Citation Nr: 21029241 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 17-13 346 DATE: May 13, 2021 REMANDED The issue of entitlement to service connection for a neck condition (cervical spine) is remanded. The issue of entitlement to service connection for a bilateral knee condition is remanded. The issue of entitlement to service connection for a back condition is remanded. VETERAN CONTENTIONS The Veteran contends that he injured his knees while doing low crawls on stones during basic training. He further contends that he injured his neck and back when he fell down a flight of stairs during service. Finally, the Veteran contends that he has further injured his back while compensating for his bilateral knee condition. He asserts that inclement weather exacerbates his conditions. The Veteran reports that he did not seek medical attention for many years due to the excessive drinking and drugs he used to self-medicate and manage his pain. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1980 to January 1981. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran's claim of entitlement to service connection for a bilateral knee condition was denied in a March 1981 decision. He filed a Notice of Disagreement that same month and a May 1981 Statement of the Case (SOC) was issued in response. The Veteran did not appeal the SOC and the decision became final in March 1982. See 38 C.F.R. § 20.1103. The Veteran's claim of entitlement to service connection for a neck condition was denied in a March 1982 decision. That decision was not appealed and became final in March 1983. Id. In the May 2013 rating decision currently on appeal before the Board, the RO implicitly determined that new and material evidence was received for the Veteran's claim of entitlement to service connection for both a bilateral knee condition and a neck condition. However, the RO continued denial of both claims. The Board now finds that new and material evidence has been associated with the record for both conditions thus warranting a reopening of both claims. In furtherance of those claims, there was an April 2021 Board hearing before the undersigned Veterans Law Judge (VLJ), and the transcript is of record. 1. The issue of entitlement to service connection for a neck condition (cervical spine) is remanded. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In this case, the Veteran was afforded one VA examination in furtherance of his claim of entitlement to service connection for a neck condition. See 5/8/2013 VA Examination. However, the Board now finds that opinion inadequate for VA purposes because it was conclusory and did not contain a reasoned explanation. See Stefl v. Nicholson, 21 Vet. App. 120 (2007). Thus, remand to obtain a new opinion is necessary. 2. The issue of entitlement to service connection for bilateral knee condition is remanded. The Veteran was similarly afforded one VA examination in furtherance of his claim of entitlement to service connection for a bilateral knee condition. See 5/8/2013 VA Examination. The Board also finds that opinion inadequate due to its conclusory nature. While the examiner opined that the Veteran's bilateral knee condition clearly and unmistakably existed prior to service, he also noted that the Veteran's entrance examination was silent as to a knee condition. However, the examiner provides no rationale which would assist the Board in understanding that inconsistency. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Therefore, remand is warranted. 3. The issue of entitlement to service connection for a back condition is remanded. The Veteran asserts that his back condition is secondary to his bilateral knee condition. See 4/12/2021 Hearing Transcript. Because the Board is remanding the issue of entitlement to service connection for the Veteran's bilateral knee condition for an additional medical opinion, a decision on service connection for his back condition would be premature. Where a pending claim is inextricably intertwined with a claim currently on appeal, the appropriate remedy is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Forward the claims file, including a copy of this remand to an appropriate clinician to provide a medical opinion regarding the nature and etiology of the Veteran's neck, back, and knee conditions. The examiner is asked to review the file and then address the following: (a) Is it at least as likely as not (50 percent probability or greater) that the Veteran's neck condition had its onset in, was caused by, or is otherwise related to service? The examiner should specifically address the Veteran's in-service torticollis diagnosis, his statements regarding continuity of symptomatology, and gaps in his treatment records due to claimed self-medicating through drug abuse. (b) Is it at least as likely as not (50 percent probability or greater) that the Veteran's bilateral knee condition had its onset in, was caused by, or is otherwise related to service? The examiner should specifically address the Veteran's in-service chondromalacia patellae diagnosis, his entrance examination's silence with regard to knee conditions, his statements regarding continuity of symptomatology, and gaps in his treatment records due to claimed self-medicating through drug abuse. A complete rationale for the examiner's opinion should be provided, citing to specific evidence of record, as necessary. If the examiner cannot provide an opinion without resort to speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. 2. Identify any current back condition by diagnosis. (a) For any back disability identified, please state whether it is at least as likely as not (50 percent probability or more) that the disability had its onset in, was caused by, or is otherwise related to service. (b) In the event that the criteria for a diagnosis of back condition are not met, the examiner should specifically state whether there is any functional impairment associated with the Veteran's complaints of back pain. Please complete the "Functional Impact" section of the report of examination. If there is functional impairment, please offer an opinion as to whether it is at least as likely as not that such impairment is associated with the Veteran's service. For the purpose of providing the opinion(s) requested in part (b) and (c), please accept as valid the Veteran's lay report that he developed a back condition after falling in service, he developed or exacerbated his back condition while attempting to compensate for knee pain, and that his pain has persisted; and state whether a nexus between the Veteran's back condition and service is medically consistent with the information provided by the Veteran. (The Board reminds the Veteran that in asking the examiner to accept the history he provided, the Board is not at this time assessing the credibility of his statements). In offering any opinion, the clinician should consider medical and lay evidence dated both prior to and since the filing of the claim (December 2011). (c) For each diagnosis (or, if a diagnosis is not made, for any functional impairment of the back), the examiner should state whether it is at least as likely as not that the condition was caused by the Veteran's bilateral knee condition? Please explain why or why not. (d) If not caused by the Veteran's bilateral knee condition, is it at least as likely as not that the condition has been worsened beyond normal progression by his bilateral kneed condition? Please explain why or why not. (e) If the examiner finds that the condition has been worsened beyond normal progression (aggravated) by the Veteran's bilateral knee condition, please describe the degree in aggravation beyond the baseline level of back condition that is attributed to the bilateral knee condition (e.g., increase severity, decrease strength, decrease range of motion). The clinician should provide a complete rationale for any opinion rendered. If he or she cannot provide the requested opinions without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why that is so. S. C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sloley, 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.