Citation Nr: 21027962 Decision Date: 05/07/21 Archive Date: 05/07/21 DOCKET NO. 17-45 576 DATE: May 7, 2021 REMANDED Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right elbow disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from March 1992 to March 1996. These matters come before the Board of Veterans' Appeals (Board) on appeal from a September 2014 rating decision. In July 2020, the Veteran testified before the undersigned Veterans Law Judge at a video conference hearing. Unfortunately, the Veteran's appeal must be remanded for further development. Although the Board regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide these issues so that the Veteran is afforded every possible consideration. 1. Entitlement to service connection for a left ankle disability is remanded. 2. Entitlement to service connection for a right elbow disability is remanded. The Veteran seeks entitlement to service connection for a left ankle disability and a right elbow disability. The Veteran testified at his Board hearing that he injured his ankle and elbow during service and that he has continued to experience symptoms ever since. The Veteran's service treatment records show that he injured his left ankle during basic training in March 1992. He was diagnosed with Achilles tendonitis and fitted with a cast. Service treatment records further contain multiple reports right elbow pain that the Veteran reported began following a fall in service. The Veteran underwent VA examinations on his left ankle and right elbow in September 2014. With regard to the Veteran's ankle, the examiner diagnosed left ankle arthralgia. With regard to the Veteran's right elbow, the examiner diagnosed right elbow arthralgia. Upon examination, the examiner opined that the Veteran's left ankle and right elbow disorders are less likely than not incurred in or caused by service, noting that there is no evidence of chronicity or ongoing treatment for either condition for many years following service. The Board finds the VA medical opinions to be inadequate because the examiner did not provide sufficiently detailed medical rationale to support her conclusions. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 302-04 (2008) (holding that it is the factually accurate, fully articulated, and sound reasoning for the conclusion that contributes to the probative value of a medical opinion). Moreover, the examiner did not take into the account the Veteran's competent lay statements regarding the in-service onset and continuity of symptomatology of his claimed disabilities. Once VA undertakes the effort to provide an examination or opinion when developing a service connection claim, it must provide one that is adequate for the purposes of the determination being made. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Therefore, remand is required to afford the Veteran new VA examinations and medical opinions before the Board can render an informed decision on the Veteran's claims. See Douglas v. Shinseki, 23 Vet. App. 19, 26 (2009). The requested medical opinions, outlined in the directives below, must consider the Veteran's full medical history, including his service treatment records, as well as his lay assertions regarding the in-service onset of his disabilities and continuity of symptomatology since service. The Board also notes that at his July 2020 hearing, the Veteran testified that the boots he wore during service aggravated or ruptured his right ankle condition. As such, on remand, the VA examiner must address the Veteran's contention that the boots the Veteran wore during service resulted in his present disability. Accordingly, the matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination with a VA physician (M.D.) of appropriate expertise to determine the nature and etiology of his claimed disabilities. The examiner must review the Veteran's entire claims file, to include a copy of this REMAND, and that review must be noted in the report. A complete history of symptoms should be elicited from the Veteran. Left Ankle Disability (a) Is it at least as likely as not (50 percent or greater probability) that the Veteran's left ankle disability was incurred in service or within one year of separation, or is otherwise causally related to the Veteran's active service or any incident therein? It is imperative that the examiner's report reconcile the evidence of record, to include the Veteran's lay statements, service treatment records, post-service medical records, and any other pertinent lay evidence of record. Specifically, the requested opinion must address the (i) the March 1992 Achilles tendonitis that required use of a cast, (ii) the Veteran's hearing testimony that the boots he wore during service contributed to his injury, and (iii) the Veteran's hearing testimony as to continuity of symptomatology since service. Right Elbow Disability (b) Is it at least as likely as not (50 percent or greater probability) that the Veteran's right elbow disability was incurred in service or otherwise causally related to the Veteran's active service or any incident therein? It is imperative that the examiner's report reconcile the evidence of record, to include the Veteran's lay statements, service treatment records, post-service medical records, and any other pertinent lay evidence of record. Specifically, the requested opinion must address the following: (i) November 1994 right elbow injury and (ii) the Veteran's testimony as to continuity of symptomatology since service. The examiner is reminded that the term "at least as likely as not" does not mean "within the realm of possibility." Rather, it means that the weight of the medical evidence both for and against the claim is so evenly divided that it is as medically sound to find in favor of the claim as it is to find against it. The examiner is advised that the Veteran is competent to report his symptoms and history, including in regard to onset and continuity of symptomatology of his disabilities, and such reports must be acknowledged and considered in formulating any provided opinions. (Continued on the next page) The examiner must provide a complete rationale for any opinions offered, citing to medical evidence or other evidence in the record, when necessary, to support the conclusion reached. If an opinion cannot be reached without resorting to speculation, the examiner must fully explain why that is so. LESLEY A. REIN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Rosenthal, Ariana 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.