Citation Nr: 21076760 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 15-89 890A DATE: December 27, 2021 REMANDED Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a lower back disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from February 1976 to September 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2014 rating decision. In August 2021, the Veteran testified before the undersigned Veterans Law Judge at a videoconference hearing. A transcript of the hearing is of record. Although the Board regrets the additional delay, a remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. 1. Entitlement to service connection for a left knee disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. 3. Entitlement to service connection for a lower back disability is remanded. The Veteran contends that his bilateral knee and lower back disabilities are the result of his military service. The Veteran contends that he initially injured his lower back in January 1977, and then reinjured it again in both July 1978 and January 1980, all while in the service. He contends that he has suffered from recurrent back spasms since service. Regarding his knees, the Veteran contends that he began to suffer from chronic knee pain in 1976 as a result of working on a cement floor, and that he complained about chronic aches and soreness on several occasions, but they were unable to determine a cause. He contends that his knees have continued to cause problems and are often exacerbated by his back condition. See February 2014 VA Form 21-4138; see also December 2015 VA Form 9. The Veteran was afforded VA examinations for his bilateral knees and lower back in April 2014. The VA examiner reported that the Veteran had diagnoses of right knee degenerative joint disease (DJD) and lumbar degenerative joint and disc disease. The VA examiner noted that the record indicated the Veteran had knee pain in 1977 and that he was seen in service for back pain in 1977, 1978, and 1980. However, the VA examiner opined the Veteran's right knee condition was less likely as not (less than 50/50 probability) caused by or a result of military service. By way of rationale, the examiner explained that the right knee condition at the time was mild, and DJD is considered an age-related change. The examiner explained that the record in the Veteran's claims file does not indicate any trauma or chronic treatment that would be considered causative to the present diagnosis of DJD, and that the Veteran reported right knee symptoms for just the last 6 to 7 years, thus there is no association to the symptoms in service in 1977. With respect to the Veteran's lower back, the VA examiner opined that the condition was less likely as not (less than 50/50 probability) caused by or a result of military service. By way of rationale, the examiner explained that the Veteran has degenerative disc disease (DDD) and DJD of the lumbar facets, and both are considered age-related changes; further, episodes of back pain in the claims file are all consistent with acute spasms that would be considered short-term conditions with resolution. See April 2014 VA examination reports. After his April 2014 VA examinations, the Veteran provided additional information about his knee and back problems. The record includes several articles submitted by the Veteran pertaining to lumbar degenerative disc disease and osteoarthritis of the knee. Additionally, during his August 2021 hearing, the Veteran testified that he performed work on airplanes on a daily basis during his four years in service and that this work required him to walk and kneel on concrete, crouch down underneath the airplanes, and drag and mount heavy hoses and fuel tanks. He testified that the work involved a lot of twisting and turning with heavy weight on his back and knees. He testified that it was very painful for him to squat or kneel, and that it is nearly impossible to get back up afterwards. He testified that he is unable to walk very far or even stay on his feet for longer periods of time. He testified that his back has been going out for years and the pain is unbelievable. The Veteran also testified that he had recently undergone an MRI in June 2021 and an EMG in August 2021, and that he had been to pain management in July and August 2021. He further testified that the doctor that performed his EMG said that everything went back to the back injury. See August 2021 Hearing Transcript. Given the assertions of the Veteran and his additional description of symptoms during and since service, the Board believes updated opinions should be ordered to assess the nature and etiology of the Veteran's claimed bilateral knee and lower back disabilities. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file outstanding VA treatment records. 2. Invite the Veteran to submit, or authorize VA to obtain on his behalf, any records of private care for his knees or back that have not already been associated with the claims file. Take all appropriate steps to obtain identified treatment records. 3. Schedule the Veteran for bilateral knee examinations. The examiner must review the entire claims file, to include the hearing transcript, medical articles submitted by the Veteran, and a copy of this remand. Based on a review of the record and a new examination, the examiner should respond to the following: a) Identify all left and right knee disabilities for the period on appeal. b) For any left and right knee disability identified, opine as to whether it is at least as likely as not (approximately 50 percent or greater probability) that such had onset in or is otherwise related to service, to specifically include wear and tear from the physical rigors of his service. The examiner should specifically discuss whether the nature of the Veteran's current bilateral knee disabilities, from a medical perspective, is consistent with the Veteran's in-service duties and his lay reports of ongoing symptoms after service. A complete medical rationale for all opinions expressed must be provided. 4. Schedule the Veteran for a spine examination. The examiner must review the entire claims file, to include the hearing transcript, medical articles submitted by the Veteran, and a copy of this remand. Based on a review of the record and a new examination, the examiner should respond to the following: a) Identify all lower back disabilities for the period on appeal. b) For any lower back disability identified, opine as to whether it is at least as likely as not (approximately 50 percent or greater probability) that such had onset in or is otherwise related to service, to specifically include wear and tear from the physical rigors of his service. The examiner should specifically discuss whether the nature of the Veteran's current back disability, from a medical perspective, is consistent with the Veteran's in-service duties and his lay reports of ongoing symptoms after service. c) Notwithstanding the answer to the question above, is it at least as likely as not that the Veteran's spine disability is caused or aggravated by his right and/or left knee disabilities? A complete medical rationale for all opinions expressed must be provided. 5. Thereafter, readjudicate the issues on appeal. If the benefits sought remain denied, issue the Veteran and his attorney a supplemental statement of the case and inform the Veteran of his appeal options. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board L. Fulmer, Associate 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.