Citation Nr: 21026353 Decision Date: 04/30/21 Archive Date: 04/30/21 DOCKET NO. 18-13 000 DATE: April 30, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1963 to November 1965. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an April 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in June 2019 and September 2020 when they were remanded for further development. 1. Entitlement to service connection for a back disability is remanded. 2. Entitlement to service connection for a bilateral knee disability is remanded. Although the additional delay is regrettable, the Board finds remand for new medical opinions addressing the etiology of the Veteran’s disabilities is warranted before a decision can be made on the claims. In the September 2020 Board remand, the Board asked a VA examiner to provide an opinion as to whether any currently diagnosed back and knee disabilities were at least as likely as not related to an event, disease, or injury in service. The Board directed the examiner to accept as valid the Veteran’s lay statements regarding onset of his conditions and that he had private treatment shortly after separation from service and periodically thereafter. Regarding the Veteran’s back disability, in December 2020, a VA examiner opined that the Veteran’s back disability was not related to his service. In support of the opinion, the examiner noted that there was no chronic diagnosis for a back condition during service. The examiner also noted that available medical records did not note medical treatment or a diagnosis for a back condition during service, noting that the Veteran’s symptoms were per self-report and are not confirmed in the claims file. The examiner indicated that the Veteran’s lay statements and private treatment shortly after service and periodically thereafter had been considered in providing the opinion; however, the examiner noted that the Veteran was not capable of diagnosing a medical condition related to those symptoms. Although the examiner notes that the Veteran’s lay statements were considered, the Board finds the examiner failed to adequately address the Veteran’s contentions. Specifically, in the November 2010 statement, the Veteran reported that he injured his back during service while picking up dead bodies from the battlefield and this was not addressed in the opinion. In addition, the examiner did not adequately address the Veteran’s statements that he received treatment shortly after separation and periodically thereafter. Thus, the Board finds remand for a new medical opinion is required. Regarding the Veteran’s bilateral knee disability, a December 2020 VA examiner opined that the Veteran’s condition was not related to his service. In support of the opinion, the examiner indicated that the Veteran’s in-service knee problems were acute only, noting there was no evidence of chronicity of care. The examiner also noted that the Veteran’s lay statements and private treatment shortly after separation and periodically thereafter were considered in providing the opinion; however, the examiner noted that the Veteran was not capable of diagnosing a medical condition related to those symptoms. The Board also finds this opinion inadequate because the examiner failed to adequately address the Veteran’s lay statements. In noting medical records did not establish chronicity of care, it’s clear the examiner did not consider the Veteran’s lay statements that the records were destroyed. Thus, remand for a new medical opinion is required. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from a VA examiner other than the December 2020 VA examiner for an addendum opinion addressing the etiology of the Veteran’s back disability. The Veteran’s claims file should be made available to the examiner for review. An examination should only be scheduled if the examiner deems one is necessary for providing the requested opinions. Following a review of the claims file, the examiner is asked to provide an opinion on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s back condition is related to his active service, to include picking up and removing dead bodies from the battlefield. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran's degenerative arthritis of the spine (i) began during active service, (ii) manifested within one year after discharge from service, or (iii) was noted during service with continuity of the same symptomatology since discharge from service. In providing the opinions, the examiner is asked to address the Veteran’s statements that he did not have time to see a doctor during service but sought treatment shortly after separation and periodically thereafter but records of his visits were destroyed as they are old. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, with reasoning why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 2. Obtain an addendum opinion from a VA examiner other than the December 2020 VA examiner for an addendum opinion addressing the etiology of the Veteran’s bilateral knee disability. The Veteran’s claims file should be made available to the examiner for review. An examination should only be scheduled if the examiner deems one is necessary for providing the requested opinions. Following a review of the claims file, the examiner is asked to provide an opinion on the following: (a) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran’s bilateral knee disability is related to his active service, to include his in-service treatment for knee pain. (b) Whether it is at least as likely as not (a 50 percent or greater probability) the Veteran's osteoarthritis of the knees (i) began during active service, (ii) manifested within one year after discharge from service, or (iii) was noted during service with continuity of the same symptomatology since discharge from service. In providing the requested opinions, the examiner should address the Veteran’s statements that he did not have time to see a doctor during service but sought treatment shortly after separation and periodically thereafter but records of his visits were destroyed as they are old. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated with reasoning why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. G. E. Wilkerson Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Jiggetts 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.