Citation Nr: 21016043 Decision Date: 03/19/21 Archive Date: 03/19/21 DOCKET NO. 15-18 724 DATE: March 19, 2021 REMANDED Entitlement to service connection for a left knee disorder, to include as secondary to service-connected chronic groin strain, is remanded. Entitlement to service connection for a right knee disorder, to include as secondary to service-connected chronic groin strain, is remanded. Entitlement to service connection for a left hip disorder, to include as secondary to service-connected groin strain, is remanded. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected groin strain, is remanded. Entitlement to service connection for a lumbar spine disorder, to include as secondary to chronic groin strain, is remanded. REASONS FOR REMAND The Veteran, who is the appellant, had active service from September 1992 to September 1997. She also had service in the United States Army Reserves. The Veteran appeared at an August 2018 hearing before the undersigned Veteran Law Judge. A transcript of the hearing is of record. This matter was previously before the Board in March 2020 at which time it was remanded for further development. As will be discussed in detail below, the matter must once again be remanded for further development. As it relates to the claim of service connection for left and right knee disorders, the Board notes at the time of the prior remand, it was observed that the Veteran had been issued profiles in 2002, 2006, and 2007 for knee problems, which were described as chronic, during her Reserve service. The Board requested that the Veteran be scheduled for a VA examination to determine the nature and etiology of any current right or left knee disorder, to include arthritis. The examiner was requested to offer the following opinion: Was it at least as likely as not (50 percent probability or greater) that any right or left knee disorder to include arthritis, if found, had its onset in service or was otherwise related to the Veteran's service, to include due to disease or injury during a period of ACDUTRA or due to injury during a period of INACDUTRA? In an October 2020 VA opinion, as it related to the right knee, the examiner opined that the claimed condition was less likely than not incurred in or caused by the claimed inservice injury event or illness. The examiner indicated that during service, right knee condition, was acute only in 1992. She stated there was no evidence of chronicity of care on active duty despite ample visits to report chronic knee pain. She noted that the exit examination was silent for chronic left or right knee condition and that X-rays were normal in 2010 and showed a tear and chondromalacia in 2016. She stated that the Veteran was obese and that 2016 was well after 1997 release from active duty. A nexus had not been established. Unfortunately, the examiner did not address the profiles issued with regard to the Veteran’s knee problems in 2002, 2006, and 2007. The Board further observes that in her September 1997 service separation report of medical history, the Veteran reported that her knees would swell in the narrative portion of the report. The Veteran has also testified as to having had continuous knee problems since service. Given the foregoing, the matter should be returned to the October 2020 VA examiner to address the above notations and discuss what impact, if any, these findings have upon the prior opinion concerning the right knee. Similarly, with the left knee, the examiner found that that the claimed condition was less likely than not incurred in or caused by the claimed inservice injury event or illness. She noted that during service, the left knee condition was acute only in 1992. There was no evidence of chronicity of care on active duty despite ample visits to report chronic knee pain. She noted the exit examination was silent for chronic left or right knee condition. She further observed that 1999 notes showed left knee tendinitis. She indicated that this was the beginning of chronic left knee issues and was after active duty. A nexus to active duty had not been established. The Board observes that in her September 1997 service separation report of medical history, the Veteran reported that her knees would swell in the narrative portion of the report. The Veteran has also testified as to having had continuous knee problems since service. The examiner also did not address the profiles issued with regard to the Veteran’s knee problems in 2002, 2006, and 2007. Given the foregoing, the matter should be returned to the October 2020 VA examiner to address the above the above findings and discuss what impact, if any, these findings have upon the prior opinion. As it relates to the right hip, the examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner noted that during active duty, the right hip condition was acute only. She stated that based upon review of the chart she was unable to find any chronicity of care for a right groin condition since active duty in the available treatment records. She stated that there was a groin strain on the problem list, however; this was likely added after initial VA examination in 1997 and carried through on notes. She indicated that the only references to right groin symptoms were on VA exams. She observed that right hip tendinitis was noted on exit examination and in 2003, but again, no chronicity of care for a right hip condition/symptoms was documented in the treatment notes, only the VA examination. The examiner stated that she realized the Veteran had been service-connected for groin strain for years; however, there was no evidence of chronicity in treatment notes. She was unable to establish right hip condition related to active duty. A review of the Veteran’s service treatment records reveals that she was found to have decreased right hip flexion at the time of her September 1997 service separation examination. In the summary of defects portion of the examination, “chronic right hip pain 1993” was reported. Moreover, on the Veteran’s September 1997 service separation report of medical history, she was noted to have joint problems with her hips in the “note” section of the report. The Veteran has also testified as to having had right hip problems since service. Given the foregoing, the matter should be returned to the October 2020 VA examiner to address the above the above documentation and discuss what impact, if any, these findings have upon the prior opinion. As it relates to the left hip, the examiner opined that the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness. As rationale, the examiner noted that no chronic diagnosis was made for left hip on active duty. She stated that there was no evidence of chronicity of care on active duty despite ample visits to report chronic hip pain. She also noted that records through 2010 were silent for chronicity of care for a left hip condition. She stated that a nexus had not been established. The Board observes that on the Veteran’s September 1997 service separation report of medical history, she was noted to have joint problems with her hips in the note section of the report. The Veteran has also testified as to having had left hip problems since service. Given the foregoing, the matter should be returned to the October 2020 VA examiner to address the above the above points and discuss what impact, if any, these findings have upon the prior opinion. As it relates to the above issues, in accordance with Dalton v. Nicholson, 21 Vet. App. 23 (2007), the examiner must acknowledge and discuss the Veteran's assertions that she experienced hip and knee disorders in service which had continued to the present. As it relates to the low back disorder, the Board notes that the Veteran has indicated that in addition to injuring her low back in service, her low back disorder is also caused or aggravated by her lower extremity problems. Given that the Board is remanding the issues of service connection for hip and knee disorders, actions taken with regard to the disabilities may have an impact on the Veteran’s claim for a low back disorder. As such, this matter is also remanded. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. If available return the file to the examiner who prepared the October 2020 VA opinions. Following a review of the file, the examiner is requested to render the following opinions: As it relates to the left and right knees, is it at least as likely as not that the Veteran’s right and left knee disorders had their onset in service or are otherwise related to the Veteran’s period of service. When rendering these opinions, the examiner must address and discuss the September 1997 service separation report of medical history, wherein the Veteran reported that her knees would swell in the narrative portion of the report. The examiner must also address and discuss the Veteran’s testimony as to having had continuous knee problems since service as well as the profiles issued with regard to the Veteran’s knee problems in 2002, 2006, and 2007. As it relates to the right and left hips, the examiner is requested to rendering the following opinions: Is it at least as likely as not that the Veteran’s right and/or left hip disorder had their onset in service or are otherwise related to the Veteran’s period of service? As to the right hip, the examiner is to address and discuss the September 1997 service separation examination which revealed decreased right hip flexion and the summary of defects portion of the examination report, wherein “chronic right hip pain 1993” was reported. The examiner should also address the Veteran’s September 1997 service separation report of medical history, wherein it was noted that she had joint problems with her hips and the testimony of the Veteran as to having had right hip problems since service. As to the left hip, the examiner is to address the service separation report of medical history, wherein the Veteran was noted to have joint problems with her hips in the note section of the report and the testimony of the Veteran as to having had left hip problems since service. If following the above review, the examiner relates any hip or knee disorder to service, she is then requested to render an opinion as to whether it is at least as likely as not that the non-related hip, knee, or low back disabilities are caused or aggravated by the disability which is related to service. Complete detailed rationale is required for any opinion that is rendered. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. S. Kelly, 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.