Citation Nr: 21076070 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 17-48 610 DATE: December 22, 2021 REMANDED Entitlement to service connection for a left knee disorder, to include as secondary to service-connected residuals of a right ankle injury, is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for a prostate disorder is remanded. Entitlement to service connection for pseudofolliculitis barbae is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from May 1971 to September 1998, to include service in Southwest Asia. These matters come to the Board of Veterans' Appeals (Board) on appeal from a July 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of this appeal is currently with the RO in Houston, Texas. The Veteran testified at a virtual video conference hearing before the undersigned Veterans Law Judge of the Board in August 2021. A transcript of the hearing has been associated with the claims file. 1. Service Connection Left Knee Disorder The Veteran seeks entitlement to service connection for a left knee disorder as due to his military service. Specifically, the Veteran testified that he did not have left knee pain prior to active service, that he injured his ankle during service that resulted in overcompensating on his left side, and that he was diagnosed with leg length discrepancy with an altered gait. See Board hearing transcript, August 6, 2021. The Veteran does not assert that his left knee pain began during service, but rather began after prolonged overcompensation on his left side due to his right side in-service injury. Id. The Veteran was afforded a VA examination in March 2019. At that time, the examiner diagnosed left knee degenerative arthritis, and opined that such diagnosis was less likely than not proximately due to or the result of the Veteran's service-connected condition. Supporting rationale or further explanation was not provided. Accordingly, the Board finds the March 2019 VA opinion inadequate to decide the claim. Stefl v. Nicholson, 21 Vet. App. 120 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Given these deficiencies, remand is required to afford the Veteran an additional VA examination to determine the nature and etiology of any currently present left knee disorder, to include as secondary to service-connected disabilities. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). 2. Service Connection Sinusitis, Hypertension, Prostate Disorder, and Pseudofolliculitis Barbae The Veteran seeks entitlement to service connection for sinusitis, hypertension, prostate disorder, and pseudofolliculitis barbae as due to his military service. Specifically, the Veteran testified that the symptoms of such disorders had their onset during active service and have continued since. See Board hearing transcript, August 6, 2021. In addition, the Veteran seemed to assert that his hypertension was secondary to his service-connected disabilities and interference with physical activity. Id. The Board notes that the Veteran's service treatment records demonstrate complaints related to an upper respiratory infection, facial cysts and a prostate condition. Additionally, post-service treatment records show diagnoses for a prostate disorder, hypertension, and pseudofolliculitis barbae. Additionally, the Board is cognizant of the recent holding in Saunders v. Wilkie which stated that where pain causes functional impairment, a disability for VA compensation purposes exists, even if there is no underlying diagnosis. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). In light of the foregoing, the Board concludes that the Veteran should be afforded VA examinations to determine the nature and etiology of the any currently present sinusitis, hypertension, prostate disorder, and pseudofolliculitis barbae. See McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records. Specifically, the RO should request and attempt to obtain continuing private treatment records from San Antonio, Family Medical Clinic. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and his representative and afford him an opportunity to submit any copies in his possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any currently diagnosed left knee disorder. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran's left knee disorder had its onset during any period of service, or is otherwise related to such period of service? (B) Is at least as likely as not (50 percent or greater probability) that the Veteran's left knee disorder was caused by or aggravated by service-connected residuals of a right ankle injury? The examiner should specifically consider the Veteran's contentions that his right side in-service injury resulted in overcompensation on the left side and altered gait and leg length discrepancy. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Following the receipt of outstanding records, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any currently diagnosed sinusitis. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the Veteran's sinusitis had its onset during any period of service or is otherwise related to such period of service? The examiner should also address the impact, if any, complaints of an upper respiratory infection in February 1977, November 1978 and June 1995; the assessment of viral syndrome in January 1979; the finding of strep throat in January 1979; an upper respiratory infection in November 1990; an upper respiratory infection in February 1991; an upper respiratory infection in July 1991; a viral upper respiratory infection in November 1992 and early bronchitis in June 1993 The examiner should specifically consider the Veteran's contentions that his sinusitis symptoms had their onset during active service and address the reports of sinus congestion shown in his service treatment records. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 4. Following the receipt of outstanding records, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any currently diagnosed hypertension. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following questions: (A) Is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension had its onset during any period of service, or is otherwise related to such period of service? (B) Is at least as likely as not (50 percent or greater probability) that the Veteran's hypertension was caused or aggravated by any service-connected disorder? The examiner should specifically consider the Veteran's contentions that his hypertension symptoms had their onset during active service. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 5. Following the receipt of outstanding records, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any currently diagnosed prostate disorder. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the Veteran's prostate disorder had its onset during any period of service, or is otherwise related to such period of service? The examiner should address the impact, if any, of the finding of urinary tract infections in July 1986 and chronic prostatitis in July 1987. The examiner should specifically consider the Veteran's contentions that his prostate symptoms had their onset during active service, and address the reports of urinary tract infections, prostatitis, and benign prostate hypertrophy shown in his service treatment records. The examiner must reconcile any conflicting medical evidence of record. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 6. Following the receipt of outstanding records, schedule the Veteran for an examination(s) by an appropriate clinician(s) to determine the nature and etiology of any currently diagnosed pseudofolliculitis barbae. Any and all indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The need for further in-person examination is left to the discretion of the examiner. Thereafter, the examiner is asked to furnish an opinion with respect to the following question: Is at least as likely as not (50 percent or greater probability) that the Veteran's pseudofolliculitis barbae had its onset during any period of service or is otherwise related to such period of service? The examiner should address the impact, if any, of the reports of a cyst in May 1984, facial cyst in April 1990 and May 1990, a facial mole in May 1995, pseudofolliculitis barbae in January 1998 and a nodule on the mandible in February 1998. The examiner should specifically consider the Veteran's contentions that his pseudofolliculitis barbae symptoms had their onset during active service, and address the reports of facial cysts, ingrown hairs, and sebaceous cysts shown in his service treatment records. A clear rationale for all opinions must be provided, and a discussion of the facts and medical principles involved would be of considerable assistance. If the examiner opines that any of the above questions cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. A rationale should be provided for any opinion offered. If it is not possible to provide a specific opinion regarding the above questions, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The medical opinion must support the conclusions reached with an analysis that is adequate to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Mariah N. Sim, 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.