Citation Nr: 21007056 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 17-26 316 DATE: February 8, 2021 ORDER Entitlement to a service connection for patellar chondromalacia of the left knee, as secondary to the service-connected bilateral ankle disabilities, is granted. Entitlement to service connection for patellar chondromalacia of the right knee, as secondary to the service-connected bilateral ankle disabilities, is granted. REMANDED Entitlement to service connection for a bilateral hearing loss disability is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to an initial evaluation greater than 10 percent for left ankle lateral collateral ligament strain is remanded. Entitlement to an initial evaluation greater than 10 percent for right ankle degenerative changes is remanded. FINDINGS OF FACT 1. The Veteran’s patellar chondromalacia of the left knee is proximately due to his service-connected bilateral ankle disabilities. 2. The Veteran’s patellar chondromalacia of the right knee is proximately due to his service-connected bilateral ankle disabilities. CONCLUSIONS OF LAW 1. The criteria for service connection for patellar chondromalacia of the left knee, as secondary to the service-connected bilateral ankle disabilities, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. 2. The criteria for service connection for patellar chondromalacia of the right knee, as secondary to service-connected bilateral ankle disabilities, have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service in the U.S. Army from June 1998 to August 1998 and from January 2002 to February 2002. These matters are on appeal from April 2014 and January 2017 rating decisions. In September 2020, the Veteran testified at a Board of Veterans’ Appeals hearing before the undersigned. Service Connection 1. Entitlement to a service connection for a left knee disability, to include as secondary to the service-connected bilateral ankle disabilities. 2. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected bilateral ankle disabilities. The Veteran testified that his bilateral knee disabilities are proximately due to his service-connected bilateral ankle disabilities. The Veteran has not been afforded a VA examination in connection with his claims of entitlement to service connection for a left knee and right knee disability. In December 2018, Dr. W.B., a Board Certified orthopedic surgeon, performed an independent medical evaluation of the Veteran. Dr. W.B. specializes in the shoulder, hip, and knee. He summarized medical literature regarding the abnormal body mechanics caused by ankle injuries and the effects on the knees. Based upon a May 2017 magnetic resonance imaging (MRI), the Veteran was diagnosed with bilateral patellar chondromalacia. Dr. W.B. opined that the Veteran’s left and right knee disabilities were at least as likely as not caused by his bilateral ankle conditions. He reiterated that the medical literature supports a finding that abnormal biomechanics are caused by ankle injuries that affect the knees. The Veteran’s abnormal gait placed additional strain on the Veteran’s knee cartilages. There are no negative medical opinions of record. The December 2018 opinion is probative because it was based on a review of the Veteran’s medical records and relevant medical literature. The Board finds that service connection for patellar chondromalacia of the left and right knees is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to service connection for a bilateral hearing loss disability is remanded. 2. Entitlement to service connection for tinnitus is remanded. Although the January 2015 VA examination report includes a diagnosis for bilateral hearing loss, the results of the examination were invalid for rating purposes. The February 2017 VA examination and August 2019 private audiological examination indicate that the Veteran has normal hearing. In September 2020, the Veteran indicated that he was experiencing greater difficulty understanding conversations and hearing the television. The Veteran attributes his hearing problems to inservice noise exposure including noise while he attended motor vehicle transport operator school at Fort Leonard Wood, Missouri. A remand is required to afford the Veteran a contemporaneous VA examination to determine if he meets the criteria for a hearing loss disability under the applicable law. Lastly, there is conflicting evidence of record regarding whether the Veteran’s tinnitus is related to his in-service noise exposure. There is an August 2019 positive opinion of record. However, it is unclear whether the audiologist reviewed the record. On remand, the VA examiner should also provide a clarifying opinion regarding the etiology of the Veteran’s tinnitus. 3. Entitlement to an initial evaluation greater than 10 percent for left ankle lateral collateral ligament strain is remanded. 4. Entitlement to an initial evaluation greater than 10 percent for right ankle degenerative changes is remanded. In September 2020, the Veteran testified he experienced increased bilateral ankle instability and was prescribed soft and hard cast splint sleeves by his VA orthopedist. He also indicated that he received private orthopedic treatment and was recently treated at a private urgent care facility. These records are missing from the file. A remand is required to obtain these records. Additionally, the Veteran underwent his most recent VA ankle examination in April 2015. A remand is required to afford the Veteran a contemporaneous ankle examination. The matters are REMANDED for the following actions: 1. Ask the Veteran to complete a VA Form 21-4142 for all relevant private healthcare providers. Make two requests for the authorized records, unless it is clear after the first request that a second request would be futile. 2. Obtain all the Veteran’s recent and relevant VA treatment records. 3. Schedule the Veteran for a VA examination for his bilateral hearing loss and tinnitus. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is the Veteran’s bilateral hearing loss at least as likely as not related to service, including his conceded in-service noise exposure? Is the Veteran’s tinnitus at least as likely as not related to service, including his conceded in-service noise exposure? With regard to the tinnitus opinion, the VA examiner is asked to address the August 2019 private opinion of record. A rationale to support the opinion must be provided. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left ankle lateral collateral ligament strain and right ankle degenerative changes. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 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). 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). 5. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R.R. Watkins, 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.