Citation Nr: 21074491 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 17-65 441 DATE: December 15, 2021 REMANDED 1. Entitlement to service connection for a left ankle disability is remanded. 2. Entitlement to service connection for a left eye cataract is remanded. 3. Entitlement to service connection for right knee degenerative arthritis is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from November 1966 to October 1968, and had additional reserve service. This matter is before the Board of Veterans' Appeals (Board) on appeal from an August 2017 rating decision. In a December 2017 VA Form 9, the Veteran's representative requested a videoconference hearing. In September 2021 correspondence, the Veteran and his representative were informed of an October 2021 Board hearing. In November 2021 correspondence, the Board noted that Veteran that he did not appear for his October 2021 Board hearing; indicated that it was unclear whether he had withdrawn the hearing request; and asked him to submit a written statement within thirty days if he wished to reschedule a hearing. He has not responded. 1. Entitlement to service connection for a left ankle disability. In his April 2017 VA 21-526EZ Fully Developed Claim, the Veteran reported a left ankle injury inservice and attached a copy of a December 1967 service treatment record (STR) which notes a "Jeep Accident." Left ankle x-rays at the time were interpreted as normal. On May 2017 VA (ankle) examination, the provider indicated that the Veteran does not have a current diagnosis of a left ankle disability (and that no current imaging or diagnostic results were available for review). A review of the claims file found that a May 2017 x-ray was interpreted as showing smooth marginated calcification adjacent to the lateral malleolus without overlying soft tissue swelling that is likely sequalae of remote trauma. Accordingly, remand for an addendum medical opinion reconciling the conflicting evidence regarding the presence of a left ankle disability is necessary. 2. Entitlement to service connection for an early nuclear sclerotic cataract of the left eye. The Veteran's October 1966 pre-service report of medical history notes the Veteran's report of eye trouble described as "foreign body left eye" two months prior and is "O.K." [Notably, this pre-service report of medical history is dated over a month prior to the Veteran's entry on active-duty and places the foreign body left eye trauma at over three months prior to his entry onto active duty.] His October 1966 service entrance examination notes amblyopia and an [illegible] eye condition. The Veteran's STRs are silent for complaints of, treatment for, or a diagnosis of, a left eye cataract. A medical examination conducted to assess the Veteran's qualifications for a combat arms military occupational specialty (MOS) found a diagnosis of myopic astigmatism. The Veteran's service separation examination report is silent for an eye disability, and his report of medical history then notes a "yes" for eye trouble. The military medical provider who reviewed the Veteran's report of medical history noted that none of the Veteran's answers were found to be of medical significance. [The Veteran is also assigned a PULHES value of 2 for eyes; he received an eyeglass prescription in service.] On May 2017 VA (eye) examination, the diagnoses were bilateral nuclear sclerotic cataracts and dermatochalasis of both upper eyelids. The Veteran reported onset of the disability in the 1970's as trouble seeing things far away. He stated that the disability progressed to small cataracts, and indicated he had to obtain stronger glasses to correct vision. The examiner determined that a visual field defect (due to the eyelid condition) is secondary to the Veteran's dermatochalasis (excessive skin); noted that otherwise visual fields were normal, and there were no complaints of a visual field defect. The Board notes that no provider has addressed whether the Veteran's diagnosed early nuclear sclerotic cataract of the left eye is related to his military service. Further development for an adequate medical examination is necessary. See Barr v. Nicholson, 21 Vet. App. 303 (2007). 3. Entitlement to service connection for right knee degenerative arthritis. The Veteran's STRs note that he reported an injury from a fall in August 1967. A military medical provider noted the Veteran's diagnosis of traumatic arthritis of the right knee, but found him fit for duty. On May 2017 VA (knee) examination, right knee degenerative arthritis was diagnosed. In a July 2017 medical opinion, another provider opined that the right knee disability is less likely than not incurred in or caused by the claimed injury, event, or illness in service based on lack of evidence of a chronic condition [in service] and the 49 year gap between the complaint of right knee pain in August 1967 and the current diagnosis of right knee arthritis. The provider did not explain how the Veteran's diagnosis of arthritis during service in 1967 and his 2017 diagnosis of arthritis may be distinguished. A remand an addendum (clarifying) medical opinion is necessary. The matters are REMANDED for the following: 1. Arrange for the Veteran's claims file to be forwarded to appropriate clinician (in orthopedics) for review and a medical advisory opinion regarding the likely etiology of his right knee and left ankle disabilities. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] The consulting provider should offer opinions that respond to the following: (a.) Identify (by diagnosis) each right knee disability and left ankle disability entity shown during the pendency of this claim. (b.) Identify the likely etiology for each right knee and left ankle disability entity diagnosed. Is it at least as likely as not (a 50 percent or better probability) that the diagnosed disability had its onset/was incurred during the Veteran's active service? [The rationale must reconcile the conclusion by the May 2017 examiner that right knee arthritis is unrelated to service with the August 1967 STR notation of traumatic arthritis (a chronic disability) of the right knee.] 2. Also arrange for the Veteran's claims file to be forwarded to appropriate clinician (in eye disorders) for review and a medical advisory opinion regarding the likely etiology of his left eye cataract disability. [If further examination of the Veteran is deemed necessary for an opinion sought, such should be arranged.] The consulting provider should respond to the following: Identify the likely etiology for the Veteran's left eye cataract disability diagnosed. Is it at least as likely as not (a 50 percent or better probability) that it had its onset/was incurred during (or as a result of) the Veteran's active service? If not, identify the likely etiology for the left eye cataract. All opinions must include rationale that cites to supporting factual data and/or medical literature, as deemed appropriate. If an opinion sought cannot be provided without resort to mere speculation, there must be explanation why that is so. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Lederman, Michael 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.