Citation Nr: 21075355 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 18-14 308 DATE: December 20, 2021 ORDER Service connection for a left knee disability is denied. Service connection for a right knee disability is denied. Service connection for a right wrist disability is denied. REMANDED Service connection for a skin disability of the face and scalp is remanded. Service connection for a neck disability is remanded. FINDING OF FACT The preponderance of the evidence of record is against finding that the Veteran has had a left knee, right knee, or right wrist disability at any time during or approximate to the pendency of the claim. CONCLUSION OF LAW The criteria for service connection for a left knee, right knee, or right wrist disability are not met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service in the U.S. Air Force from November 2008 to February 2013, with additional service in the Air National Guard, including active duty for training from November 2014 to May 2016. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision. In June 2019, the Board remanded the claim for service connection for a neck disability and denied the claims for service connection for the left knee, right knee, right wrist, and skin condition. The Veteran appealed those denials to the U.S. Court of Appeals for Veterans Claims (Court). In a December 2020 decision, the Court remanded those issues back to the Board for further adjudication. The Board then remanded them in July 2021. Service Connection Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Left knee, right knee, and right wrist disabilities The Board previously denied service connection for the left knee, right knee, and right wrist in June 2019. The basis for those denials was that the evidence did not establish current disabilities for any of the claims. The Board noted at the time that the Veteran's post-service treatment records did not include any complaints, treatment, or diagnoses related to those claims. The Court vacated the Board's denials because the Board did not discuss whether VA had satisfied its duty to assist, including providing the Veteran with VA examinations. In July 2021, the Board remanded the claims to obtain examinations. Those VA examinations were conducted in July 2021, and the reports were published in October 2021. For the both the knees and the right wrist, the examiner stated that there was no diagnosed disability. This was based on normal x-ray findings, normal range of motion findings, and the absence of any evidence of pain on examination. The Veteran had reported experiencing pain in these joints, and he is competent to make that assertion. However, pain alone, without an accompanying diagnosis of a present disease, is a disability for VA purposes only if it "reaches the level of a functional impairment of earning capacity." Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Given the normal range of motion findings from the VA examinations, including with repetitive testing, functional impairment has not been shown. Because a current disability for VA purposes has not been established for the left knee, right knee, or right wrist, service connection is not warranted. Regarding VA's duty to assist, the Veteran was provided VA examinations which adequately assessed whether a current disability was present, including recording a history from the Veteran, conducting a physical examination, and obtaining diagnostic imaging. Neither the Veteran nor his representative have asserted that any other duty to assist error regarding these claims. REASONS FOR REMAND Service connection for a skin disability of the face and scalp In its December 2020 decision, the Court found that the Board relied on an inadequate March 2017 VA examination and opinion in denying the Veteran's claim for service connection for a skin disability. The Court noted that the Veteran was treated for xerosis cutis on his face during service, but the examiner did not mention whether the Veteran had a current skin condition on his face. In addition, the examiner only noted tinea cruris (which is already service-connected) in the diagnosis and findings section but referenced a dry scalp in the opinion. A new examination was obtained in October 2021. That examiner stated that there was no current skin disability, including dry skin of the face or scalp. However, prior to adjudicating the claim, an opinion should be obtained to address whether the dry scalp, present in March 2017, is etiologically related to the xerosis cutis diagnosed during service. Service connection for a neck disability The Veteran contends that he has a neck disability secondary to his service-connected temporomandibular joint (TMJ) dysfunction. The Board remanded the claim in July 2021 to obtain an opinion addressing that contention. An October 2021 VA examiner stated that the Veteran had a normal neck examination with no diagnosis of a neck condition. However, an October 2019 VA examination diagnosed cervical strain and intervertebral disc syndrome (IVDS). A previous examination in March 2017 also diagnosed cervical strain. In addition, the examiner stated that the Veteran was diagnosed with TMJ dysfunction in 2019 with decreased lateral neck range of motion, which is not consistent with TMJ. The Board does not find this explanation to be adequate as it does not provide any further detail regarding why decreased lateral neck motion would not be associated with the TMJ disorder. An addendum opinion should be obtained to address whether the diagnosed neck disabilities, present in March 2017 and October 2019, are etiologically related to the Veteran's service-connected TMJ disorder. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's dry scalp, diagnosed in March 2017, is at least as likely as not related to xerosis cutis diagnosed during service in January 2013. A complete explanation of the opinion must be provided. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's cervical strain and IVDS, diagnosed in March 2017 and October 2017, are at least as likely as not a) proximately due to service-connected TMJ dysfunction, or b) aggravated beyond their natural progression by service-connected TMJ dysfunction. A complete explanation of the opinion must be provided. JOHN Z. JONES Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shamil Patel, 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.