Citation Nr: 21026990 Decision Date: 05/04/21 Archive Date: 05/04/21 DOCKET NO. 15-11 600 DATE: May 4, 2021 REMANDED Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for hepatitis C is remanded. Entitlement to service connection for a liver disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1970 to January 1979. In May 2018, a videoconference hearing was held before the undersigned Veterans Law Judge. A transcript is of record. In September 2018, the Board remanded the current claims for additional development. The Board notes that in two separate December 2019 rating decisions the Regional Office (RO) denied entitlement to service connection for the issues of diabetes mellitus, sleep apnea, a heart condition, and leukocytosis. The Veteran appealed this rating decision and selected the Hearing Review lane. As these issues are appealed under the AMA, they will be the subject of a separate Board decision. 1. Entitlement to service connection for a right knee disorder is remanded. In October 2019, the Veteran underwent a VA examination to evaluate the nature and etiology of his right knee disorder. The examiner diagnosed right knee osteoarthritis and rendered a negative nexus opinion. The examiner explained that there was no verification of onset of a chronic right knee condition during or due to active duty, the Veteran's service treatment records were silent regarding a right knee complaint or treatment, and the earliest documentation of a right knee disorder was 2012. This rationale, however, is conclusory on its face because the examiner did not provide an explanation of the underlying medical principles involved in concluding that the Veteran's current right knee disorder was not related to service. Moreover, although the examiner appears to rely on the fact that there was no documentation of right knee problems during service or until 2012, the examiner failed to adequately consider/discuss the Veteran's testimony that he continued to have right knee problems off and on since service. See May 2018 Board Hearing Transcript. In the September 2018 remand, the Board specifically instructed that the VA examiner should consider the Veteran's reports of symptoms/ history. As such, the VA examiner did not substantially comply with the previous remand instructions and remand is warranted for a new VA medical opinion consistent with the directives herein. See Stegall v. West, 11 Vet. App. 268 (1998). 2. Entitlement to service connection for hepatitis C is remanded. In the September 2018 remand, the Board also instructed that the RO procure a VA examination to determine the etiology of the Veteran's hepatitis C. The Board specifically directed that the VA examiner should consider and discuss the Veteran's statement that he was exposed to a soldier's blood during active duty service. In October 2019, the Veteran underwent a VA examination to evaluate his hepatitis C. The examiner rendered a negative nexus opinion and explained that there was no verification/evidence of exposure to hepatitis C during or due to active duty and the risk factors were not applicable to the Veteran. The examiner explained further that the Veteran's known military occupational specialty would not expose him to any of the occupational risk factors that have been identified by the National Institutes of Health. The examiner, however, did not discuss the significance, if any, of the Veteran's statement's regarding exposure to a separate soldier's blood. As such, the VA examiner did not substantially comply with the previous remand instructions. See Stegall, 11 Vet. App. at 268. 3. Entitlement to service connection for a liver disorder is remanded. The Veteran's claims for service connection for a liver disorder is inextricably intertwined with his claim for service connection for a kidney disorder, as they are claimed as secondary. Accordingly, remand for this inextricably intertwined claim is also required. The matters are REMANDED for the following actions: 1. Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's right knee disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner in conjunction with the medical opinion. The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's right knee disorder had its onset in or is otherwise related to his active duty service. In rendering the above opinion, the examiner must specifically consider and discuss the Veteran's testimony regarding the onset and continued problems with his knee. See May 2018 Board Hearing Transcript. The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Obtain a VA medical opinion from an appropriate examiner to determine the nature and etiology of the Veteran's hepatitis C and liver disorder. The claims folder (including a copy of this remand) must be provided to and reviewed by the examiner in conjunction with this medical opinion. a) The examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's hepatitis C had its onset in or is otherwise related to his active duty service. In rendering this opinion, the examiner is specifically instructed to consider and discuss the Veteran's statement that he was exposed to a soldier's blood during active duty service. b) If the examiner responds to paragraph (a) with a positive etiological opinion, the examiner should opine as to whether it is at least as likely as not (i.e., 50 percent probability or greater) that the Veteran's liver disorder was caused or aggravated by his hepatitis C. Aggravation in this context is defined as any increased in severity. In rendering this opinion, the examiner must specifically consider and discuss the January 2015 VA Treatment record that indicates the cirrhosis and hepatocellular carcinoma are due to HCV (hepatitis C). The examiner is advised that the Veteran is competent to report his symptoms/history and that such reports must be acknowledged and considered in formulating any opinion. If his reports are discounted, the examiner should provide a reason for doing so. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. A. ISHIZAWAR Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Metzner, Paul 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.