Citation Nr: 21077552 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 17-45 331 DATE: December 30, 2021 REMANDED Entitlement to service connection for right sciatic radicular pain is remanded. Entitlement to service connection for a right hip condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a cervical spine condition is remanded. Entitlement to service connection for a lumbar spine condition is remanded. Entitlement to service connection for a left hip condition is remanded. Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for left sciatic radicular pain is remanded. Entitlement to a compensable evaluation for residual surgical scar is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1951 to March 1954. In October 2021, the Veteran appeared and provided testimony at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of the hearing is of record. 1. Entitlement to service connection for right sciatic radicular pain is remanded. 2. Entitlement to service connection for a right hip condition is remanded. 3. Entitlement to service connection for a right knee condition is remanded. 4. Entitlement to service connection for a cervical spine condition is remanded. 5. Entitlement to service connection for a lumbar spine condition is remanded. 6. Entitlement to service connection for a left hip condition is remanded. 7. Entitlement to service connection for a left knee condition is remanded. 8. Entitlement to service connection for left sciatic radicular pain is remanded. The Board finds that remand is required for additional development. The Veteran claimed that these conditions were a result of an accident in service or secondary to an in-service surgery to remove a pilonidal cyst. The Board notes that there are three opinions of record, a positive private opinion, and two negative VA opinions. In February 2011, a private physician submitted a nexus opinion. The physician recounted the Veteran's in-service surgery and stated that it resulted in a tender surgical site. The physician noted that the pain caused the Veteran to alter his gait, leading to significant lower back, knee, and hip problems. The physician determined that the Veteran's low back syndrome, degenerative joint disease of the bilateral hips, and degenerative joint disease of the bilateral knees was more likely than not related to postural changes related to the failed in-service surgery. The physician also determined that the Veteran's bilateral sciatic radicular pain was more likely than not related to stenosis of the spine. The Board finds this opinion is inadequate as it is largely lacking rationale. The Veteran was provided with VA examinations to evaluate his conditions in March 2013. It was determined that the Veteran did not have a cervical spine, bilateral hip, bilateral knee, or bilateral peripheral neuropathy diagnosis. The Veteran was diagnosed with degenerative lumbar spondylosis. The examiner denied nexus and stated that no attempt was made to provide diagnoses for the Veteran's claimed cervical spine condition, degenerative joint disease of the hips, and degenerative joint disease of the knees as a review of current medical literature was silent for any mechanism by which the residuals of a scar from surgery may cause or aggravate any conditions. The examiner also noted that the Veteran's complaints of neck, hip, and knee pain were likely due to the aging process and noted the long period of time between discharge and complaint for these issues. The examiner then denied nexus for the Veteran's lumbar spondylosis with accompanying bilateral radiculopathy. As rationale the examiner stated that the condition was likely age related. The examiner again noted that long time period between service and complaint for the condition. The Board finds this opinion to be less probative as it is not adequately supported by rationale. The examiner did not provide any medical explanation for his opinion. He simply noted the time period between service and complaint for the Veteran's claimed conditions and then related these conditions to aging without any medical explanation. An addendum medical opinion was provided in April 2013. The examiner found that none of the Veteran's claimed conditions were caused or aggravated by the pilonidal cyst surgery. The examiner noted that the pilonidal cyst, the surgery, and the resulting scar were superficial processes that are geographically separate from the spinal cord, spinal nerve roots, spinal skeletal column, hip, and knee joints. As a result, there was no direct involvement between the claimed conditions. The examiner addressed the private February 2011 opinion and noted that the altered gait resulting from the surgery could not have caused the claimed conditions because there was no disturbance of locomotion or altered gait noted on any of the VA examinations. The examiner stated that the degenerative arthritis of the hips and knees were more likely due to the accumulated effect of wear and tear. He noted that such joints involved both weight bearing and range of motion features which made them susceptible to the degenerative process. The examiner then denied aggravation of any of the conditions by the surgery as the VA examination from March 2013 did not indicate any worsening of the conditions. The Board finds the April 2013 VA opinion to be the most probative in this case as it is sufficiently supported by rationale and medical evidence. The Board notes, however, that remand is still required as no opinion was provided as to direct service connection. The April 2013 examiner only addressed whether the Veteran's claimed conditions were related to his in-service pilonidal cyst surgery. In the October 2021 hearing; however, the Veteran stated that his conditions may have also been due to a fall in-service. He stated that he fell and was injured to the point that he needed to be transported in a two-wheel trailer. No opinion was provided as to whether the Veteran's claimed conditions could have stemmed from this in-service injury. The Board notes that the Veteran's service treatment records (STRs) are unavailable due to a fire-related incident. VA has a heightened duty to consider the applicability of the benefit of the doubt rule when there is evidence that a Veteran's service records have been lost or destroyed. Therefore, the examiner should carefully consider the Veteran's lay statements. See Cromer v. Nicholson, 19 Vet. App. 215, 217 (2005) (quoting O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991)). 9. Entitlement to a compensable evaluation for residual surgical scar is remanded. Where there is evidence that a Veteran's service-connected disability has worsened since his last VA examination, and the last examination is too remote to constitute a contemporaneous examination, a new examination is required. The Veteran was last afforded a VA examination to evaluate his scar in March 2013, over eight years ago. At the October 2021 hearing, Veteran asserted that his scar was now painful and sensitive. Thus, on remand, the Veteran should be afforded a new VA examination to determine the current nature and severity of his scar condition. The matters are REMANDED for the following action: 1. Provide the Veteran with an appropriate examination to determine the etiology of his lumbar spine, cervical spine, bilateral hip, bilateral knee, and bilateral lower peripheral neuropathy conditions. The claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. An explanation for all opinions expressed must be provided. The examiner is asked to provide an opinion regarding whether it is at least as likely as not (50 percent or greater probability) that the lumbar spine, cervical spine, bilateral hip, bilateral knee, and bilateral lower extremity peripheral neuropathy had onset in, or is otherwise related to, active military service, to include a fall in service. The VA examiner is advised that the Veteran's service treatment records are not available due to a fire. The absence of evidence of treatment for symptoms related to the disability in the Veteran's available service treatment records cannot, standing alone, serve as the basis for a negative opinion. 2. After any additional records are associated with the claims file, provide the Veteran with an appropriate examination to determine the severity of the service-connected scar. The entire claims file must be made available to and be reviewed by the examiner. Any indicated tests and studies must be accomplished, and all clinical findings must be reported in detail and correlated to a specific diagnosis. H.M. WALKER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board AK 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.