Citation Nr: 21042224 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 17-24 135 DATE: July 12, 2021 REMANDED Entitlement to an initial compensable rating for bilateral hearing loss is remanded. Entitlement to an initial compensable rating for right knee patellofemoral syndrome is remanded. Entitlement to service connection for a bilateral ankle condition, to include as due to a Gulf War undiagnosed illness, is remanded. Entitlement to service connection for a left knee condition, to specifically include patellofemoral syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty from November 2001 to October 2007. These matters come to the Board of Veterans' Appeals (Board) on appeal from a March 2013 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2020, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge; the hearing transcript has been associated with the claims file. While additional pertinent VA treatment records have been associated with the claims file since issuance of the April 2017 statement of the case without waiver of Agency of Original Jurisdiction (AOJ) consideration, the RO will have the opportunity to review the evidence on remand. As a final initial matter, the Board notes that the Veteran has additional claims on appeal to the Board under the Appeals Modernization Act (AMA) that will be addressed in a separate decision. 1. Entitlement to an initial compensable rating for bilateral hearing loss. 2. Entitlement to an initial compensable rating for right knee patellofemoral syndrome. The Veteran seeks a compensable disability rating for her bilateral hearing loss disability, as well as her right knee patellofemoral syndrome. The Board finds that additional development is necessary prior to the adjudication of the claims. The Veteran last underwent VA examinations for her service-connected disabilities on appeal in January 2013. At the March 2020 Board hearing, the Veteran indicated that her bilateral hearing loss and right knee disability have increased in severity since her last VA examinations. While the mere passage of time is not a basis for requiring a new examination, when there is evidence there has been a material change in the Veteran's disability, the current rating may be incorrect, or where the Veteran asserts that the disability has undergone an increase in severity since the last examination, a new examination must be provided. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007); Caffery v. Brown, 6 Vet. App. 377 (1994); Snuffer v. Gober, 10 Vet. App. 400 (1997). Thus, additional development is needed. 3. Entitlement to service connection for a bilateral ankle condition. The Veteran contends that she has a bilateral ankle condition that is directly related to her active military service. Specifically, the Veteran contends that she injured her ankles carrying heavy equipment and jumping off of the deuces and other transportation vehicles. See March 2020 Board hearing transcript. Additionally, in the alternative, the Veteran contends that her undiagnosed ankle condition was caused by exposure to environmental toxins while serving in the Persian Gulf. See March 2020 Board hearing. Although the Board regrets additional delay, the matter is remanded in order to obtain a VA examination and etiological opinion. The evidence of record shows that the Veteran has consistently complained of bilateral ankle stiffness, pain, and swelling. The Veteran contends that she sustained injuries to her ankles during her six years of active duty service, to include service in the Persian Gulf, that included carrying heavy equipment and jumping off of the deuces and other transportation vehicles. While a September 2020 statement from Dr. F.G. indicates that the Veteran's bilateral ankle condition is related to service, Board finds that additional development is needed. The Veteran has not yet been afforded a VA examination to determine the nature and etiology of her bilateral ankle condition. Upon remand, the Veteran must be afforded a VA examination to determine whether her disabilities are related to her military service. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Additionally, service personnel records (SPRs) confirm the Veteran served in the Persian Gulf War, and she is afforded the presumptions of a Persian Gulf War veteran. 38 U.S.C. § 1117; 38 C.F.R. § 3.317. However, it is unclear whether the Veteran has a current diagnosis for the symptoms she is experiencing, as she has not yet been afforded a VA examination regarding her bilateral ankle condition. As such, a remand is necessary in order to schedule the Veteran an appropriate VA examination. 4. Entitlement to service connection for a left knee condition, to specifically include patellofemoral syndrome. The Veteran contends that her left knee condition is also due to the physical demands she experienced during active duty, to include carrying heavy equipment and jumping off of the deuces and other transportation vehicles. See March 2020 Board hearing transcript. Once the VA undertakes providing a veteran with an examination, it has a duty to ensure it is adequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). In January 2013, the Veteran was afforded a VA examination and was diagnosed with right and left knee patellofemoral syndrome. However, the examiner only proffered a nexus opinion regarding the etiology of the right knee disability. Additionally, the Board acknowledges the September 2020 statement from Dr. F.G. However, the private opinion is conclusory in nature and does not provide thorough rationale supported by the evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120 (2007). As such, it is inadequate to grant the Veteran's claim. The Board also notes that service connection for a right knee disorder is in effect; thus, consideration of service connection on a secondary basis is warranted. Accordingly, remand is necessary in order to obtain an addendum opinion addressing the etiology of the Veteran's left knee condition to allow the Board to make a fully informed decision. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Schedule the Veteran for a VA examination to determine the current severity of her bilateral hearing loss disability. The claims file, to include a copy of this Remand, should be made available to and reviewed by the examiner. All findings should be reported in detail. 3. Schedule the Veteran for a VA examination to determine the current severity and manifestations of her right knee disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should report all signs and symptoms necessary for evaluating the Veteran's right knee disability. In particular, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, or is not medically appropriate, in this case; he or she should clearly explain why that is so. The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability due to these factors (including any additional loss of motion). The examiner should also discuss any additional functional impairment that occurs during flare-ups, including any additional limitation of motion. To the extent possible, he or she should address the frequency, duration, characteristics, and severity of flare-ups (through an examination, review of the medical records, and/or history provided by the Veteran). If the examination is not provided during a flare-up, and the examiner cannot otherwise opine as to functional loss, he or she must provide an explanation. If there is pain on motion, the examiner should note the point in the range of motion where pain occurs. In addition, to the extent possible, identify any symptoms and functional impairments due to the right knee disability and discuss the effect of the Veteran's right knee disability on any occupational functioning, to include physical and sedentary employment, and activities of daily living. A complete rationale is required for all opinions expressed. 4. Schedule the Veteran a VA examination to determine the nature and etiology of her bilateral ankle disability. A complete copy of the claims file, to include a copy of this remand, should be provided to the examiner for review. Following a review of the entire record, the examiner should provide an opinion on the following: (a.) Is the Veteran's bilateral ankle condition attributable to a known clinical diagnosis? If yes, is this disability at least as likely as not (a 50 percent or greater probability) caused by, or is otherwise etiologically related to, the Veteran's active military service, which included exposure to burn pits and jet fuel. The examiner should address the Veteran's lay statements regarding in-service injuries, as well as the September 2020 statement from Dr. F.G. (b.) If the Veteran's symptoms are not attributable to a known diagnosis, could her symptoms represent an undiagnosed illness, or a medically unexplained chronic multi-symptom illness related to Persian Gulf War environmental hazards? A complete rationale should be provided for any opinion expressed. 5. Schedule the Veteran a VA examination to determine the nature and etiology of her left knee disability. A complete copy of the claims file, to include a copy of this remand, should be provided to the examiner for review. Following a review of the entire record, the examiner should opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's left knee condition was caused by, or is otherwise etiologically related to, the Veteran's active military service. The examiner should address the Veteran's lay statements regarding in-service injuries, as well as the September 2020 statement from Dr. F.G. The examiner should also opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's left knee condition was proximately due to or aggravated by her service-connected right knee disorder. A complete rationale should be provided for any opinion expressed. C. CRAWFORD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N. B. Smith, 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.