Citation Nr: 21013255 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 17-32 039 DATE: March 9, 2021 REMANDED Entitlement to service connection for a left knee condition is remanded. Entitlement to service connection for a right knee condition is remanded. Entitlement to service connection for a back condition is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1982 to May 1986. These matters come before the Board of Veterans' Appeals (Board) from a November 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In February 2020, the Veteran testified at a video conference before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for a left knee condition is remanded. 2. Entitlement to service connection for a right knee condition is remanded. 3. Entitlement to service connection for a back condition is remanded. The Veteran contends her back and knee conditions are due to military duties as a systems installer operator, to include ruck marches and running with boots, and injuries sustained from falling from a telephone pole during training at Fort Gordon, GA. The Veteran has diagnoses of lumbar spondylosis; lumbosacral neuritis; bilateral sacroiliac pain; lumbar disc degeneration; lumbago; herniated intervertebral disc; spinal stenosis, lumbar, without neurogenic claudication; and bilateral knee pain. The October 2015 VA examiner opined that it is less likely than not, that the Veteran’s bilateral knee and back conditions are related to an in-service injury, event, or disease, including lumbar spine and knee injuries in service. The rationale was that although there is a record of treatment in service for the claimed condition, no permanent residual or chronic disability is shown by the service treatment records or demonstrated by evidence following service. Private medical records from the last 5-6 years report multiple medical conditions which include joint pains – back and knee. The Veteran's current joint pains appear to be related to a systemic disorder. The medical opinion is inadequate to evaluate the claims because it is couched in speculative terms. See Polovick v. Shinseki, 23 Vet. App. 48, 54 (2009) (holding that a doctor's statement that a veteran's brain tumor "may well be" connected to Agent Orange exposure was speculative); Bloom v. West, 12 Vet. App. 185, 187 (1999) (noting that the use of the term "could," without other rationale or supporting data, is speculative); Obert v. Brown, 5 Vet. App. 30, 33 (1993) (noting that a medical opinion expressed in terms of "may" also implies "may or may not" and is too speculative to establish a causal relationship). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008) (citing Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion ... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions.")). Thus, new VA examinations must be provided to determine the nature and etiology of any bilateral knee and back conditions. Additionally, the Veteran testified that she was treated at military treatment facilities after service in Fort Hood, Texas, Ilesheim, Germany, and Salt Lake City. She also identified outstanding private treatment records from Dr. M. On remand, the RO should attempt to obtain these records. The matters are REMANDED for the following action: 1. Contact the Veteran to identify the names, addresses, and approximate dates of treatment for all VA and non-VA health care providers who treated her from discharge until the present for her knee and back disabilities, including military treatment facilities after service in Fort Hood, Texas, Ilesheim, Germany, Salt Lake City, and Dr. M. With any necessary authorization from the Veteran, the RO should attempt to obtain copies of pertinent treatment records identified by the Veteran which have not previously been secured. If any requested records cannot be obtained, inform the Veteran the results of the requests for records and a negative response must be associated with the claims file. 2. Once the development above is completed, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral knee and back conditions, including lumbar spondylosis; lumbosacral neuritis; bilateral sacroiliac pain; lumbar disc degeneration; lumbago; herniated intervertebral disc; spinal stenosis, lumbar, without neurogenic claudication; and bilateral knee pain. The claims file, to include this Board remand, must be made available to and reviewed by the examiner. A note that such review was completed should be provided in the examiner’s report. Any indicated test and studies should be performed. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, to include ruck marches and running with boots, and injuries sustained from falling from a telephone pole during training at Fort Gordon, GA. The examiner should indicate whether such knee and back disabilities are consistent with the type of knee and back injuries that the Veteran has described as having occurred in service (i.e., whether the claimed in-service knee and back trauma left chronic residuals). In providing these opinions, the examiner should consider any lay evidence of symptoms experienced over the years. All opinions should be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Edwin B. Esmenda, 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.