Citation Nr: 21009922 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 20-19 700 DATE: February 23, 2021 REMANDED Entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral ankle disabilities is remanded. Entitlement to service connection for a left knee disability, to include as secondary to service-connected bilateral ankle disabilities is remanded. Entitlement to service connection for a right knee disability, to include as secondary to service-connected bilateral ankle disabilities is remanded. Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral ankle disabilities is remanded. Entitlement to service connection for irritable bowel syndrome (IBS), to include as secondary to service-connected gastroesophageal reflux disease (GERD) is remanded. Entitlement to service connection for sleep apnea, to include as secondary to service-connected GERD is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1960 to May 1968. In January 2021, he testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is in the record. 1. Entitlement to service connection for a low back disability is remanded. 2. Entitlement to service connection for a left knee disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. 4. Entitlement to service connection for sleep apnea is remanded. The Veteran maintains that he developed low back and bilateral knee disabilities during active duty service. He alternatively argues that the respective disabilities were caused or aggravated by his service-connected ankle disabilities. Service treatment records show that the Veteran did report experiencing a history of back pain during service. The Veteran also maintains that his sleep apnea is secondary to his service-connected GERD. In support of his claim, he submitted an Internet article which suggests there may be a causal relationship between the two medical conditions. Considering the Veteran’s credible testimony and the medical evidence of record, he should be afforded a VA examination with opinion on these issues. 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). 5. Entitlement to service connection for a left hip disability is remanded. 6. Entitlement to service connection for IBS is remanded. The Veteran was afforded a VA examination in February 2017 to evaluate the etiology of his diagnosed IBS. In January 2018, he also underwent an examination for his left hip disability, diagnosed as left hip osteoarthritis. Both examiners provided inadequate conclusory medical opinions regarding the respective disabilities. Remand is needed to obtain supplemental opinions. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of his claimed sleep apnea, low back and bilateral knee disabilities. The claims folder must be made available to the examiner. The examiner should then answer the following questions: (a.) Please identify all diagnoses related to the Veteran’s claimed sleep apnea, low back and bilateral knee disabilities. (b.) Is it as likely as not (50 percent or greater probability) that any diagnosed condition identified above either had its onset in or is otherwise related to the Veteran’s active duty service? (c.) Is it at least as likely as not (50 percent or greater probability) that any diagnosed condition is caused or aggravated (defined as any increase in disability) by his service-connected GERD or bilateral ankle disabilities? A complete rationale should be provided for any opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, evidence would permit such an opinion to be made. 2. Obtain an opinion from an appropriate VA clinician regarding the etiology of the Veteran’s diagnosed left hip osteoarthritis and IBS. Copies of all pertinent records must be made available to the examiner for review. If the examiner determines that an opinion cannot be provided without an examination, (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) one should be scheduled. Following review of the claims file, the clinician should answer the following question: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed left hip osteoarthritis and IBS had its onset in or is otherwise related to active duty service? (b.) Is it at least as likely as not (50 percent or greater probability) that the Veteran’s diagnosed left hip osteoarthritis and IBS is caused or aggravated (defined as any increase in disability) by his service-connected GERD or bilateral ankle disabilities? A complete rationale should be provided for any opinion. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and note what, if any, evidence would permit such an opinion to be made. M. E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jack S. Komperda, 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.