Citation Nr: 21028039 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-62 018 DATE: May 10, 2021 REMANDED Service connection for a right-knee condition is remanded. Service connection for a right-hand condition is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1972 to June 1974. This matter originally came before the Board of Veterans' Appeals (Board) from a December 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board for further development in October 2020. This matter is again before the Board and has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). Service connection for a right knee condition and service connection for a right-hand condition are remanded. The Veteran believes that service connection for a right knee condition and service connection for a right-hand condition is warranted. See April 2021 Appellate Brief. An October 2020 Board decision remanded the matter for right knee and right-hand VA examinations. The examinations were to address the Veteran's lay statements concerning right knee and right-hand pain due to strenuous duties, including scraping paint while on his hands and knees, during service. See October 2020 BVA Decision. The right knee and right-hand examinations took place in November 2020. See December 2020 C&P Exam. The examinations found that the right-knee and right-hand conditions were not related to service because the claims file was silent for complaints, treatment, and/or diagnoses of the conditions and there was no chronicity of care. The Board finds the November 2020 examinations inadequate for multiple reasons. Among other reasons, the examinations did not substantially comply with the Board's remand instructions. See Stegall v. West, 11 Vet. App. 268 (1998). Specifically, the examinations did not address the Veteran's lay statements concerning pain due to strenuous duties, including scraping paint while on his hands and knees, during service when providing the opinions. Additionally, the examinations were inadequate because they did not consider/were unable to consider all the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, among other evidence, the examinations did not consider/were unable to consider medical records from 2008 showing a diagnosis of neuropathy of the right hand radial nerve; the Veteran's report that it was common knowledge that soldiers engage in strenuous training and that this repeated overuse of muscles could lead to problems; and medical records from 2006 showing that the Veteran had had knee pain on and off for many years, had symptoms of frequent popping sensations and occasional giving out sensations, and was not following up with doctors for the problems. See December 2020 CAPRI; September 2020 Appellate Brief; December 2006 VA Examination. For these reasons, a remand is needed for new examinations. The matter is REMANDED for the following action: 1. Provide the Veteran with an opportunity to identify any relevant outstanding private and/or VA treatment records, including but not limited to, medical records from Henry Ford Hospital in 1976. After obtaining any necessary authorizations from the Veteran, make all reasonable attempts to obtain the outstanding records in accordance with 38 C.F.R. § 3.159. 2. Attempt to obtain the Veteran's Social Security records, including all underlying medical records, in accordance with 38 C.F.R. § 3.159. 3. Update VA and private treatment records. VA treatment records appear current up to December 2020. 4. Schedule one or more appropriate VA examinations for the Veteran's right knee and right-hand conditions. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all right knee and right-hand disabilities existing at any point during the pendency of the appeal (i.e. since September 2016), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is related to service, including but not limited to, if it had its onset during service? (C) Is it at least as likely as not (a 50 percent or greater probability) that any right knee and/or right-hand arthritis manifested to a compensable degree within one year following the Veteran's separation from service? If yes, which ones? (D) Is it at least as likely as not (a 50 percent or greater probability) that right knee and/or right-hand arthritis symptomatology was noted during service/within one year following the Veteran's separation from service, with continuity of symptomatology since? If yes, which ones? In addition to the other relevant evidence of record, the examiner is asked to consider and address as appropriate the following information with a caution that this list is not a substitute for a review of the record: (1) Medical records from 2008 showing a diagnosis of neuropathy of the right-hand radial nerve, chronic bilateral knee pain, and bilateral knee osteoarthritis. Medical records from 2010 showed the Veteran's report that his right knee was locking up on him. Medical records from 2012 showed the Veteran's report of arthritis in the hands and knees. Medical records from 2020 showed the Veteran's report that his hands were aggravated when they got cold or were used a lot. Further information is provided. See December 2020 CAPRI. (2) A medical record from 2020 showing diagnoses of right knee arthritis in 2006 and right-hand arthritis. The Veteran reported that while home on leave during service, he was walking down the street and his right knee gave out. He placed an ace bandage around it. Periodically throughout service, he had right knee pain. During service, he worked as a deckhand on a ship, laid cable, had no knee pads, and did not have the right equipment. He was always bending on the right knee. He also used a deck crawler device to chip paint and was on his knees for long periods of time. The device would vibrate while he was on his knee. While using the device, his right thumb hyperextended. He was seen by the medic, treated with pain medication, and was told to keep his right hand wrapped. He was placed on light duty due to right hand pain for a short time. He was not seen again during service for the right hand. His current right-hand problem was the same problem that occurred during service. He began going to VA in 2006. He was seen at the Henry Ford Hospital in 1976 for knee pain. The Veteran believed that service caused the right knee problem. Further information is provided. See December 2020 C&P Exam. (3) The Veteran's report that it is common knowledge that soldiers engage in strenuous training and that this repeated overuse of muscles could lead to inflammation and irritation of the tendons in the affected muscle group. See September 2020 Appellate Brief. (4) The Veteran's report that he was seen during service for hand and knee pain caused by using the deck crawler to remove paint from the deck. He performed this duty in the cold. See January 2017 NOD. (5) Medical records showing that the knee pain comes and goes. See October 2016 CAPRI. (6) The Veteran's report that during service, he was a boatswain mate and did a lot of scraping and painting on his knees. He recalled that those activities caused him pain and trembling in the hands and knees. See September 2016 Statement in Support of Claim. (7) A medical record from 2006 showing a long history of knee pain that was on and off. The symptoms were worse during cold and rainy weather. The Veteran reported a history of frequent knee popping sensations and occasional sensations of the knee giving out. The symptoms usually lasted for a couple of days and then subsided by themselves. He was not following up with doctors for the problem. There was a diagnosis of right knee arthritis. See December 2006 VA Examination. (8) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran's documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community's knowledge or due to the limits of the examiner's medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 5. Readjudicate the issues on appeal. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Dougan, 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.