Citation Nr: 21015556 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-13 009 DATE: March 17, 2021 REMANDED Service connection for a left knee disorder. Service connection for venous insufficiency of the right lower extremity. Service connection for venous insufficiency of the left lower extremity.   REASONS FOR REMAND The Veteran served on active duty from August 1988 to June 1990 and from January 1991 to March 1991. The case is on appeal from a January 2010 rating decision. In August 2015, the Veteran testified at a Board hearing. Most recently, in a September 2019 decision, the Board denied the claims. The Veteran appealed the decision to the United States Court of Appeals for Veterans Claims (Court). Pursuant to a September 2020 Joint Motion for Remand (JMR), the Court vacated the Board’s September 2019 decision by a September 2020 Order and remanded the case to the Board. 1. Service connection for a left knee disorder. In its February 2019 decision, the Board denied the claim for service connection for a left knee disorder. The Board relied on the April 2019 VA examination report which indicated the Veteran’s left knee disorder clearly and unmistakably preexisted service and was clearly and unmistakably not aggravated beyond the natural progression by service. Additionally, the April 2019 examiner opined the Veteran’s left knee disorder was not directly related to service. In the September 2020 JMR, the parties indicated the April 2019 VA examination report was inadequate, as the examiner determined that a January 1991 service treatment record (STR) was the only service record that discussed the Veteran’s left knee problems. The JMR stated this is inconsistent with the other service records, which include a February 1991 record which described bilateral knee pain and a separate February 1991 record which noted that the left knee condition that had “resolved” was actually the pre-service knee condition. The JMR further indicated the examiner failed to adequately address the Veteran’s lay statements regarding how in-service running aggravated the Veteran’s knees. Thus, pursuant to the September 2020 JMR, remand is necessary to afford the Veteran a VA examination to determine the nature and etiology of his left knee disorder, including whether the preexisting condition was aggravated by service. 2. Service connection for venous insufficiency of the right lower extremity. 3. Service connection for venous insufficiency of the left lower extremity. The Board denied the claims for service connection for bilateral lower extremity venous insufficiency in the February 2019 decision and also relied on the April 2019 VA examination report in its decision. The examiner determined the lower extremity disorders are not related to service, to include the in-service use of Accutane. She stated the side effects of Accutane use do not include the development of venous insufficiency or varicose veins. In the September 2020 JMR, the parties agreed the April 2019 VA examination report was inadequate, as the examiner did not address the lay evidence of record or medical literature regarding the side effects of Accutane. Thus, pursuant to the September 2020 JMR, the Board finds that remand is necessary to afford the Veteran a VA examination to determine the nature and etiology of his bilateral lower extremity venous insufficiency, including whether the disorders are related to the in-service use of Accutane and its side effects. In light of the remand, updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records from April 2019. 2. Thereafter, schedule the Veteran for a VA examination (or telehealth interview, records review, etc. if an in-person examination is not feasible) to obtain a medical opinion by an appropriate medical professional to determine the nature and etiology of the left knee disorder. The examiner should address the following: (a) Is it clear and unmistakable (i.e., undebatable from a medical standpoint) that the Veteran had a left knee disorder prior to service? (b) If so, is it clear and unmistakable (i.e., undebatable from a medical standpoint) that the Veteran’s preexisting left knee disorder was not aggravated by service? Aggravation is an increase in severity beyond a temporary flare-up or natural progress of the disease. (c) Regardless of the above answers, is it at least as likely as not (50 percent probability or greater) that the Veteran’s left knee disorder had its onset during, or is otherwise related to, service? The Veteran’s STRs related to the left knee should be addressed, including from January 1991 and multiple records from February 1991. The Veteran’s lay statements should also be discussed by the examiner, including the August 2015 Board hearing testimony 3. Schedule the Veteran for a VA examination (or telehealth interview, records review, etc. if an in-person examination is not feasible) to obtain a medical opinion by an appropriate medical professional to determine the nature and etiology of the venous insufficiency of the bilateral lower extremities. The examiner should opine whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s bilateral lower extremity disorders had their onset during, or are otherwise related to, service, including his in-service use of Accutane. The examiner must address the lay evidence of record, including the August 2015 Board hearing testimony. The examiner should also discuss the relevant medical literature of record, to include that which addresses the side affects of Accutane, such as causing red patches or bruises on the legs. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Isaacs, 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.