Citation Nr: 21074954 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 11-33 050 DATE: December 16, 2021 REMANDED The claim of entitlement to service connection for painful joints of knees, hands, and feet is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to April 1968. This appeal is from a September 2008 rating decision. This appeal was last remanded by the Board in September 2020 for additional development. Since then, the Veteran had a personal hearing with the undersigned VLJ, in August 2021. On review of the record, the Board finds that still another remand is required. The Board regrets the additional delay that the remand will cause, but finds it necessary in order to preserve the Veteran's due process rights. The claim of entitlement to service connection for painful joints of knees, feet, and hands is remanded. The Board notes that the Veteran reported in 1977 that he received treatment at the Lowell, Massachusetts, VA outpatient clinic. He reported, in a 2007 statement, that he had gotten most of his treatment from there for the preceding 30 years. It is not clear that records from the 1970s and 1980s have ever been requested, which shall be achieved on remand. Further, the most recent VA examination report, from January 2021, continues to be inadequate for adjudication. As for the knees, the September 2020 remand asked that an opinion on whether the Veteran's service-connected spondylolisthesis with sciatica aggravated the Veteran's knees. The January 2021 VA examiner did not address this aspect of secondary service connection. Further, the opinion on whether the knee disabilities were directly caused by service is inadequate. The examiner mentioned the Veteran was involved in a post-service motor vehicle accident as a possible interceding cause; however, none of the evidence shows he injured either knee in that accident. The examiner opined that the Veteran's arthritis of the knees is in its early stages, and could not have incepted during service, but did not provide adequate explanation as to why the Veteran's in-service complaints of knee pain were not related to his current diagnoses. Accordingly, another attempt shall be made to obtain an opinion. As for the feet, the examiner did not consider the Veteran's in-service complaints of bilateral foot pain, and based the opinion largely on a lack of documentation of treatment, which is an inadequate basis on which to deny service connection. Another opinion must be obtained. Finally, as for the hands, the September 2020 remand asked that the examiner to consider the April 2019 VA examiner's statement regarding the possibility that the Veteran's bilateral hand arthritis was related to his work as a medic while in service, which was not done. Instead, the examiner cited the Veteran's treating physician who indicated that, although the Veteran had reported ongoing symptoms since 1968, it was impossible to date exactly when the Veteran had the onset of symptoms. The examiner attributed the arthritis to wear and tear throughout the years without adequately considering whether wear and tear during service was as likely as not also a cause, which the April 2019 VA examiner indicated was conceivable. On remand, another opinion must be obtained. The matters are REMANDED for the following action: 1. Associate updated VA treatment records with the claims file. 2. Attempt to locate any archived VA treatment records from the Lowell OPC (or corresponding VAMC) dating from the 1980's and earlier, starting at least from 1977. If there are not records, this should be documented in the file and the Veteran notified of the unavailability. 3. After completion of directives 1 and 2, schedule the Veteran for an appropriate examination for a report on whether it is as likely as not (50/50 probability or greater) that any knee, hand, or foot joint diagnosis is related to service. The examiner is asked to review the record and elicit from the Veteran a detailed history of his symptoms in and since service. The examiner is asked to address whether the symptoms complained of in and since service and/or his duties in service caused his current disabilities. In regard to the knees, the examiner is also asked to address whether the Veteran's service-connected spondylolisthesis with sciatica aggravated the right and/or the left knee. "Aggravated" means to cause any increase in severity beyond the normal progression and it need not be permanent in nature. The Veteran has complained of joint pains in his knees, hands, and feet, since 1968, when he filed this claim. The examiner is advised that he filed this claim prior to separation, and the claim is evidence of in-service complaints and symptoms. Given the timing of this evidence, the Board finds his statements regarding persistent symptoms since service to be credible. He is currently diagnosed with bilateral knee osteoarthritis and degenerative meniscus, bilateral feet degenerative arthritis and gout, and bilateral hand degenerative arthritis. The Veteran complained of pain in these joints during service. He attributes the pain to vigorous training, which caused injuries because he was smaller than the other recruits. He reports that his job as a medic at the hospital caused his symptoms because his duties moving bodies and beds were also hard on his body. The April 2019 VA examiner indicated that it was conceivable that the Veteran's duties caused his hand disabilities. All opinions are to be supported with explanation. The examiner is advised that a lack of documentation of treatment is not dispositive of the question. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Gibson 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.