Citation Nr: 21041825 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 16-03 106 DATE: July 10, 2021 REMANDED Entitlement to service connection for a right knee condition, to include as secondary to service-connected left knee condition, is remanded. Entitlement to service connection for left trigger, ring, middle, and index fingers is remanded. Entitlement to service connection for carpal tunnel syndrome of the left wrist is remanded. Entitlement to service connection for left wrist condition is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from July 1973 to February 1981 and September 1981 to August 1996. In June 2019, the Board of Veterans' Appeals (Board) remanded the issues of entitlement to service connection for a right knee condition, left trigger finger, left wrist carpal tunnel syndrome, and left wrist pain for further development. Specifically, the Board instructed the agency of original jurisdiction (AOJ) to schedule the Veteran for VA examinations pertaining to his claims. 1. Entitlement to service connection for a right knee condition, to include as secondary to service-connected left knee condition, is remanded. The Board finds that a new VA examination and etiological opinion is warranted for the Veteran's claims. The Veteran contends that his right knee condition is the result of spending many hours kneeling and crawling on cold concrete during service. An addendum opinion provided by a VA examiner without examination of the Veteran was associated with the Veteran's claims file in December 2019. The examiner opined that the Veteran's right knee condition was less likely than not related to service and less likely than not proximately due to or the result of the Veteran's service-connected left knee condition. He explained that the Veteran's right knee injury during service was acute only and that there was no chronicity of care. He also noted that the Veteran's right knee condition is a separate entity entirely from the service-connected condition and unrelated to it, that medical literature does not support a medical relationship, that arthritis in one knee does not cause degenerative joint disease in the other knee, and that there no permanent aggravation of such. The December 2019 examiner used the incorrect definition for his aggravation opinion for secondary service connection. Per a recent decision from the United States Court of Appeals for Veterans Claims (Court), "any incremental increase in disability and any additional impairment of earning capacity in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence" constitutes aggravation. Ward-Neal v. Wilkie, 31 Vet. App. 233 (2019). As such, remand for a new examination is warranted to adequately address the nature and etiology of the Veteran's right knee condition. 2. Entitlement to service connection for left trigger, ring, middle, and index fingers is remanded. 3. Entitlement to service connection for carpal tunnel syndrome of the left wrist is remanded. 4. Entitlement to service connection for left wrist condition is remanded. The Board finds that a new VA examination and etiological opinion is warranted for the Veteran's claims. The Veteran contends that his left fingers and left wrist conditions are related to his duties as an aircraft engine mechanic during service. Addendum opinions for the Veteran's left trigger finger condition, left wrist carpal tunnel syndrome, and left wrist condition, provided by the same VA examiner, were associated with the Veteran's claims file in December 2019. The examiner opined that none of the Veteran' conditions were related to service because there was no service treatment record injury of note and onsets of conditions were post-service around 2000-2003. He noted the Veteran's military occupational specialty (MOS) and his notice of disagreement (NOD). Despite noting the Veteran's MOS and his contentions in his NOD, the December 2019 examine failed to meaningfully address the competent and credible lay statements of record regarding the Veteran's contentions regarding the onset of pain in his left trigger fingers, left wrist carpal tunnel syndrome, and left wrist condition. The Veteran is competent to report symptoms within the realm of his personal knowledge, such as pain. Finally, the examiner did not provide an etiology or any possible causes for the Veteran's left hand/wrist conditions, merely limiting his opinions to finding that none of the conditions were related to service. As such, the Board is unable to adequately decide the Veteran's claims. Accordingly, the Board finds that a remand is warranted for a new examinations and opinions. See Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The evidence also indicates that, in November 2019, the AOJ requested that the Veteran provide the names, addresses, and approximate dates of treatment of all medical care providers that provided him with treatment pertinent to his claims. The AOJ also provided the Veteran and his representative with a VA Form 21-4142, Authorization to Disclose Information, and VA Form 21-4142a, General Release for Medical Provider Information, to allow the AOJ to obtain the Veteran's medical records on his behalf. See November 2019 Subsequent Development Letter. To date, the Veteran has not responded to the request. VA's duty to assist is not a "one-way street," and a Veteran seeking help cannot passively wait for it in those circumstances where he may or should have information that is essential in obtaining pertinent evidence. See Wood v. Derwinski, 1 Vet. App. 190, 193 (1991). Nonetheless, as a remand of this matter is otherwise warranted, the Board finds that the AOJ should make one more attempt to identify and obtain any pertinent medical records. The Veteran is cautioned that failure to cooperate with any requested development may result in the denial of his claim. 38 C.F.R. § 3.655. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims file any updated and relevant outstanding treatment records, including all private treatment records. All attempts to obtain these records pursuant to 38 C.F.R. § 3.159(c)(1) must be documented. 2. Schedule the Veteran for a VA examination with an appropriate examiner to determine the nature and etiology of the Veteran's left knee condition. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and an examination of the Veteran, the examiner should respond to the following: (a.) Obtain a detailed history of the Veteran's right knee condition, to include all diagnosed conditions and symptomatology. (b.) For each diagnosed condition, the examiner should state whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's right knee condition had its onset in or is related to service, to include hours of kneeling and crawling on hard concrete. (c.) For each diagnosed condition, the examiner should state whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's right knee condition was caused or aggravated by the service-connected left knee condition. The examiner must address both causation and aggravation. Note that the onset of the diagnosis is irrelevant; the assessment is whether the service-connected condition eventually caused or aggravated the non-service-connected condition. (d.) If the examiner finds that the Veteran's right knee condition was aggravated by his service-connected left knee condition, then they should specify the baseline level of disability of the right knee condition prior to aggravation due to the left knee condition. Note that aggravation means any incremental increase in disability in the right knee condition (i.e., any additional impairment of earning capacity) resulting from the service-connected left knee condition. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 3. Schedule the Veteran for VA examinations to determine the nature and etiology of the Veteran's left fingers, left wrist carpal tunnel syndrome, and left wrist condition. The claims file should be made available to the examiner for review in connection with the examination. Based on review of the record and an examination of the Veteran, the examiner should respond to the following: (a.) Obtain a detailed history of the Veteran's left fingers and wrist conditions, to include all symptomology. (b.) Determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's claimed left finger condition had its onset in or is related to service, to include from duties as an aircraft engine mechanic. See January 2015 Notice of Disagreement; July 2020 Veteran Statement. (c.) Determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's left wrist carpal tunnel syndrome had its onset in or is related to service, to include from duties as an aircraft engine mechanic. See January 2015 Notice of Disagreement; July 2020 Veteran Statement. (d.) Determine whether it is at least as likely as not (i.e., at least a 50 percent probability) that the Veteran's left wrist condition had its onset in or is related to service, to include from duties as an aircraft engine mechanic. See January 2015 Notice of Disagreement; July 2020 Veteran Statement. The examiner must provide the rationale for all proffered opinions. If the examiner is unable to provide any required opinion, he or she should explain why. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. 4. Then readjudicate the claims. If any benefit sought is not granted, the Veteran and his representative should be furnished an SSOC and given the requisite opportunity to respond before the case is returned to the Board. ERIC MINE Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. L. Park, 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.