Citation Nr: 21075125 Decision Date: 12/17/21 Archive Date: 12/17/21 DOCKET NO. 15-11 600 DATE: December 17, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a hepatitis C is remanded. Entitlement to service connection for a liver disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to January 1979. In May 2018, a videoconference hearing was held before the undersigned Veterans Law Judge. A transcript is of record. In May 2021, the Board remanded the current claims for additional development. The Board notes that in two separate December 2019 rating decisions the Regional Office (RO) denied entitlement to service connection for the issues of diabetes mellitus, sleep apnea, a heart condition, and leukocytosis. The Veteran appealed these rating decisions and selected the Hearing Review lane. As these issues are appealed under the Appeals Modernization Act (AMA), they will be the subject of a separate Board decision. Entitlement to service connection for a right knee disorder, hepatitis C, and liver disorder is remanded. In the May 2021 remand, the Board requested that VA medical opinions be obtained to address the etiology of the Veteran's right knee disorder, hepatitis C, and liver disorder. The Board specifically instructed that, in rendering an etiological opinion, the VA examiner(s) should consider the Veteran's competent reports of continuing knee problems since service and in-service blood exposure and, if an opinion could not be provided without resorting to mere speculation, the examiner(s) should provide a complete explanation as to why. In June 2021, the RO procured VA medical opinions in an attempt to comply with the Board's May 2021 remand directives. The same VA examiner rendered medical opinions for all the Veteran's claimed conditions. With regard to the right knee, the examiner found that this disorder was not etiologically related to the Veteran's service and noted that, although the Veteran reported he injured his knee after kicking a tree in service and had problems with his right knee off and on since then, these were the Veteran's subjective reports and there was no objective evidence of this. The examiner then concluded she was unable to determine the cause of the Veteran's current right knee condition without mere speculation. With regard to the Veteran's hepatitis C and liver disorder, the examiner found that these disorders were not etiologically related to service and noted that it was less likely the Veteran was exposed to a wounded soldier's blood by reason of him not having been in a combat zone and being an operations system management specialist. The examiner then concluded she was unable to determine the cause or onset of hepatitis C without mere speculation. In spite of the RO's attempts at obtaining sufficient VA medical opinions, the Board finds that the VA medical opinions do not substantially comply with the Board's remand directives as indicated above. In that regard, while the VA examiner appears to have considered the Veteran's competent reports of knee pain since service and in-service exposure to blood, the examiner has not provided an adequate explanation for discounting them. The examiner merely indicated that the Veteran's reports of knee pain were subjective and, although the examiner correctly identified the Veteran's military occupational specialty (MOS), the examiner ignored the fact that the Veteran's MOS required airlift support and his reported blood exposure was from when he assisted wounded out of an aircraft. Moreover, while the examiner indicated she was unable to determine the cause or onset of the right knee disorder and/or hepatitis C without mere speculation, the examiner did not otherwise provide a complete rationale for making this determination. As the June 2021 VA medical opinions do not comply substantially with the Board's remand directives, remand is warranted for new VA medical opinions consistent with the directives herein. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's right knee disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner in conjunction with the medical opinion. The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's right knee disorder had its onset in or is otherwise related to his active duty service. In rendering the above opinion, the examiner must specifically consider and discuss the Veteran's testimony regarding the onset and continued problems with his knee. See May 2018 Board Hearing Transcript. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the 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. 2. Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's hepatitis C and liver disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner in conjunction with this medical opinion. a) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hepatitis C had its onset in or is otherwise related to his active duty service. In rendering this opinion, the examiner is specifically instructed to consider and discuss the Veteran's statement that he was exposed to a soldier's blood during active duty service. b) If the examiner responds to paragraph (a) with a positive etiological opinion, the examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's liver disorder was caused or aggravated by his hepatitis C. Aggravation in this context is defined as any increased in severity. In rendering this opinion, the examiner must specifically consider and discuss the January 2015 VA Treatment record that indicates the cirrhosis and hepatocellular carcinoma are due to HCV (hepatitis C). The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the 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. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.