Citation Nr: 21022975 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 14-13 004 DATE: April 19, 2021 REMANDED Entitlement to service connection for a left elbow disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1974 to April 1979. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2013 rating decision by the Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran presented testimony at a Board hearing in August 2015. A transcript of the hearing is associated with the Veteran’s claims folder. This case was previously before the Board in November 2015, September 2016, June 2017, April 2018, June 2019, and July 2020 on which occasions the claim was remanded. In the Board’s July 2020 decision, claims of service connection for bilateral hip disabilities were remanded. The RO granted service connection for bilateral hip disabilities in a February 2021 rating decision. The February 2021 rating decision represents a full grant of benefits sought on appeal and therefore the Board no longer has jurisdiction over the claims. Entitlement to service connection for a left elbow disability is remanded. Upon review of the claims file, the Board has determined that further development is necessary before the Veteran’s claim can be adjudicated. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. In the July 2020 Board decision, the Veteran’s claim was remanded for addendum opinions regarding whether the Veteran’s left elbow disability had its onset in service, and whether his left elbow disability was caused, or aggravated by, his service-connected bilateral knee disabilities. In accordance with the July 2020 remand directives, a VA examiner proffered addendum opinions in February 2021. Regarding whether the Veteran’s left elbow disability was related to service, the examiner concluded that it was less likely than not incurred in or caused by service. In rendering an opinion, the examiner noted that the Veteran was treated for elbow pain during service, but found that there was no evidence of chronicity of care until 2013. (2/21/2021, C&P Exam, p. 5). Regarding whether the Veteran’s left elbow disability was caused or aggravated by his service-connected bilateral knee disabilities, the examiner concluded that there was no relationship between the Veteran’s knee disabilities and his left elbow disability, as there was no “documentation indicating that the [V]eteran’s left elbow condition has been attributed to his bilateral knee conditions.” (2/21/2021, C&P Exam, p. 5). The Board finds that the February 2021 addendum opinion is inadequate for evaluation purposes. In this regard, in concluding that the Veteran was not treated for elbow pain until 2013, the examiner made an inaccurate factual finding. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (A medical opinion based on an inaccurate factual premise has no probative value.). As specifically noted in the Board’s July 2020 opinion, the Veteran’s post-service treatment records reveal left elbow complaints commencing in October 2002. (11/8/2013, Medical Treatment Record, p. 331). Additionally, in addressing whether the Veteran’s left elbow disability was caused or aggravated by his service-connected knee disabilities, the examiner failed to address the Veteran’s assertion that his left elbow disability develop as a result of needing to brace himself and pull himself out of his car. (8/27/2015, Hearing Request, p. 24). The Board is required to consider all theories of entitlement to service connection. See Szemraj v. Principi, 357 F.3d 1370, 1371 (Fed. Cir. 2004). In sum, the Board finds that the February 2021 addendum opinion is inadequate for evaluation purposes as the examiner’s opinion was based on an inaccurate factual premise and failed to address all theories of entitlement raised by the Veteran. As such, the claims must be remanded for further medical development. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records for the Veteran’s disabilities from March 2021 to the present. 2. Obtain an addendum opinion from an appropriate clinician regarding the following: (a.) Is it at least as likely (probability of at least 50 percent) that the Veteran’s left elbow disability had its onset during service, or is otherwise related to his period of active service? In rendering an opinion, the examiner MUST address the Veteran’s in-service complaints of elbow pain AND a notation indicating that his upper extremities were clinically abnormal during his separation examination. (4/7/2017, STR, p. 1, 3, 10, 13, 30). (b.) If not, is it at least as likely as not (probability of at least 50 percent) that the Veteran’s left elbow disability was caused by his service-connected bilateral knee disabilities? If not, is it at least as likely as not (probability of at least 50 percent) that the Veteran’s left elbow disability has been aggravated (any incremental increase in disability) by his service-connected bilateral knee disabilities? If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran’s statements as to the nature, severity, and frequency of his observable symptoms over time. In rendering an opinion, the examiner MUST address the Veteran’s assertion that due to his service-connected knee disabilities he has to use his arms to pull himself out of cars and brace himself when he loses balance, which caused his left elbow disability. (Continued on the next page)   The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. If any opinion cannot be given without resorting to speculation, the examiner should explain why and state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), the record (additional facts are required), or the examiner does not have the knowledge or training. As appropriate, the AOJ should conduct additional development or supplement the record. Eric S. Leboff Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Glenn, 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.