Citation Nr: 21023387 Decision Date: 04/20/21 Archive Date: 04/20/21 DOCKET NO. 16-38 427 DATE: April 20, 2021 REMANDED Entitlement to service connection for right knee disability, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for left elbow disability, to include as secondary to service-connected disabilities, is remanded. Entitlement to service connection for right elbow disability, to include as secondary to service-connected disabilities, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1987 to June 1992. This matter comes before the Board of Veterans’ Appeals (the Board) on appeal from a June 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in June 2019 and a transcript of the hearing has been associated with his claims file. 1. Entitlement to service connection for right knee disability, to include as secondary to service-connected disabilities The Veteran contends that he suffers from a right knee disability as a result of his service. The Veteran claims that he “first injured his right knee in 1988 when he slipped on water in the kitchen while he was serving as a cook in the military.” See March 2012 VA examination. The Veteran also contends that he hyperextended his right knee when he was playing competitive basketball in the military. He has also stated that he injured his right knee in Germany when he was stepping off the back of a deuce and a half truck. See June 2019 Board hearing transcript. In the alternative, the Veteran contends that his right knee disability is secondary to his service-connected disabilities. See July 2016 VA Form-9. The evidence of record includes private treatment records from June 2010 showing a diagnosis for bilateral quadriceps tendonitis and early osteoarthritis of the bilateral knees. The Veteran was provided with a March 2012 examination where he was diagnosed with bilateral knee strain with impairment of the knee. The Veteran was provided with examination in June 2016 where he was diagnosed with bilateral degenerative arthritis of the knees. The examiner noted that the Veteran’s right knee disability was less likely than not proximately due to or the result of the Veteran’s service-connected left knee disability because “the two conditions are not medically related.” The examiner noted that the Veteran’s right knee disability “is a separate entity entirely from the service connected condition and unrelated to it.” At the June 2019 Board hearing, the Veteran testified that he has been having ongoing symptoms in his right knee since his time in service. In June 2019, the Veteran submitted a buddy statement indicating that he has been “active his entire life,” and that he “began to complain with knee problems” after military service. The Board notes that the June 2016 examiner did not include a discussion regarding aggravation of the Veteran’s right knee disability by his service-connected left knee disability. As such, the matter should be remanded in order to obtain a medical opinion that addresses whether the Veteran’s right knee disability was aggravated by his service-connected left knee disability. Additionally, as no VA examiner has opined whether the Veteran’s right knee disability is due to his service or is secondary to his other service-connected disabilities, the addendum medical opinion should also address the etiology of the Veteran’s right knee disability on a direct and secondary basis. 2. Entitlement to service connection for left elbow disability 3. Entitlement to service connection for right elbow disability The Veteran contends that he suffers from a bilateral elbow disability as a result of his service. Specifically, the Veteran contends that his elbow disabilities are the result of his playing competitive basketball while in the military. The Veteran also contends that his elbow disabilities are the result of his duties as a food service specialist while in service which consisted of lifting heavy equipment and repetitive motion of the elbows while preparing meals. See June 2019 Board hearing transcript. In the alternative, the Veteran contends that his bilateral elbow disabilities are secondary to his service-connected disabilities. See July 2016 VA Form-9. The evidence of record includes VA treatment records from March 2012 indicating that the Veteran was diagnosed with bilateral lateral epicondylitis that he attributed to playing basketball in the military. VA treatment records from June 2012 show that the Veteran was diagnosed with progressive chronic bilateral elbow pain. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for bilateral elbow disabilities because no VA examiner has opined whether the Veteran’s elbow disabilities are related to his service or secondary to his service-connected disabilities. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician regarding the following: a) Is it at least as likely as not that the Veteran’s right knee disability is related to his service? b) Is it at least as likely as not that the Veteran’s right knee disability was (A) caused or (B) aggravated beyond its normal progression by his service-connected disabilities? Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. However, if there is a medical reason to doubt its veracity, the examiner should explain why the Veteran's statements or recollection are inconsistent with the evidence in this case, medical principles relating to the onset and progress of the disease, the specific findings in the record, and/or your professional judgment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 2. Schedule the Veteran for a VA examination for his left and right elbow disabilities. The examiner must review the claims file. The examiner is asked to provide a response to the following: a) Is it at least as likely as not that the Veteran’s left or right elbow disabilities are related to his service? b) Is it at least as likely as not that the Veteran’s left or right elbow disabilities were (A) caused or (B) aggravated beyond its normal progression by his service-connected disabilities? Aggravation means an increase in disability – any additional impairment of earning capacity – of the nonservice-connected disability. If aggravation is found, the examiner must attempt to establish a baseline level of severity of the diagnosed disability prior to aggravation by the service-connected disability. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. However, if there is a medical reason to doubt its veracity, the examiner should explain why the Veteran's statements or recollection are inconsistent with the evidence in this case, medical principles relating to the onset and progress of the disease, the specific findings in the record, and/or your professional judgment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. M. Donohue Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Morrad, 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.