Citation Nr: 21011670 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 16-28 996 DATE: March 2, 2021 REMANDED The appeal for service connection for a hypothyroid disorder is remanded. The appeal for service connection for a right hip disorder is remanded. The appeal for service connection for a left knee disorder is remanded. The appeal for service connection for a right knee disorder is remanded. The appeal for service connection for bilateral leg cramps is remanded. REASONS FOR REMAND The Veteran had active service from July 1971 to January 1972. A Travel Board hearing was held in April 2018 before the undersigned Veterans Law Judge and the hearing transcript is of record. The Board remanded the claims for further development in November 2018. 1. Entitlement to service connection for a hypothyroid disorder. In November 2018, the Board remanded the claim, in part, so that the agency of original jurisdiction (AOJ) could request the Veteran’s clinical records for hospitalization due to thyroid problems during service, from November 1971 to December 1971. It does not appear that the AOJ attempted to obtain the requested records. Therefore, a remand is required. See Stegall v. West, 11 Vet. App. 268 (1998). The November 2019 VA examiner determined that there was clear and unmistakable evidence of a preexisting hypothyroid disorder, and it was also clear and unmistakable that that such was not aggravated beyond its natural progression during service. If, on remand, the hospital records are obtained, a VA addendum opinion should also be obtained from the November 2019 examiner to address whether such records would change the prior opinion. 2. Entitlement to service connection for a right hip disorder is remanded. 3. Entitlement to service connection for a left knee disorder is remanded. 4. Entitlement to service connection for a right knee disorder is remanded. 5. Entitlement to service connection for bilateral leg cramps. Although a November 2019 VA examiner opined against a relationship between the Veteran’s hip, leg and knee conditions and service, the opinion was largely based on an absence of documented treatment or complaint during service. The examiner did not adequately reconcile the opinion with the Veteran’s reported history of having symptoms of the bilateral lower extremity muscle cramps, knee disorders, and hip disorder since service. See Transcript page 8. Additionally, with respect to the muscle cramp disorder, the examiner reasoned that direct service connection was not warranted because the Veteran’s medical board proceeding in service did not directly address muscle cramps. However, as discussed in the November 2018 remand, the Veteran’s separation report of medical history contained the Veteran’s report of muscle cramps. For these reasons, a remand is required to obtain new opinions addressing the etiology of the Veteran’s disabilities. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records dated since October 2019. 2. With any assistance needed from the Veteran, obtain any outstanding service clinical records regarding the Veteran’s hospitalization from November 1971 to December 1971. The Board notes that the last page of the hospital summary is already of record. If these records are unable to be found, or are otherwise unavailable, this should be made clear in the record. 3. If, and only if, hospital records dated from November 1971 to December 1971 are found, associate them with the record and seek a VA addendum opinion from the clinician who performed the November 2019 thyroid disease examination, if available. The clinician is asked to review the newly obtained in-service hospital records and re-address the questions posed in the prior Remand—namely: (a.) Is it clear and unmistakable (i.e., undebatable) that the Veteran’s thyroid disorder preexisted the Veteran’s entry into service beginning in July 1971? (b.) If the answer to (a.) is “YES,” is it also clear and unmistakable that the disorder was NOT aggravated by service? Consider that the Veteran was hospitalized for approximately one month during service, beginning in November 1971, for his hypothyroid disorder. Consider also the Veteran’s lay testimony that his thyroid medication was taken from him when he started basic training and that he did not feel that he was allowed to seek treatment from sick call when he began to experience the effects of not having his thyroid medication. (c.) If the answer to either (a.) or (b.) is “NO,” then assume as true that the Veteran entered service without a hyperthyroid disability. With that assumption in mind, is it at least as likely as not (50 percent or greater probability) that the hypothyroid disorder and onset in, or is otherwise related to his active duty service, to specifically include his assertion that he was forced to stop taking medication from July 1971 to November 1971? (d.) Complete rationale must be offered for any opinion rendered. If the reviewing clinician determines that the questions above cannot be answered without an in-person or virtual examination or interview, such should be scheduled. If the November 2019 examiner is unavailable to provide the addendum opinion, such should be requested of another qualified clinician. 4. Obtain addendum opinions from a clinician other than the November 2019 examiner, to address the nature and etiology of any leg cramp, knee, or right hip disorder, to include arthritis in the right knee and right hip. The reviewing clinician is asked to address the following, after review of the record: (a.) Identify all disorders of the left and right knees, right hip, and leg muscles, including leg cramps. (b.) For each disorder identified, is it at least as likely as not (50 percent or greater probability) that such had onset in, or is otherwise related to an in-service injury, event, or disease. The examiner must consider the Veteran’s statements that his current disorders began during basic training in service. The examiner is reminded that the Veteran is competent to report his observations of pain and cramping in service even if he was not treated for the same. Additionally, the examiner should consider the Veteran’s sworn testimony that his training instructor threatened to report him as AWOL if he left training to seek treatment (Transcript page 16) and thus, the Veteran did not feel that he could seek such treatment during basic training. If there is a medical reason to call into question the Veteran’s reported history of experiencing symptoms associated with his current disabilities during and since service, this should be made clear. (c.) For any disorder found to be not directly related to service, the examiner is asked to opine as to whether it is at least as likely as not caused or aggravated beyond its natural progression by the Veteran’s hypothyroid disorder. (d.) Complete rationale must be offered for any opinion rendered. If in the opinion of the reviewing clinician answers the questions above cannot be answered without an in-person or virtual examination or interview, such should be scheduled. (Continued on Next Page) 5. Then readjudicate the issues on appeal. V. Chiappetta Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Donna D. Ebaugh, 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.