Citation Nr: 21077239 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 13-22 962 DATE: December 29, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left elbow disorder is remanded. Entitlement to service connection for a right elbow disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for chronic fatigue syndrome is remanded. Entitlement to service connection for a sleep disorder is remanded. Entitlement to service connection for genitourinary problems is remanded. Entitlement to service connection for impotency is remanded. Entitlement to service connection for abdominal discomfort is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1988 to March 1992, to include service in Southwest Asia. In March 2018, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript is of record. In June 2018, the Board remanded the claim seeking entitlement to service connection for a right knee disorder for additional development. In April 2021, the Board remanded the claims seeking service connection for a right/left elbow disorders, right/left ankle disorders, chronic fatigue disorder, sleep disorder, abdominal discomfort, genitourinary problems, and impotency for additional development. The Board notes that, in a June 2021 Notice of Disagreement (VA Form 10182), the Veteran selected to opt-in to the modernized review system from the May 2021 Supplemental Statement of the Case (SSOC) with regard to the claim for an increased disability rating for posttraumatic stress disorder (PTSD). As such, the Veteran effectively withdrew his legacy appeal as to that issue, and the appeal for an increased rating claim for PTSD will be addressed in a separate decision under the Appeals Modernization Act (AMA) framework. 1. Entitlement to service connection for a right knee disorder is remanded. In the June 2018 remand, the Board directed the Regional Office (RO) to obtain a VA examination to address the etiology of the Veteran's right knee disorder. The examiner was instructed to specifically consider the Veteran's competent reports that he hurt his right knee due to an incident in Germany in 1989 when he fell off a Howitzer and due to running. In May 2021, the Veteran was afforded a VA examination and medical opinion. The May 2021 VA examiner rendered a negative nexus opinion. The examiner acknowledged the Veteran's reports of knee pain since a 1989 injury but explained that there were no service treatment records showing a knee injury or treatment for the right knee and that the Veteran had complaints for knee pain in December 2018, which was post-service. Although the examiner seems to rely on the distance in temporal proximity between the Veteran's service and the December 2018 complaints of knee pain to support her negative nexus opinion, the examiner did not otherwise provide a reason for discounting the Veteran's competent reports of experiencing symptoms since service. Moreover, the Veteran's treatment records show complaints of knee pain in March 1998. This evidence seems to contradict the VA examiner's rationale and was not considered/discussed. Consequently, the Board finds the May 2021 VA medical opinion insufficient for adjudication purposes and remand is warranted for a new VA medical opinion consistent with the directives herein. 2. Entitlement to service connection for a left/right elbow disorders, left/right ankle disorders, sleep disorder, chronic fatigue disorder, genitourinary problems, impotency, and abdominal discomfort remanded. In April 2021, the Board remanded the claims for service connection for left/right elbow disorders, left/right ankle disorders, sleep disorder, chronic fatigue disorder, genitourinary problems, impotency, and abdominal discomfort for VA medical opinions and adjudication. Since then, these issues have been returned to the Board. Significantly, however, the record reflects that no SSOC has been issued and the RO has not otherwise completed the requested development. Accordingly, these claims must be remanded for substantial compliance with the April 2021 remand and an appropriate SSOC must be issued. See Stegall v. West, 11 Vet. App. 268 (1998). The matters are REMANDED for the following actions: 1. Conduct all necessary development as directed by the April 2021 Board remand. 2. 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. All findings should be reported in detail. The examiner should provide an opinion 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 the Veteran's active duty service. In rendering the above opinion, the examiner must specifically consider and discuss the Veteran's reports of knee pain due to running in service and since an injury that occurred in 1989 when he fell off a howitzer. The examiner must also consider the Veteran's reports of knee pain as early as March 1998. 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. (Continued on the next page) 3. Then, readjudicate the remanded issues on appeal. If any decision is adverse to the Veteran, issue an SSOC and allow the applicable time for a response. 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.