Citation Nr: 21042063 Decision Date: 07/11/21 Archive Date: 07/11/21 DOCKET NO. 17-04 073 DATE: July 11, 2021 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a disability of the digestive system, to include the intestine, stomach, and esophagus, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2002 to October 2008. These matters come to the Board of Veterans' Appeals (Board) on appeal from a November 2015 Department of Veterans Affairs (VA) regional office (RO) rating decision. In August 2019, the Board remanded these issues for further development. Preliminarily, the Board notes that the Veteran's claim for an increased rating for posttraumatic stress disorder (PTSD) is no longer a part of this legacy appeal as he validly opted in to the Appeals Modernization Act (AMA) framework by submitting a Supplemental Claim for an increased rating for PTSD following a January 2021 Supplemental Statement of the Case (SSOC). Therefore, the Board no longer has jurisdiction over it. 1. Entitlement to service connection for a right knee disability is remanded. The 2015 VA examiner stated that the Veteran did not have a right knee disability, but then stated that the chronic right knee swelling may be a sign of internal derangement. In August 2019, the Board remanded this claim for another VA examination to determine if the Veteran had internal derangement in his right knee, and whether it was related to service. June 2016 VA treatment records show that the Veteran has arthritis in his knees. While a November 2015 Gulf War general examination fails to diagnose the Veteran with a right knee disability, it states that the Veteran participated in over 60 jumps from a transport plane while deployed in Alaska, resulting in chronic knee pain. As a result of the August 2019 remand, the Veteran participated in a January 2021 VA examination for his right knee. The Veteran reported that his right knee pain onset in 2006 while jumping in airborne status when he landed badly. The examiner diagnosed the Veteran with an ACL repair onset 2018. The examiner opined that the Veteran's ACL injury was less likely than not related to service as he was never diagnosed with a knee disability in service and first complained of knee pain in 2015 (seven years after separation from the military). The examiner specifically opined that the Veteran tore his ACL in 2018 after playing basketball with his son. The Board finds that remand is necessary for an addendum VA medical opinion. The January 2021 VA examiner solely diagnosed the Veteran with an ACL repair. However, the Veteran's post-service treatment records indicate that he has additionally been diagnosed with knee arthritis (which preceded his 2018 basketball injury). Therefore, an addendum VA examination addressing the etiology of all of the Veteran's right knee disabilities must be obtained. See McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that service connection may be granted for a disability that manifests at any point during the pendency of a claim, even if it subsequently resolves prior to resolution of the claim). Furthermore, the Board notes that the Veteran's arthritis is eligible to be service connected as a chronic disability. See 38 C.F.R. § 3.309(a). Upon remand, the examiner must consider the November 2015 Gulf War general examinations finding that the Veteran's participation in airborne status resulted in chronic pain, and the Veteran's reports that his pain has been continuous since service. See Miller v. Wilkie, 32 Vet. App. 249 (2020) (holding that an examiner must address the Veteran's lay statements to provide an adequate medical opinion). 2. Entitlement to service connection for a disability of the digestive system, to include the intestines, stomach, and esophagus, is remanded. The 2015 VA examiner stated that the Veteran's current symptoms of mild mid-abdominal pains with loose stools may fulfill the criteria for irritable bowel syndrome (IBS), but did not actually diagnose it. The examiner then stated that the Veteran did not have a medically unexplained chronic multi-symptom illness that is defined by a cluster of signs or symptoms. The August 2019 Board decision noted that the Veteran may be entitled to a presumption of service connection if he does have IBS. See 38 U.S.C. § 1117(a)(2)(B). The Board remanded the claim to obtain a VA examiner to determine whether the Veteran in fact has IBS. At a January 2021 VA examination, the Veteran reported that he has an upset stomach that has been "happening for years," loose stools, and cramping. The VA examiner opined that there was no objective evidence of IBS. Importantly, the VA examiner stated that the Veteran's symptoms related to defecation are "indicative" of a stomach or esophageal disability but that it was "outside the scope" of the current examination. The Board notes that when a Veteran makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). Here, the January 2021 VA examiner makes clear that the Veteran's symptoms are "indicative" of some underlying digestive disability. As such, the Board will expand the claim, and remand for a VA examination. 3. Entitlement to an evaluation of total disability because of individual unemployability (TDIU) is remanded. Two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered. Because a decision on the other issues remanded here could significantly impact a decision on the issue of TDIU, the issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180 (1991). Remand of the inextricably intertwined TDIU claim is therefore required as well. The matters are REMANDED for the following action: 1. Obtain an addendum VA medical opinion to determine the nature and etiology of the Veteran's right knee disability. If another VA examination (or telehealth interview, review of the record, or similar action, if in-person examination is not feasible) is deemed necessary, then one must be obtained. The clinician must provide responses to each of the following: (a) Whether the Veteran has a current diagnosis of arthritis, an ACL tear, or any other right knee disorder. For each diagnosis identified, the examiner should state whether it is at least as likely as not that the disorder manifested in service, within one year of service separation, or is otherwise related to the Veteran's military service, including any circumstances therein. (b) If the examiner determines that any findings constitute symptomatology that is not attributable to a known clinical diagnosis, he or she should state whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisymptom illness, as established by history, physical examination, and laboratory tests. If so, the examiner should also report all signs and symptoms necessary for evaluating the illness under the rating criteria. The clinician must provide a thorough rationale for all findings, explaining in detail the reasons for the opinions rendered. In rendering each of these decisions, the VA examiner must specifically comment on the November 2015 Gulf War general examiner's finding that the Veteran's participation in airborne status resulted in knee pain, the June 2016 VA treatment records reflecting arthritis in the knee, and the Veteran's lay reports that his knee pain has been continuous since service. 2. Obtain a VA examination (or telehealth interview, review of the record, or similar action, if in-person examination is not feasible) to determine the nature and etiology of the Veteran's digestive tract disability. The clinician must provide responses to each of the following: (a) Whether the Veteran has a current diagnosis of IBS or any other disorder of the digestive tract, to include the intestines, stomach, and esophagus. For each diagnosis identified, the examiner should state whether it is at least as likely as not that the disorder manifested in service, within one year of service separation, or is otherwise related to the Veteran's military service, including any circumstances therein. (b) If the examiner determines that any findings constitute symptomatology that is not attributable to a known clinical diagnosis, he or she should state whether the Veteran has objective indications of a chronic disability resulting from an undiagnosed illness or medically unexplained chronic multisymptom illness, as established by history, physical examination, and laboratory tests. If so, the examiner should also report all signs and symptoms necessary for evaluating the illness under the rating criteria. The clinician must provide a thorough rationale for all findings, explaining in detail the reasons for the opinions rendered. Caroline B. Fleming Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Finelli, 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.