Citation Nr: 21006332 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 17-05 658 DATE: February 3, 2021 REMANDED Entitlement to service connection for tendonitis of the hands is remanded. Entitlement to service connection for hearing loss is remanded. Entitlement to an initial compensable rating for left knee patellofemoral pain syndrome is remanded. REASONS FOR REMAND The Veteran had active service in the United States Air Force from April 2007 to January 2011. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah. The Veteran submitted a notice of disagreement in December 2016. A statement of the case was issued in January 2017. The Veteran perfected the present appeal via VA Form 9 received in January 2017. The Veteran and his representative appeared at a virtual Board hearing before the undersigned Veterans Law Judge in June 2020. A transcript of the proceeding is associated with the claims file. 1. Entitlement to service connection for tendonitis of the hands is remanded. In August 2016, the Veteran submitted a claim seeking entitlement to service connection for tendonitis. The November 2016 rating decision denied the claim because the Veteran did not specify the joint affected and VA treatment records did not reflect any complaints or treatment for tendonitis. In his January 2017 VA Form 9, the Veteran stated that the claimed tendonitis was in his hands. During the June 2020 Board hearing, the Veteran explained that he was pursuing a claim for a bilateral hand disorder. He described his work as a jet mechanic during service, requiring frequent repetitive hand motions and gripping of tools for 10-12 hour shifts, often in cold weather. He also described current problems with his hands, including cramps and trouble holding chalk or the phone for long periods. The Veteran stated that he sought treatment at a VA facility for the problems with his hands as recently as 2-3 weeks prior to the hearing. Service treatment records are negative for complaints of hand pain, injury, or treatment. The lay evidence, however, is sufficient to trigger VA’s duty to assist the Veteran by providing him an examination and medical opinion. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Additionally, the Veteran’s testimony indicates that there may be outstanding relevant VA treatment records. Any VA treatment records are within VA’s constructive possession and are considered potentially relevant to the issue on appeal. A remand is required to allow VA to obtain them. 2. Entitlement to service connection for hearing loss is remanded. While the record contains an October 2016 VA examination regarding the Veteran’s hearing loss, the medical opinion is insufficient to allow the Board to make a fully-informed decision regarding right ear hearing loss. Notably, the examiner stated, “It is not clearly known if hearing loss existed prior to service” regarding the right ear. The examiner then checked a box indicating that hearing loss existed prior to service. The examiner also indicated that he could not provide an opinion on the etiology of the Veteran’s right ear hearing loss without resorting to speculation. Given these inconsistencies, the Board finds it necessary to remand this claim to obtain a medical opinion that clearly addresses the etiology of the Veteran’s hearing loss, to include the issue of whether any right ear hearing loss existed prior to service. 3. Entitlement to an initial compensable rating for left knee patellofemoral pain syndrome is remanded. While the record contains a contemporaneous VA examination regarding the service-connected left knee disability, the examination does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The examination does not contain passive range of motion measurements or pain on weight-bearing testing. An additional relevant opinion pertaining to flare-ups was also issued by the Court in Sharp v. Shulkin, 29 Vet. App. 26 (2017). Accordingly, remand for a new examination is warranted. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2016 to present. 2. Schedule the Veteran for a VA examination for the claimed tendonitis of the hands. The examiner must review the claims file and provide an opinion addressing the following questions: (a.) Does the Veteran have a diagnosed hand condition? (b.) If a diagnosis cannot be provided but the Veteran’s hand condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinion(s) below. (c.) Is any diagnosed hand condition or disability at least as likely as not related to the Veteran’s service, including his duties as a jet mechanic, which he described as involving frequent repetitive hand motions and gripping of tools for 10-12 hour shifts, often in cold weather? 3. Forward the entire claims file to an audiologist for the purpose of obtaining an addendum opinion regarding the etiology of the Veteran’s right ear hearing loss. A new examination is not required, unless it is deemed necessary by the examiner. The examiner is asked to provide an opinion addressing the following questions: (a.) Was hearing loss for VA purposes demonstrated in the RIGHT ear upon enlistment into service? The examiner is requested to provide an opinion based upon the collective December 2006 audiological findings and all other relevant evidence. (b.) If the Veteran demonstrated hearing loss for VA purposes in the RIGHT ear upon enlistment, is it at least as likely as not that the pre-existing RIGHT ear hearing loss underwent an increase in severity in service, including as due to noise exposure from the Veteran’s time spent as a jet mechanic, which exposed him to engine noise on the flight line? (c.) If any pre-existing RIGHT ear hearing loss for VA purposes increased in severity during service, is that increase clearly and unmistakably due to the natural progress of the disorder? (d.) If the Veteran did not demonstrate hearing loss for VA purposes in the RIGHT ear upon enlistment, is it at least as likely as not that the current RIGHT ear hearing loss is related to an in-service injury, event, or disease, including noise exposure from the Veteran’s time spent as a jet mechanic, which exposed him to engine noise on the flight line? (e.) A fully articulated medical rationale for each opinion expressed must be set forth in the medical report. The medical professional should discuss the particulars of this Veteran’s medical history and the relevant medical sciences that apply to this case. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability. (a.) The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. (b.) In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, AND at what degree of motion he demonstrates such objective evidence (e.g., 0 to 130 degrees with pain at 115 degrees). If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (c.) The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jamison, Elizabeth G. 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.