Citation Nr: 21021031 Decision Date: 04/09/21 Archive Date: 04/09/21 DOCKET NO. 14-34 159 DATE: April 9, 2021 REMANDED The claim for service connection for left ankle condition is remanded. The claim for service connection for right ankle condition is remanded. The claim for service connection for bilateral knees is remanded. REASONS FOR REMAND This appeal returns to the Board from its January 2019 remand for a medical opinion as to the etiology of the Veteran’s bilateral knee and ankle conditions, which was obtained in August 2019 and turned out negative. However, the rationale offered in support of the rendered opinion appears to be contrary to the evidence of record and based only on partial information. Specifically, the VA examiner notes the Veteran’s record of treatment for a left knee MCL strain during service and opined that there was no permanent residual or chronic disability condition subject to service connection shown by the “SMRs” or any records post military, because a physical examination on the day of the opinion was normal. Regarding the right knee, the examiner opines that the medical evidence of record and physical examination fail to show/support that the claimed disability has been clinically diagnosed because there is no objective evidence that the Veteran has a right knee condition on physical examination. Of note, service connection may be granted for a resolved disability or otherwise unobserved on examination, so long as the evidence of record shows the existence of the claimed disability at some point during the pendency of the claim. Here, the Veteran filed his claim in August 2012 prior to his discharge in September 2012. An April 2013 VA comprehensive medical examination report reflects a diagnosis of chronic intermittent pain in both knees on and off since in-service left knee injury in 2002. The Veteran’s post-service treatment records (received from McLaren Macomb – Metro Family in July 2014) further reflect that the Veteran was observed with bilateral knee pain in May 2014. Further, a left knee MRI report (received from Oakland Regional Hospital in July 2014) reflect history of pain in the knee for many years, which was slowly worsening. The report also reflects an opinion that the MRI shows multiple small cysts associated with posterior aspect of the anterior cruciate ligament presumably synovial cysts and raising the possibility of prior injury with sprain or partial tear of the anterior cruciate ligament, some fraying along the superior articular surfaces of the anterior horn of the lateral meniscal cartilage, and mild joint effusion which is a bit more than expected physiologically. As such, contrary to the VA August 2019 examination report, the evidence of record unequivocally shows ongoing post-service bilateral knee problems and at least suggests that underlying pathology as shown by MRI may relate to an injury or injuries sustained in service. However, an assessment whether these documented post-service knee problems are etiologically related to service requires a medical opinion, while the current medical evidence of record is insufficient to decide the claim. Likewise, the examiner opines that there is no objective evidence in the Veteran’s STR or post-military records to support the claim of bilateral ankle tendonitis. However, the April 2013 VA examination assessed the Veteran with chronic intermittent pain in both ankles with mild right ankle sprain with flare-ups during prolonged walking and running, due to recurrent rolling and sprains since 1997, when he complained of stiffness and was diagnosed with ankle sprain. Further, a private DBQ (received from Dr. J.B.R., MD, in July 2014) reflects that the Veteran is diagnosed with bilateral tendonitis, achilles tendon. The Board notes that the Veteran is not expected to diagnose medical conditions or even identify them beyond reporting the general anatomical localization and associated symptoms. This is why the Board must understand whether, from a medical perspective, the Veteran’s documented bilateral achilles tendon tendonitis is acute or chronic in nature and, if so, whether this particular condition and/or his chronic intermittent ankle pain are etiologically related to his service, to include ankle and knee sprains sustained in service, as well as “wear and tear” over the twenty-year career in the military. To that end, the examination report must expressly address the Veteran’s lay statements of having ongoing ankle and knee pain on and off for a decade and then answer the Board’s specific questions which remain unanswered. Accordingly, the matters are REMANDED for the following action: Schedule the Veteran for a VA examination to address his claims of bilateral knee and ankle disabilities. The examiner is asked to answer the following questions: a) Is it at least as likely as not (50 percent or greater) that a right knee disability, however diagnosed, was incurred in, caused by, or otherwise is etiologically related to the Veteran’s 20-year military career in the Marine Corps? Why or why not? b) Is it at least as likely as not (50 percent or greater) that a left knee disability, however diagnosed, was incurred in, caused by, or otherwise is etiologically related to the Veteran’s 20-year military career in the Marine Corps? Why or why not? c) Is it at least as likely as not (50 percent or greater) that a right ankle disability, to include tendonitis of achilles tendon, was incurred in, caused by, or otherwise is etiologically related to the Veteran’s 20-year military career in the Marine Corps? Why or why not? d) Is it at least as likely as not (50 percent or greater) that a left ankle disability, to include tendonitis of achilles tendon, was incurred in, caused by, or otherwise is etiologically related to the Veteran’s 20-year military career in the Marine Corps? Why or why not? e) Is it at least as likely as not (50 percent or greater) that a knee disability was either caused or aggravated (made worse) by any of the Veteran’s disabilities, to include his achilles tendonitis, ankle condition, and/or service-connected bilateral foot disability? Why or why not? In answering the Board’s questions, the examiner should review the claims file, to include the hearing transcript (2/26/2018), private DBQ (marked VA examination 7/7/2014), MRI report from Oakland Regional Hospital (marked Medical Treatment Record – Non-Government Facility 7/7/2014), and the Board’s January 2019 and this remand order. The examiner should also consider and discuss the relevance, if any, of Veteran’s in-service injuries, to include MCL strain in his left knee and right ankle sprain, and his post-service medical records, as well as the April 2013 VA diagnoses of chronic intermittent bilateral knee and ankle pain, and the Veteran’s statements as to the onset and continuity of associated symptomatology. (Continued on the next page)   If the examiner determines that the claimed condition(s) have resolved, the examiner should clearly state so and must indicate the date when the condition(s) resolved. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Alex Bardin, 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.