Citation Nr: 21040817 Decision Date: 07/07/21 Archive Date: 07/07/21 DOCKET NO. 16-03 749 DATE: July 7, 2021 REMANDED Entitlement to service connection for a back disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1974 to August 1976. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a travel board hearing before the undersigned Veterans Law Judge (VLJ) in March 2019. The hearing transcript is of record. The Board remanded the claim in August 2019 for further development by the RO. The case has been returned to the Board for further appellate action. The Board notes that the August 2019 remand also included claims for entitlement to service connection for a right shoulder disability and a neck disability. Following remand, the RO granted the claims in a June 2020 rating decision. As this is a full grant of these issues, they are no longer in appellate status. 1. Entitlement to service connection for a back disability is remanded. 2. Entitlement to service connection for a right knee disability is remanded. Although further delay is regrettable, the Board finds that additional development is necessary prior to appellate review. Specifically, a remand is warranted in order to obtain an addendum medical opinion regarding the etiology of the Veteran's back and right knee disabilities. Pursuant to the August 2019 Board remand directives, the RO obtained examination reports and medical opinions in December 2019. The examiner opined against service connection for both disabilities. However, these medical opinions are inadequate because they do not address relevant medical records. The examiner did not address the Veteran's service treatment records (STRs) noting year-long intermittent knee pain and chronic knee pain in records dated April and June 1976, respectively. The examiner also did not address correspondence dated September 2013 from P.H., a D.O., regarding the Veteran's reported symptoms and physical activities in service, stating that "more likely than not, these factors contributed to the decline in her functional capacity," to include the Veteran's right knee and spine. The examiner also did not address correspondence dated January 2015 from Dr. B.C. stating that, while he cannot conclude that the degenerative changes in the Veteran's spine were caused by military service, the condition was exacerbated by service, to include activities such as carrying a rucksack, operating heavy machinery, and physical training. To the extent that the Veteran has attempted to submit positive nexus opinions in support of her claim, the Board notes that the statement from P.H. cannot be used to support an award of service connection because it does not provide an explanation of how she reached the conclusion. The statement from Dr. B.C. cannot be used to support an award of service connection because it does not express a level of certainty that is 50 percent or greater. See Hood v. Shinseki, 23 Vet. App. 295, 298 (2009); Obert v. Brown, 5 Vet. App. 30, 33 (1993). Thus, the case must be returned for an addendum opinion. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Thereafter, obtain an addendum opinion from an appropriate medical professional regarding the back disability. The claims file, as updated, must be made available to and reviewed by the examiner. The examiner is asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that any currently diagnosed back disability is etiologically related (caused or aggravated), in whole or in part, to the Veteran's active service. In rendering this opinion, the examiner should address the following: correspondence from P.H., a D.O., dated September 2013 and Dr. B.C., dated January 2015, respectively. If, and only if, the examiner determines that another VA examination is necessary to provide an informed opinion, such an examination should be scheduled. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. 3. Following completion of directive #1, obtain an addendum opinion from an appropriate medical professional regarding the right knee. The claims file, as updated, must be made available to and reviewed by the examiner. The examiner is asked to opine on whether it is as least as likely as not (a 50 percent probability or greater) that any currently diagnosed right knee disability is etiologically related (caused or aggravated), in whole or in part, to the Veteran's active service. In rendering this opinion, the examiner should address the following: (1) the Veteran's STRs dated April and June 1976 noting knee problems; and (2) correspondence from P.H., a D.O., dated September 2013 and Dr. B.C., dated January 2015, respectively. If, and only if, the examiner determines that another VA examination is necessary to provide an informed opinion, such an examination should be scheduled. A complete rationale should be given for all opinions and conclusions expressed. If the examiner cannot provide an opinion without resort to speculation, the examiner should provide an explanation as to why this is so and must state whether there is additional evidence that would permit the necessary opinion to be made. Nathaniel J. Doan Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Minaya, 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.