Citation Nr: 21014578 Decision Date: 03/15/21 Archive Date: 03/15/21 DOCKET NO. 16-03 238 DATE: March 15, 2021 REMANDED Entitlement to service connection for a right elbow disability, to include under the provisions of 38 C.F.R. § 3.317, is remanded. Entitlement to service connection for a left elbow disability, to include under the provisions of 38 C.F.R. § 3.317, is remanded. Entitlement to service connection for a thoracic and/or lumbar spine disability, to include under the provisions of 38 C.F.R. § 3.317, is remanded. Entitlement to service connection for a right knee disability other than Osgood-Schlatter’s disease, to include under the provisions of 38 C.F.R. § 3.317, is remanded. Entitlement to service connection for a left knee disability other than Osgood-Schlatter’s disease, to include under the provisions of 38 C.F.R. § 3.317, is remanded. Entitlement to compensation under the provisions of 38 C.F.R. § 3.317 for an undiagnosed illness or medically unexplained chronic multisymptom illness manifested by symptoms that include leg swelling and right hand/finger pain is remanded. REASONS FOR REMAND The Veteran had active service from March 1988 to November 1991. The Board remanded these issues in July 2019. The July 2019 Board remand also included the issue of entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD) and sleep impairment. An August 2020 rating decision granted the Veteran entitlement to service connection for PTSD with sleep disturbances. As this represents a total grant of the benefit sought on appeal with respect to that issue, it is not before the Board at this time. See Grantham v. Brown, 114 F.3d 1156, 1159 (Fed. Cir. 1997). The August 2020 rating decision also granted entitlement to service connection for Osgood-Schlatter’s disease of the bilateral knees. Therefore, the issues on appeal pertaining to the bilateral knees are limited to disabilities other than Osgood-Schlatter’s disease. 1. Entitlement to service connection for a right elbow disability is remanded. 2. Entitlement to service connection for a left elbow disability is remanded. 3. Entitlement to service connection for a thoracic and/or lumbar spine disability is remanded. 4. Entitlement to service connection for a right knee disability other than Osgood-Schlatter’s disease is remanded. 5. Entitlement to service connection for a left knee disability other than Osgood-Schlatter’s disease is remanded. 6. Entitlement to compensation under the provisions of 38 C.F.R. § 3.317 for an undiagnosed illness or medically unexplained chronic multisymptom illness is remanded. A remand is required to obtain a further medical opinion. The Veteran reports experiencing bilateral elbow, thoracic spine, lumbar spine, bilateral knee, hand/finger, and lower extremity symptoms. Regarding the bilateral elbows, the Veteran has been diagnosed with strain. Regarding the bilateral knees, the Veteran has been diagnosed with strain, osteoarthritis, and chondromalacia. He has also been diagnosed with a tear of the left meniscus. Regarding the spine, the Veteran has been diagnosed with lumbar spine strain and degenerative disc disease of the thoracic spine. Regarding the feet, he has been diagnosed with metatarsalgia and hallux valgus of the right foot. He has also reported swelling in the lower extremities and right hand/finger pain, which have not yet been associated with a diagnosed disability. The pathophysiology and etiology of those conditions is unclear. Accordingly, on remand, a medical opinion must be obtained to discuss these matters. The matters are REMANDED for the following action: Obtain an opinion as to the nature and etiology of his diagnosed disabilities of the bilateral elbows, thoracic spine, lumbar spine, bilateral knees (other than Osgood-Schlatter’s disease), and right foot, and for symptoms of lower extremity swelling and right hand/finger pain, which have not yet been associated with a diagnosed disability. Regarding the bilateral elbows, the Veteran has been diagnosed with strain. Regarding the bilateral knees, the Veteran has been diagnosed with strain, osteoarthritis, and chondromalacia. He has also been diagnosed with a tear of the left meniscus. Regarding the spine, the Veteran has been diagnosed with lumbar spine strain and degenerative disc disease of the thoracic spine. Regarding the feet, he has been diagnosed with metatarsalgia and hallux valgus of the right foot. The examiner must review the entire claims file, including a copy of this remand. The examiner is asked to provide responses to the following for each diagnosed disability of the elbows, thoracic spine, lumbar spine, knees, and feet and for the lower extremity swelling and right hand/finger pain that have not yet been associated with a diagnosed disability: A) Is the etiology of the Veteran’s disability or symptom (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the etiology of the disease or disability population as a whole. B) Is the pathophysiology of the Veteran’s disability or symptom (1) inconclusive, (2) partially understood, or (3) fully understood? This determination must be based on the Veteran’s specific case and cannot be based on the pathophysiology of the disease or disability population as a whole. C) If both the etiology and pathophysiology are partially understood or fully understood, then is it at least as likely as not (50 percent probability or greater) that the Veteran’s disability or symptom was incurred in, or is otherwise related to, his active service? This determination must be based on the Veteran’s service treatment records and the injuries he has reported occurred in service but were not documented in the service treatment records. The relevant service treatment records and injuries reported by the Veteran include, but are not limited to, the following: For the diagnosed bilateral elbow strain, the Veteran reported to a December 2019 VA examiner that he bumped his left elbow when he was getting out of a tank. For the diagnosed thoracic spine and lumbar spine disabilities, the Veteran has contended that those disabilities are due to his in-service duties as an armor crewman, which included being confined to a small area while driving tanks. For the diagnosed bilateral knee disabilities other than Osgood-Schlatter’s disease, the service treatment records show that the Veteran reported knee pain in April 1988, was diagnosed with left chondromalacia in January 1989, and reported right knee pain in August 1989. On his VA Form 9, the Veteran also reported that he injured his knees when he jumped from a tank. For the diagnosed right foot disabilities, the Veteran reported to the December 2019 examiner that his foot was injured in service when a tank round fell on it. For the right hand/finger pain that has not yet been associated with a diagnosed disability, the service treatment records show that the Veteran suffered blunt trauma to that hand in August 1988. For purposes of providing this opinion, the examiner should assume to be true the Veteran’s reported in-service injuries, to include bumping his left elbow on a tank and injuring his knees jumping from a tank, even if such injuries are not documented in the service treatment records. The examiner should also discuss a May 2013 VA examiner’s assessment that the Veteran’s joint pains are due to the wear and tear of daily living. A complete rationale must be provided for all opinions expressed. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. J. Anthony, 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.