020 medical examiner's opinion because they relied solely on the absence of contemporaneous treatment records and disregarded the Veteran's competent and credible testimony describing that his wrists would occasionally pop during service. Accordingly, this matter must be remanded in order for the Veteran to be afforded an adequate VA examination. 4. Service connection for hemorrhoids is remanded. The Veteran testified at the Board hearing that he would do a lot of squatting during service which resulted in him getting hemorrhoids. The Veteran further testified that he still gets hemorrhoids periodically since exiting from service. At a September 2019 medical treatment, the conducting physician discovered non-bleeding internal hemorrhoids found during an endoscopy. The Veteran was afforded a January 2021 medical examination during which the conducting physician opined that it was less likely than not that the Veteran's hemorrhoids were causally related to service because the Veteran's service treatment records silent for an in-service injury, event, or disease. The Board does not assign probative value to the January 2021 medical examiner's opinion because they relied solely on the absence of contemporaneous treatment records and disregarded the Veteran's competent and credible testimony describing that he would get hemorrhoids during service. Accordingly, this matter must be remanded in order for the Veteran to be afforded an adequate VA examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations to determine the nature and etiology of his bilateral wrist disability, left toe disability, lip papilloma, and hemorrhoids. After examining the Veteran and reviewing the Veteran's claims file, the examiner should: a. Address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's bilateral wrist disability is related to or had its onset during service. In offering the opinion the examiner is asked to address the Veteran's competent and credible testimony that his wrist would occasionally pop during service. b. Address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's left toe condition is related to or had its onset during service, or was caused or aggravated by his service-connected knee and back disabilities. c. Describe the current symptoms, if any, associated with the Veteran's lip papilloma and its residuals claimed and whether it is at least as likely as not (50 percent probability or greater) that they are related to or had their onset during service. In offering the opinion the examiner is asked to address the Veteran's competent and credible testimony that he experiences a "big knot" in his mouth that gets caught in his teeth. d. Address whether it is at least as likely as not (50 percent probability or greater) that the Veteran's hemorrhoids is related to or had its onset during service. In offering the opinion the examiner is asked to address the Veteran's competent and credible testimony that he experienced hemorrhoids during service. All opinions are to be accompanied by a rationale that is consistent with the evidence of record. A discussion of the pertinent evidence, to include the Veteran's statements, any relevant medical treatises, and generally accepted medical principles, is requested. 2. If the examiner cannot provide an opinion without resorting to speculation, he or she shall provide complete explanations stating why this is so. In so doing, the examiner shall explain whether any 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. David Gratz Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Alexander Bahus 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.