Citation Nr: 21040342 Decision Date: 07/03/21 Archive Date: 07/03/21 DOCKET NO. 17-54 898 DATE: July 3, 2021 REMANDED The appeal regarding entitlement to service connection for a cervical spine disability is remanded. The appeal regarding entitlement to service connection for a low back disability is remanded. The appeal regarding entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran had active service from December 1980 to July 1993, and from October 2002 to October 2003. She retired from the United States Air Force Reserve in October 2010. This matter comes before the Board of Veterans' Appeals (Board) from a June 2013 rating decision by the Agency of Original Jurisdiction (AOJ). The Board denied the Veteran's claims of entitlement to service connection in March 2020. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). In March 2021, the Court granted the parties' Joint Motion for Remand (JMR), vacating the Board's March 2020 decision and remanding the matter for action consistent with the terms of the JMR. The Veteran relates her claimed cervical spine, lumbar spine, and bilateral knee disabilities to physical activity during service. In the JMR, the parties agreed that the Board failed to provide adequate reasons or bases regarding whether the duty to assist had been satisfied. In this regard, the parties indicated that it was unclear whether VA made sufficient efforts to obtain relevant treatment records identified by the appellant. They indicated that the Veteran had contacted VA in January 2013 and April 2013 and identified records at Andrews Air Force Base (AFB), Bolling AFB, Offutt AFB, and the Air Reserve Personnel Center. The Board's current review of the claims file reflects that service treatment records were obtained. Those records include those from Offutt AFB for the period from July 1981 to April 1984, and records dating to May 1996; records from Maxwell AFB for the period from September 1988 to March 1991; records from Andrews AFB from October 2003 to October 2004; records from Naval Hospital Millington from March 1993; and records from Bolling AFB for the period from February 1985 to March 1988, from September 2003 to September 2005, and from October 2006 to August 2010. It is unclear whether there are outstanding records. The Veteran should be afforded the opportunity to identify any additional locations he where we was treated in service. Any outstanding records should be obtained. The parties to the JMR also discussed evidence regarding diagnoses referable to the Veteran's neck, low back, and knees. In this regard, the Board's March 2020 decision denied the Veteran's claims on the basis that there were no current diagnoses and no diagnoses during the pendency of the Veteran's appeal. The parties, however, noted that private providers had rendered diagnoses to include arthritis of the knees, and intersegmental dysfunction of the cervical and lumbar spine. The Board also notes that, pain alone can constitute a disability if it causes functional impairment. Saunders v. Wilkie, 886 F.3d 1356, 1365068 (Fed. Cir. 2018). Considering the private treatment records, and the Veteran's report of symptoms referable to her neck, back, and knees, the Board concludes that VA examinations are necessary to determine the nature and etiology of any cervical spine, low back, and/or bilateral knee disability. The matters are REMANDED for the following action: 1. The Veteran should be advised of the service treatment records already contained in the claims file, and asked to identify any other locations where he was treated in service. Any outstanding service treatment records should be sought. All actions in this regard should be recorded in the claims file. If, after making reasonable efforts to obtain named records the AOJ is unable to secure same, it must notify the Veteran and his representative and (a) identify the specific records the AOJ is unable to obtain; (b) briefly explain the efforts that the AOJ made to obtain those records; (c) describe any further action to be taken by the AOJ with respect to the claim; and (d) inform the Veteran that she is ultimately responsible for providing the evidence. The Veteran must then be given an opportunity to respond. 2. Following completion of the development, schedule the Veteran for an examination to determine the nature and etiology of her claimed cervical spine, low back, and bilateral knee disabilities. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination report must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all relevant diagnoses referable to the Veteran's cervical spine, lumbar spine, and knees, to include whether there is functional limitation due to pain. The examiner should provide an opinion regarding whether it is at least as likely as not that any such disability was incurred in, or is otherwise related to active service (from December 1980 to July 1993, and from October 2002 to October 2003). The examiner should also provide an opinion regarding whether it is at least as likely as not that any such disability is related to a disease or injury incurred during a period of active duty for training (ACDUTRA) or an injury incurred during a period of inactive duty training (INACDUTRA). In rendering these opinions, the examiner is advised that the Veteran is competent to report her symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner 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. Regarding the claimed cervical spine disability, the examiner is directed to a February 1991 MRI report indicating a minimal diffuse bulging of the annulus at C5-6 and C6-7, as well as a March 1991 report indicating chronic cervical myofasciitis. The complete rationale for all opinions should be set forth, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must 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. 3. Then, readjudicate the Veteran's claims. If the decision remains adverse to the Veteran, she and her representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.