Citation Nr: 21011637 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 13-13 653 DATE: March 2, 2021 REMANDED The issue of service connection for a bilateral knee disorder is remanded. The issue of service connection for a back disorder is remanded. The issue of service connection for a right-hand disorder. The issue of service connection for anemia is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from August 1983 to June 1987. She also served in the U.S. Army Reserve and in the Army National Guard of Georgia. In November 2015, the Veteran was afforded a videoconference hearing before the undersigned Veterans Law Judge. 1. The issue of service connection for a bilateral knee disorder is remanded. 2. The issue of service connection for a back disorder is remanded. 3. The issue of service connection for a right-hand disorder. 4. The issue of service connection for anemia is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: THIS IS A REMAND TO THE RO UNDER THE LAW IN Stegall v. West, 11 Vet. App. 268 (1998). In the October 2017 remand, the Board directed the RO to attempt to obtain the Veteran’s service treatment records (STRs) by searching under both her current and former names. A February 2018 record indicates that a physical search was completed under the Veteran’s current name only and records could not be found. Records associated with the file in March 2020 also indicate that electronic searches were completed only under the Veteran’s current name. Therefore, remand is again necessary to complete all possible searches for the records under the Veteran’s former name. A new VA medical opinion must be obtained on the issue of service connection for anemia. The April 2019 VA medical examination report states that the Veteran had anemia in service and currently has anemia. The accompanying medical opinions are in conflict with the examination report and with each other. One medical opinion indicates that, because there is not objective evidence that the Veteran is being treated with medication for anemia, service connection cannot be granted. Another states that there is no evidence that current anemia was caused by service or began in service and seems to indicate that because there was no objective evidence of chronicity of care, that service connection cannot be granted. A third medical opinion states that anemia was associated with pregnancy in-service and, therefore, service connection is warranted. This opinion only addresses in-service anemia, however, not the currently-diagnosed anemia and seems to indicate that the two are different. In September 2019, the Veteran was afforded a new anemia examination. No opinion was provided because the examiner stated that the Veteran had no anemia. Given these confusing and conflicting opinions, and given that service connection could be granted for anemia detected in April 2019, remand is necessary to obtain a new VA medical opinion. A new opinion on the issue of service connection for a bilateral knee disorder must be obtained because an April 2019 VA medical opinion states that the examiner could not determine whether the current knee disorders were caused by service without resort to mere speculation. This is an inadequate opinion. See, e.g., Jones v. Shinseki, 23 Vet. App. 382, 393-94 (2010). A new VA medical opinion must be obtained on the issue of service connection for a back disorder because the April 2019 VA medical opinions indicate that the back disorder was caused by a motor vehicle accident in 2017. VA treatment records prior to 2017 indicate treatment for and complaints of a back disorder, however. Therefore, this opinion does not adequately address the evidence in the record. If any STRs are obtained and associated with the file, a new VA medical opinion on the issue of service connection for a right-hand disorder must be obtained. THE SPECIFIC REMAND DIRECTIVES FOLLOW. 2. Complete all physical and electronic searches for missing STRs, including those searches completed in February 2018 and March 2020, under the Veteran’s former name (Kathy A. Brown). 3. AFTER ASSOCIATING THE ABOVE-REQUESTED RECORDS WITH THE FILE OR DOCUMENTING THEIR UNAVAILABILITY IN THE RECORD, obtain a VA medical opinion from an examiner who has not previously provided an opinion on the issue of service connection for anemia. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of anemia. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether the Veteran’s anemia diagnosed at her April 2019 VA examination was caused by any in-service event, injury, disease, or disorder, or in any way originated during service, including as a result of pregnancy. IN ADDITION TO ANY RECORDS ADDED TO THE RECORD AS A RESULT OF THE ABOVE DIRECTED DEVELOPMENT, the examiner’s attention is drawn to the following: *An October 1986 service laboratory report stating a hemoglobin level at 12.0 grams per deciliter (g/dl). *A March 1987 service hospital discharge summary report that indicates the Veteran’s hemoglobin level was 11.4 g/dl. *A May 1987 service laboratory report stating a hemoglobin level at 12.7 g/dl. *The Veteran’s contention that she developed anemia due to inhalation of acetone during her duties in the motor pool. See April 2010 statement on claim for service connection; July 2011 Notice of Disagreement (NOD); November 2015 Board Hearing Transcript. *April 2019 VA examination report stating that the Veteran had anemia in service and currently has anemia. 4. AFTER ASSOCIATING THE ABOVE-REQUESTED RECORDS WITH THE FILE OR DOCUMENTING THEIR UNAVAILABILITY IN THE RECORD, obtain a VA medical opinion from an examiner who has not previously provided an opinion on the issue of service connection for right and left knee disorders. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of each identified right and left knee disorders. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether each identified right and/or left knee disorder was caused by any in-service event, injury, disease, or disorder, or in any way originated during service, including as a result of the physical toll taken on her body due to her in-service MOS. IN ADDITION TO ANY RECORDS ADDED TO THE RECORD AS A RESULT OF THE ABOVE DIRECTED DEVELOPMENT, the examiner’s attention is drawn to the following: *A March 1985 STR stating that the Veteran experienced recurrent idiopathic leg pain with a negative medical work-up and subsequent referral for a neurological consult. VBMS Entry 4/22/2010, p. 31. *November 2011 VA treatment record stating a history of bilateral knee pain as a result of an injury during basic training. VBMS Entry 11/1/2017, p. 53. *December 2012 VA treatment record stating that the Veteran had right knee pain for many years and that she used to work on a tank in the military. VBMS Entry 11/1/2017, p. 112. *September 2014 VA treatment record stating that the Veteran had chronic knee pain for 30 years which had increased in severity over time. VBMS Entry 11/1/2017, p. 82. *The Veteran’s contention that she experienced injuries to her knees due to her in-service duties performing tank maintenance. See April 2010 statement on claim for service connection; July 2011 NOD; April 2013 VA Form 9; November 2015 Board Hearing Transcript; April 2019 VA examination report. *April 2019 VA knees examination report stating diagnoses of bilateral knee strain, osteoarthritis, and degenerative arthritis. 5. AFTER ASSOCIATING THE ABOVE-REQUESTED RECORDS WITH THE FILE OR DOCUMENTING THEIR UNAVAILABILITY IN THE RECORD, obtain a VA medical opinion from an examiner who has not previously provided an opinion on the issue of service connection for a back disorder. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of each identified back disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether each identified back disorder was caused by any in service event, injury, disease, or disorder, or in any way originated during service, including as a result of the physical toll taken on her body due to her in-service MOS. IN ADDITION TO ANY RECORDS ADDED TO THE RECORD AS A RESULT OF THE ABOVE DIRECTED DEVELOPMENT, the examiner’s attention is drawn to the following: *July 1986 STR stating treatment for a backache. VBMS Entry 4/22/2010, p. 81. *November 2011 VA treatment record stating that the Veteran had chronic back pain related to physical training. VBMS Entry 11/1/2017, p. 53. *The Veteran’s contention that she experienced injuries to her back due to her in-service duties performing tank maintenance. See April 2010 statement on claim for service connection; July 2011 NOD; November 2015 Board Hearing Transcript; April 2019 VA examination report. *April 2019 VA examination report stating that the Veteran had a lumbosacral strain in 1986 and degenerative arthritis and degenerative disc disease diagnosed in 2017. 6. If any new STRs are added to the record as a result of the records requested in number 2 above, obtain a VA medical opinion from an examiner who has not previously provided an opinion on the issue of service connection for a right-hand disorder. If necessary to respond to the inquiries below, schedule the Veteran for a VA examination to obtain an opinion as to the nature and etiology of each identified right hand disorder. All indicated tests and studies should be accomplished and the findings reported in detail. All relevant medical records must be made available to the examiner for review of pertinent documents. The examination report should specifically state that such a review was conducted. The examiner must provide a comprehensive explanation for all opinions provided. The examiner should address whether each identified right-hand disorder was caused by any in service event, injury, disease, or disorder, or in any way originated during service, including as a result of the physical toll taken on her body due to her in-service MOS. IN ADDITION TO ANY RECORDS ADDED TO THE RECORD AS A RESULT OF THE ABOVE DIRECTED DEVELOPMENT, the examiner’s attention is drawn to the following: *The Veteran’s contention that she experienced injuries to her right hand due to her in-service duties performing tank maintenance. See April 2010 statement on claim for service connection; July 2011 NOD; November 2015 Board Hearing Transcript; April 2019 VA examination report. *February and March 2015 VA treatment records indicating right hand pain for which the Veteran underwent therapy. VBMS Entry 11/1/2017, p. 65, 69. *April 2019 VA examination report stating diagnoses of right congenital fusion of the lunate and triquetral bones of the carpus and right-hand arthralgia. (Continued on the next page)   7. Readjudicate the issues on appeal. If any benefit sought on appeal remains denied, the Veteran should be provided a supplemental statement of the case (SSOC). An appropriate period should be allowed for response before the case is returned to the Board. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. E. Miller, 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.