Citation Nr: A21019673 Decision Date: 12/09/21 Archive Date: 12/09/21 DOCKET NO. 190412-21269 DATE: December 9, 2021 REMANDED Entitlement to service connection for a cervical spine disability is remanded. Entitlement to service connection for bilateral upper extremity neurological impairment (claimed as chronic pain syndrome) is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. REASONS FOR REMAND The Veteran had active military service from October 1984 to October 1987. This case comes before the Board of Veterans' Appeals (Board) on appeal of a January 2019 rating decision. In a July 2016 rating decision, the Veteran was denied entitlement to service connection for right and left knee disabilities. In a March 2017 rating decision, the Veteran was denied entitlement to service connection for erectile dysfunction. In a July 2017 rating decision, the Veteran was denied entitlement to service connection for chronic pain syndrome (now claimed as bilateral upper extremity radiculopathy). In a July 2018 rating decision, the Veteran was denied entitlement to service connection for a cervical spine disability. The Veteran submitted timely notices of disagreement with those Legacy system rating decisions. In September 2018, the Veteran opted to have his appeals reviewed under the modernized review system, but submitting a Rapid Appeals Modernization Program (RAMP) election form. At that time, the Veteran elected higher level review. In a January 2019 RAMP rating decision, the Agency of Original Jurisdiction (AOJ) denied the claims currently on appeal. In his April 2019 appeal to the Board, the Veteran elected the Hearing review option. The Veteran testified at a hearing before the undersigned Veterans Law Judge in July 2021. A transcript of that hearing has been associated with the claims file. As such, the Board may only consider the evidence before the AOJ at the time of the January 2019 rating decision on appeal, as well as any evidence submitted by the Veteran or his representative at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). In the January 2019 decision, the AOJ found that the Veteran has current diagnoses of right and left knee disabilities, and a cervical spine disability; and, that the private treatment notes showed a possible link between the Veteran's cervical spine disability and his right shoulder disability. The Board is bound by those favorable findings. 38 U.S.C. § 5104A (2018); 38 C.F.R. § 3.104 (2020). The Board finds that additional development is required to correct duty to assist errors that occurred prior to the January 2019 rating decision on appeal. Service Connection Cervical Spine Disability and Bilateral Upper Extremity Neurological Impairment The Veteran asserts that his cervical spine disability was caused by or incurred in active service, or in the alternative, was caused or aggravated by his service-connected right shoulder disability. At a June 2018 VA examination, the examiner opined that the Veteran's cervical spine disability was less likely than not proximately due to or the result of the Veteran's service-connected right shoulder disability. As rationale, the examiner noted that there is no evidence to support the notion that the Veteran's shoulder disability caused degenerative disc disease of the cervical spine. The Board finds the June 2018 VA examination inadequate for adjudication purposes. In this regard, the examiner failed to provide an opinion regarding aggravation. Therefore, the Veteran must be afforded a new VA examination to determine the nature and etiology of any currently present cervical spine disability. Further, the failure to appropriately develop and adjudicate the Veteran's claim of entitlement to service connection for a cervical spine disability, led to a failure to satisfy a regulatory or statutory duty with respect to the Veteran's claim of entitlement to service connection for neurological impairment of the upper extremities secondary to his cervical spine disability. As such, that issue must also be remanded pending the development and adjudication for the Veteran's claimed cervical spine disability. Service Connection Right and Left Knee Disabilities The Veteran asserts that his right knee disability was caused by or incurred in active service. Specifically, he reported that he first experienced right knee problems during service, and that his symptoms have continued since that time. Further, the Veteran has asserted that his left knee disability developed as a result of overcompensation for his right knee. At an April 2016 VA examination, the examiner opined that the Veteran's knee disabilities were less likely than not proximately due to or the result of the Veteran's service-connected shin splints. As rationale, the examiner noted that the Veteran's knee disabilities were diagnosed over 20 years following active service and there is no evidence in the record pertaining to ongoing complaints, diagnosis, or treatment of a chronic knee condition during service. The Board finds the April 2016 VA examination inadequate for adjudication purposes. In this regard, the examiner failed to adequately consider the Veteran's lay statements regarding the onset and continuity of his right knee disability. Therefore, the Board finds that the Veteran should be afforded a new VA examination to determine the nature and etiology of his right knee disability. Further, the failure to appropriately develop and adjudicate the Veteran's claim of entitlement to service connection for a right knee disability, led to a failure to satisfy a regulatory or statutory duty with respect to the Veteran's claim of entitlement to service connection for a left knee disability claimed as secondary to his right knee disability. As such, that issue must also be remanded pending the development and adjudication for the Veteran's claimed right knee disability. Service Connection Erectile Dysfunction The Veteran asserts that his erectile dysfunction is caused by his service-connected adjustment disorder or the medication he takes for his service-connected right shoulder disability. In light of the Veteran's statements and contentions and the medical evidence of record, the Board concludes that the Veteran should be afforded a VA examination to determine the nature and etiology of any currently present erectile dysfunction. McLendon v. Nicholson, 20 Vet. App. 79 (2006). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of any currently present cervical spine disability. The claims file must be made available to, and reviewed by the examiner. Any indicated studies must be performed. Based on the examination results and review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's cervical spine disability had its onset during his active service, or is otherwise etiologically related to such service. The examiner must also provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present cervical spine disability was caused or aggravated (chronically worsened) by a service-connected disability, to include any altered body mechanics resulting from such. In forming the opinion, the examiner must consider the private medical evidence of record indicating that there may be a relationship between the Veteran's cervical spine disability and his service-connected right shoulder disability. A complete and detailed rationale must be provided for all opinions expressed. 2. Schedule the Veteran for an examination to determine the nature and etiology of any currently present right knee disability. The claims file must be made available to, and reviewed by the examiner. Any indicated tests and studies must be performed. Based on the examination results and review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that the Veteran's right knee disability had its onset during his active service, or is otherwise etiologically related to such service. In forming the opinion, the examiner must consider the Veteran's lay statements regarding the onset and continuity of his symptoms. A complete and detailed rationale for all opinions expressed must be provided. 3. Schedule the Veteran for an examination to determine the nature and etiology of any currently present erectile dysfunction. The claims file must be made available to, and reviewed by the examiner. Any indicated studies must be performed. Based on the examination results and review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present erectile dysfunction, was caused or aggravated (chronically worsened) by a service-connected disability, to include medication prescribed for the Veteran's service-connected mental health disability. A complete and detailed rationale must be provided for all opinions expressed. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Umez-Eronini, 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.