Citation Nr: 21010051 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 14-37 641 DATE: February 23, 2021 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 an acquired psychiatric disorder, to include anxiety, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1984 to April 1996. The matter was most recently before the Board in April 2018, when the Board remanded for further development. The Veteran claims entitlement to service connection for bilateral knee disabilities and an acquired psychiatric disorder due to his military service. With respect to his bilateral knees, the Veteran has reported pain in both knees has been going on since 1990. See May 2012 VA treatment records. A review of the Veteran’s service treatment records indicates that in 1991 he reported bilateral knee pain for one year, and that in 1993 he reported pain in his left knee for a week and that he had fallen during a run. The Veteran reported that he performed more than 125 airborne jumps in the military in 9 years and contends that repeated jumps caused injury to his knees. See June 2017 VA treatment records; see also August 2018 VA treatment records. The Veteran has reported that he had knee pain both during service and since his discharge that has worsened. See August 2018 VA treatment records. The record reflects complaints of pain in both knees. See May 2012, June 2012, July 2013, and August 2017 VA treatment records. With respect to his acquired psychiatric disorder, the Veteran contends that his anxiety-depressive disorder began in 1991. See May 2012 VA Form 21-526. The record indicates a history of diagnoses of depression, anxiety, bipolar, PTSD, and ‘serious mental illness.’ See July 2013, November 2014, December 2016, and April 2019 VA treatment records. Unfortunately, a remand is again required in this case for the issues on appeal for the reasons discussed below. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the claim so that the Veteran is afforded every possible consideration. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. An April 2019 VA examiner reviewed the Veteran’s file and opined against a relationship between the Veteran’s current left and right knee disabilities and his period of service. By way of rationale, the examiner noted that the Veteran did not identify a specific injury, event or illness in the military regarding the knee; however, the examiner failed to consider the nature of the Veteran’s service activity, including over 100 parachute jumps, as estimated by the Veteran, some of which were weighted. To date, no opinion provider has adequately addressed whether the Veteran’s current knee disabilities may be related to repeated impacts from parachuting in service. On remand another opinion should be obtained. Entitlement to service connection for an acquired psychiatric disorder, to include anxiety, is remanded. As discussed above, the Veteran has been diagnosed, at various times post-service, with anxiety disorder, depression, bipolar, post-traumatic stress disorder, and alcohol use disorder. The Veteran was afforded a VA mental disorders examination in April 2019. The VA examiner noted only a diagnosis of alcohol use disorder in sustained remission. Additionally, the VA examiner answered that the Veteran did not have more than one mental disorder diagnosed, and opined that the current disorder was unrelated to service. The examiner did not adequately reconcile this sole diagnosis with the other evidence of record that documents treatment for several other mental health disabilities. On remand, another opinion should be obtained addressing the nature and etiology of the Veteran’s acquired psychiatric disability. The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s claims file any outstanding VA treatment records. 2. Offer the Veteran an opportunity to identify and submit, or authorize VA to obtain, any additional private treatment records not currently of record that he believes are relevant to his appeal. With proper authorization, request records from any identified source. 3. Obtain a medical opinion addressing the etiology of the Veteran’s right and left knee disabilities. A copy of the claims file must be provided to, and reviewed by the opinion provider. After a thorough review of the record, the reviewing clinician should opine as to the following: It is at least as likely as not (i.e. a probability of 50 percent or more) that the Veteran’s right or left knee disability had its onset during active service, or is otherwise related to active military service, to specifically include as a result of repeated impacts from parachuting? The clinician should consider the in-service treatment records showing care for bilateral knee pain. The reviewing clinician should provide a complete rationale for all opinions provided. The clinician should specifically discuss whether the nature of the Veteran’s current right and left knee disabilities, from a medical perspective, is consistent with the Veteran’s activities in service, and his lay reports of ongoing symptoms after service. If not, please explain why this is the case. If in the opinion of the reviewing clinician answers to the question above cannot be provided without an in-person or virtual examination or interview, such should be scheduled. 4. Obtain a medical opinion addressing the nature and etiology of the Veteran’s acquired psychiatric disability. A copy of the claims file must be provided to, and reviewed the opinion provider. After a thorough review of the record, the reviewing clinician should provide responses to the following: a) The clinician should identify all acquired psychiatric disorders that have been present since the May 2012 claim. If any of the Veteran’s disabilities were present during the appeal period, but have since resolved, this should be made clear. If current disabilities conflict with those identified in the Veteran’s treatment records, please provide information reconciling the findings. If PTSD in particular is diagnosed, please indicate the stressor upon which the diagnosis is based. b) For each currently diagnosed acquire psychiatric disorder, the reviewing clinician should offer an opinion as to whether it is at least as likely as not (i.e. 50 percent or greater probability) such had its onset in, or is otherwise related to the Veteran’s period of military service. The reviewing clinician should consider the Veteran’s reports of having symptoms since service. If in the opinion of the reviewing clinician responses to the questions above cannot be answered without an in-person or virtual examination or interview, such should be scheduled. 5. Then, readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Fulmer, 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.