Citation Nr: 21030333 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 09-42 358A DATE: May 18, 2021 REMANDED Service connection for a left wrist disability is remanded. Service connection for a right wrist disability is remanded. Service connection for a left knee disability is remanded. Service connection for a right knee disability is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1973 to November 1978 in the U.S. Army. This matter comes before the Board of Veterans' Appeals (Board) from October 2008 and March 2014 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. In a March 2021 rating decision, the RO granted service connection for somatic symptom disorder, persistent, severe (claimed as an acquired psychiatric disorder and sleep disorder). Accordingly, the issues of service connection for an acquired psychiatric disorder and sleep disorder are no longer on appeal. The Board notes that the Veteran submitted a March 2021 VA Form 10182 Notice of Disagreement requesting a higher rating for his somatic symptom disorder. The issue is currently before the Board under the Appeals Modernization Act (AMA) review system and will be addressed in a separate decision. This matter was most recently before the Board in July 2020, at which time the issues on appeal were remanded for further development. Although further delay is regrettable, for the reasons below, the Board finds that there has not been substantial compliance with the prior remand directives. Therefore, another remand is required. See Stegall v. West, 11 Vet. App. 268 (1998). Left and Right Wrist Disability A VA medical opinion was obtained in March 2021 regarding the Veteran's left and right wrist disabilities. The examiner opined that the Veteran's left and right wrist disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. Regarding the Veteran's left disability, the examiner stated that the Veteran's service treatment records (STRs) are silent for any diagnosis of a left wrist condition. Regarding the Veteran's right wrist disability, the examiner stated that the Veteran's service-treatment records show that on February 5, 1977, x-rays were negative, and the Veteran was diagnosed with contusion. Additionally, the examiner stated that during the February 2011 VA examination and during the October 2016 Board hearing, the Veteran reported that he experienced frequent pain and swelling on a daily basis during service due to his in-service typing responsibilities, however the reports are only subjective and there is no medical evidence stating that the Veteran had wrist pain during active duty. The examiner further stated that the only evidence in the Veteran's STRs noted that the Veteran suffered a right wrist contusion during active duty and the Veteran was not diagnosed with carpal tunnel until after military service. The examiner concluded that nexus has not been established. The Board has previously found the Veteran's statements regarding his bilateral wrist symptoms in service to be both competent and credible. The claims were last remanded, in part, in order to obtain a medical opinion considering these statements. As the March 2021 VA examiner relied on the lack of contemporaneous medical records of complaints or treatment during service and failed to adequately consider the Veteran's statements, a further opinion must be obtained. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). Left and Right Knee Disability A VA medical opinion was obtained in March 2021 regarding the Veteran's left and right knee disabilities. The examiner opined that the Veteran's left and right knee disabilities were less likely than not incurred in or caused by the claimed in service injury, event, or disease. The examiner stated that upon review of the Veteran's medical records, his records are silent on any diagnosis of a left knee condition while on active duty. Additionally, the examiner stated that the Veteran's STRs show treatment for right knee soreness in August 1973, however there were no further complaints, treatment, or diagnosis noted and his separation examination was silent for a right knee condition. The examiner concluded that nexus has not been established. The Board has previously found the Veteran's statements regarding his bilateral knee symptoms in service to be competent. The claims were last remanded, in part, in order to obtain a medical opinion considering these statements. As the March 2021 VA examiner relied on the lack of contemporaneous medical records of complaints or treatment during service and failed to adequately consider the Veteran's statements, a further opinion must be obtained. See Dalton v. Nicholson, 21 Vet. App. 23 (2007). TDIU Finally, because a decision on the remanded issues of entitlement to service connection for bilateral wrist and knee disabilities could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. Obtain an addendum medical opinion from an appropriate physician regarding the nature and etiology of the Veteran's bilateral wrist disabilities. The physician should review the entire claims file, to include a copy of this Remand, and the opinion should include a discussion of the Veteran's documented history and assertions. If an examination is deemed necessary by the physician, one should be scheduled. The physician should identify all current bilateral wrist disabilities, to include any musculoskeletal or neurological conditions. For each diagnosis, the physician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral wrist disability had its onset during active service, or is otherwise related to any in-service injury, event, or disease. The physician must specifically address the Veteran's contentions in his February 2011 VA examination and October 2016 Board hearing that he experienced frequent pain and swelling on a daily basis due to his in-service typing responsibilities. While a medical opinion is required, the examiner is asked to consider the Veteran's lay reports and may state whether they are medically-consistent or medically-inconsistent with other evidence of record. The physician must opine as to whether the Veteran's current bilateral wrist disabilities are related to his in-service typing responsibilities. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. The physician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. A complete rationale must be provided for all opinions offered. 3. Obtain an addendum medical opinion from an appropriate physician regarding the nature and etiology of the Veteran's bilateral knee disabilities. The physician should review the entire claims file, to include a copy of this Remand, and the opinion should include a discussion of the Veteran's documented history and assertions. If an examination is deemed necessary by the physician, one should be scheduled. The physician should identify all current bilateral knee disabilities. For each diagnosis, the physician should opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's bilateral knee disability had its onset during active service, or is otherwise related to any in-service injury, event, or disease. The physician must specifically address the Veteran's October 2016 testimony that he began experiencing knee symptoms during service and has continued experiencing such symptoms on and off since service. While a medical opinion is required, the examiner is asked to consider the Veteran's lay reports and may state whether they are medically-consistent or medically-inconsistent with other evidence of record. The physician is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be considered in formulating the requested opinion. The physician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. (Continued on the next page) A complete rationale must be provided for all opinions offered. J. Smith Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Kernen, 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.