Citation Nr: 21007612 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 17-22 221 DATE: February 10, 2021 REMANDED 1. Entitlement to service connection for bilateral shin splints is remanded. 2. Entitlement to service connection for a bilateral ankle disability is remanded. 3. Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from December 1993 to March 2001, January 2003 to January 2005, November 2007 to June 2008, August 2009 to July 2010, and had additional service in the United States Army National Guard. These matters are before the Board of Veterans’ Appeals (Board) on appeal of a June 2016 Department of Veterans Affairs (VA) rating decision. In October 2019, a videoconference hearing was held before the undersigned; a transcript is in the record. [The Board notes a timely notice of disagreement (NOD) was received November 18, 2016 for the June 2016 rating decision. Accordingly, the timely NOD initiated the appeals for the claims of service connection for bilateral shin splints, a bilateral ankle condition, and a bilateral knee condition and do not require to be reopened.] 1. 2. 3. Entitlement to service connection for bilateral shin splints, a bilateral ankle disability, and a bilateral knee disability. The Board finds that further development of the record is needed for a proper adjudication of these claims. The Veteran alleges his shin splints, a bilateral ankle disability, and a bilateral knee disability are related to his active duty service and, specifically, to due to trauma sustained parachuting including from hard landings. His treatment records raise an alternate possible etiology for his bilateral knee disability, that it is secondary to his service-connected bilateral hip disability and altered gait from such disability. See August 2016 VA treatment record. The Veteran’s service treatment records (STRs) from his active duty periods of service show he was seen multiple times in service for bilateral knee complaints, shin splints, and ankle pain. While the record contains portions of his STRs, it is not clear from the record that any additional STRs may be outstanding. Notably, in April 2016, he submitted additional STRs that were not previously associated with the record (to include sick slips for right ankle pain (see February 2010 STR) and a left knee injury (see October 2009 STR)). Additionally, July and September 2008 VA treatment records note complaints of sports related right knee pain since March (when he would have been deployed to Iraq). The record does not contain STRs for when he was deployed to Iraq. As any STRs found may contain information pertinent (and perhaps critical) to each of the claims on appeal, and because service records are considered to be of record, an exhaustive search for such records is necessary. At the October 2019 hearing, the Veteran testified that he sought treatment for his knees and ankles at the West Los Angeles VA medical center (VAMC) in 2005 and received prescriptions for knee and ankle braces. A review of the record found that VA treatment records from West Los Angeles VAMC prior to January 12, 2007 were not obtained (and it is not shown in the record that such records do not exist) and are outstanding. Additionally, he testified that he is currently receiving treatment at the Encino VAMC. Pertinent VA treatment records are constructively of record, and must be secured. On June 2016 VA ankle examination, bilateral lateral collateral ligament sprain (chronic/recurrent) was diagnosed. In the opinion against the claim, the examiner opined (without) rationale that it is “possible the condition resolved” and does not state what condition he is referring to. It is inadequate for rating purposes. On June 2016 VA knee examination, the Veteran reported being subjected to many jump landings as a paratrooper and running an average of 10 miles per day while in service. Bilateral knee strain and shin splints were diagnosed. While the examiner stated diagnostic testing did not find degenerative or traumatic arthritis in his knees, a May 2016 VA radiology report found mild degenerative arthritis and narrowing of bilateral medial compartments and patellofemoral joints as well as minimal right-sided effusion. In the opinion against the claim for service connection for his bilateral knee disabilities, the examiner noted a February 1997 report of a knee condition sustained in a basketball game, but opined there are no records following service documenting treatment and follow up of the Veteran’s knee condition. The opinion is inconsistent with findings in the VA treatment record documenting arthritis, does not address all of the left and right knee complaints/treatment noted in the STRs, and also does not address the post-service VA treatment record notations regarding potential ongoing knee disabilities. Additionally, in the opinion against the claim of service connection for shin splints, the examiner did not address the multiple physical profiles and complaints of shin splints during his active duty service. It is inadequate for rating purposes. A June 2017 private opinion states (without rationale) that it is “medically possible” that the repeated jumps when he was a paratrooper have contributed to his bilateral knee and ankle pain. As the record does not include an adequate examination and opinions regarding the nature and etiology of the Veteran’s ankle, knee, and shin disabilities, another orthopedic examination to secure a fully adequate medical opinion regarding the nature and likely etiology of the ankle, knee, and shin disabilities is necessary. The matters are REMANDED for the following: 1. Arrange for an exhaustive search to secure for the record the Veteran’s complete STRs (and any service personnel records) that may contain information pertaining to treatment he received for the disabilities on appeal (specifically from during his active duty service from January 2003 to January 2005, November 2007 to June 2008, and August 2009 to July 2010). The search should encompass all storage facilities where such records may have been retired. If the records are unavailable because they have been irretrievably lost or destroyed, the AOJ should so certify (describing the scope of the search), and the Veteran should be so notified (and asked to provide any copies of STRs he may have in his possession). 2. Ask the Veteran to identify the provider(s) of all evaluations and treatment (records of which are not already in the claims file) he has received for ankle, knee, and shin problems, and to submit authorizations for VA to secure for the record any private records of such evaluations and/or treatment. Obtain complete records of such evaluations and/or treatment from all providers identified. If any private records identified are not received pursuant to an AOJ request, the Veteran should be so notified and advised that ultimately, it is his responsibility to ensure that private records are received. Arrange for exhaustive development to locate, and secure for the record, all outstanding (including to the present) VA records of evaluations and treatment the Veteran received for ankle, knee, and shin disabilities (specifically including from West Los Angeles VAMC prior to January 12, 2007). The search should encompass all storage facilities where such records may have been retired (and any facilities where the records may have been transported for scanning into his electronic file). If any records are unavailable because they have been irretrievably lost or were destroyed, it should be so certified for the record (with the scope of the search described in detail), and the appellant should be so notified. 3. After the development requested above is completed, arrange for the record to be forwarded to an appropriate clinician (in orthopedics) for review and a medical advisory opinion regarding the etiology of his current bilateral ankle, knee, and shin disabilities. [If further examination is deemed necessary, it should be arranged.] The entire record (to include the complaints noted in service and any evidence of postservice continuity of complaints/symptoms) must be reviewed by the consulting provider. The consulting provider should: (a.) Identify (by diagnosis) each ankle, knee, and shin disability entity found/or shown by the record (b.) Identify the likely etiology for each ankle, knee, and shin disability entity diagnosed. Specifically, is it at least as likely as not (a 50% or greater probability) that the disability is etiologically related to the Veteran’s service (to include as due to his reported parachuting activities with multiple hard landings, and multiple complaints and injuries noted therein)? (c.) If a diagnosed ankle, knee, or shin disability is found to not be directly related to service, opine further whether it is at least as likely as not (a 50% or greater probability) that the disability was caused or aggravated by (increased in severity due to) his service-connected bilateral hip disability (to include an altered gait from his bilateral hip disabilities). [The opinion must address aggravation.] (d.) If a service-connected disability did not cause, but aggravated, the ankle, knee, and/or shin disability, specify, to the extent possible, the degree of disability (symptoms/impairment) that resulted from such aggravation. (e.) If a diagnosed ankle, knee, and/or shin disability is found to be unrelated to service and to not have been caused or aggravated by a service-connected disability, identify the etiology considered to be more likely (and explain why that is so). All opinions must include complete rationale. If an opinion sought cannot be provided without resort to speculation, it must be so stated (with explanation why speculation is required). GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Naumovich, 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.