Citation Nr: 21077614 Decision Date: 12/30/21 Archive Date: 12/30/21 DOCKET NO. 18-49 397 DATE: December 30, 2021 REMANDED Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for a right knee injury is remanded. Entitlement to service connection for residuals of right ankle fracture is remanded. REASONS FOR REMAND The Veteran, the appellant in this matter, served on active duty from January 1969 to December 1972. This matter comes before the Board of Veterans' Appeals (Board) on appeal from the April 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). A Board video-conference hearing was held in June 2021 before the undersigned Veterans Law Judge; a transcript of the hearing has been associated with the record. Entitlement to service connection for diabetes mellitus The Veteran contends that his diabetes mellitus is secondary to exposure to high levels of polychlorinated biphenyls (PCBs) while stationed at Moffett Field during service. See February 2016 statement in support of claim. As an initial matter, the Veteran has been diagnosed with diabetes mellitus. See October 2018 VA examination report. A VA examination was conducted in October 2018. In the accompanying opinion, the examiner, a nurse practitioner, addressed each article cited by the Veteran and his representative in support of the correlation between exposure to PCBs and diabetes. She concluded the research reviewed was inconclusive and called for further human trials and there was no evidence of lead toxicity or asbestos related diseases in the Veteran. A remand is warranted to obtain an addendum as the examiner failed to provide an actual etiology opinion. Instead, she merely addressed the supporting articles and found such did not provide a sound basis to conclude a relationship between PCBs and diabetes mellitus. On remand, the examiner should address the articles and provide an opinion as to whether, in the specific circumstances of the Veteran, exposure to PCBs in service likely caused his diabetes mellitus. Entitlement to service connection for a right knee injury The Veteran contends that his right knee disability is related to service. Specifically, the Veteran asserts that he was treated in service for knee pain, which continued from service, leading to a total knee replacement. The Veteran was provided a VA examination and opinion in March 2016. The examiner, a medical doctor, noted the only diagnosis of status-post right total knee replacement. The examiner opined the right knee disability was not related to service. She stated that the Veteran reported no specific injury in service and instead reported his belief that his disability was brought on by repetitive use, jumping, and kneeling, and had an in-service diagnosis of pre-patellar bursitis. That diagnosis, according to the examiner, would not lead to a later knee replacement. The Board finds that another examination and medical opinion are required. The examiner diagnosed only status post right total knee replacement and did not address what disability precipitated the need for the total knee replacement. The Board notes that the Veteran testified the replacement was due to "bone on bone" in his knee. Thus, another VA examination and opinion are necessary. Any testing deemed necessary by the examiner should be undertaken in order to determine the current nature of the knee disability. Moreover, the examiner should provide rationale for the opinion that the pre-patellar bursitis would not lead to a knee replacement and to address the reports of repetitive movements in service. Entitlement to service connection for residuals of right ankle fracture The Board recognizes that the Veteran has not been provided a VA examination for his right ankle disability. Here, the Veteran is noted to have deformity in his ankle consistent with osteoarthritis. See January 2014 Private Treatment Record. In addition, he testified that he fractured his ankle while in service, which was noted in a September 1971 service treatment record (STR). As there is insufficient evidence on which to decide the claim, an examination and medical opinion should be provided. 38 U.S.C. § 5103A(d) (2012); McLendon v. Nicholson, 20 Vet. App. 79 (2006). In addition, during the hearing, the Veteran stated he received treatment for his ankle from an orthopedic foot specialist in Williamsport. A remand is required to also allow VA to obtain authorization and request these records. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate then with the claims file. 2. Ask the Veteran to complete a VA Form 21-4142 for the orthopedic foot specialist identified in his hearing as treating his ankle disability. Once identified, make two requests for the authorized records from the doctor or facility unless it is clear after the first request that a second request would be futile. 3. Forward the claims file and a copy of this remand to the October 2018 VA examiner, if available, for the purpose of obtaining an addendum as to the etiology of the Veteran's diagnosed diabetes mellitus. If the examiner is unavailable, forward the claims file and a copy of this remand to a qualified clinician. After a review of the claims file and a copy of this remand, the examiner is asked to respond to the following: (a) Provide an opinion as to whether it at least as likely as not (50 percent or higher probability) the Veteran's diagnosed diabetes mellitus is related to exposure to polychlorinated biphenyls (PCBs), or otherwise related to service. In doing so, the examiner should consider and address the articles submitted by the Veteran. See February 2016 Correspondence to VA. 4. Provide the Veteran with a VA examination to help determine the likely etiology of the claimed right knee injury. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After a review of the claims file and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify any right knee disability diagnosed during the appeal period. All testing deemed necessary by the examiner should be undertaken. (b) Provide an opinion as to whether it at least as likely as not (50 percent or higher probability) any of the diagnosed right knee disabilities are related to service, to include as related to the in-service diagnosis of pre-patellar bursitis, and/or to repetitive use, jumping, and kneeling in service. In answering these questions, the examiner is asked to consider the Veteran's testimony that he struggled with knee pain since he was discharged from service; the knee pain developed from repetitive use, jumping, and kneeling; and that "bone on bone" issues in his knee led to the total knee replacement. 5. Provide the Veteran with a VA examination to help determine the likely etiology of the claimed residuals of right ankle fracture. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After a review of the claims file and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify any right ankle disability diagnosed during the appeal period. All testing deemed necessary by the examiner should be undertaken. (b) Provide an opinion as to whether it at least as likely as not (50 percent or higher probability) any of the diagnosed right ankle disabilities are related to service, to include as related to the Veteran's fractured ankle in service. In answering these questions, the examiner is asked to consider the Veteran's report of ankle fracture noted in the September 1971 STR; the Veteran's testimony that he struggled with walking since his fracture in service; and the January 2014 private treatment record noting deformities in the ankle consistent with osteoarthritis. Any opinions rendered should be supported by rationale. 6. Thereafter, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Moldawer, 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.