Citation Nr: 21042322 Decision Date: 07/12/21 Archive Date: 07/12/21 DOCKET NO. 15-31 729 DATE: July 12, 2021 ORDER The claim of entitlement to service connection for a bilateral knee condition is reopened. REMANDED Entitlement to service connection for a bilateral knee condition, to include gout, rheumatoid arthritis, and degenerative arthritis, is remanded. Entitlement to service connection for gout and rheumatoid arthritis of the bilateral ankles, bilateral feet, right hand, and right wrist is remanded. Entitlement to service connection for degenerative arthritis of the bilateral ankles is remanded. Entitlement to service connection for degenerative arthritis of the right hand is remanded. Entitlement to degenerative arthritis of the right wrist is remanded. FINDINGS OF FACT 1. The March 2005 rating decision that denied the Veteran's claim of service connection for a bilateral knee condition is final. 2. Evidence received since the March 2005 rating decision is both new and material to the claim of entitlement to service connection for a bilateral knee condition. CONCLUSIONS OF LAW 1. The March 2005 rating decision that denied the service connection for a bilateral knee condition is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2020). 2. New and material evidence has been received sufficient to reopen the claim of service connection for a bilateral knee condition. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant in this case, served on active duty from January 1976 to August 1985. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019, the Board remanded the case for additional development. After reviewing the contentions and evidence of record, the Board finds that the issues on appeal are more accurately stated as listed on the title page of this decision. When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. See Brokowski v. Shinseki, 23 Vet. App. 79 (2009) (holding that a claimant may satisfy the requirement to identify the benefit sought by referring to a body part or system that is disabled or by describing symptoms of the disability). Therefore, in consideration of the holdings in Brokowski and the diagnoses of record, the Board has recharacterized the issues on appeal as reflected above. New and Material Evidence Whether new and material evidence has been received to reopen the previously denied claim of entitlement to service connection for a bilateral knee condition. The March 2005 rating decision that denied the service connection for a bilateral knee condition is the last final rating decision on this matter. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. On review, the Board reopens the service connection claim for a bilateral knee condition based on the Veteran's statements that his bilateral knee arthritis symptoms manifested within one year of his separation from active service and have been continuous since service. See December 2014 statement. This new and material evidence, coupled with the evidence already in the file, raises a reasonable possibility of substantiating the claims. 38 C.F.R. § 3.156(a). REASONS FOR REMAND The Veteran was afforded VA examinations in December 2019, with nexus opinions obtained in August 2020. Once VA undertakes the effort to provide an examination when developing a claim, even if not statutorily obligated to do so, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). 1. Entitlement to service connection for a bilateral knee condition, to include gout, rheumatoid arthritis, and degenerative arthritis, is remanded. The record indicates that the Veteran has been diagnosed with degenerative arthritis of the bilateral knees. See September 2011 VA x-ray report (noting moderate degenerative joint disease of the left knee); March 2013 VA x-ray reports (noting degenerative joint disease of the right and left knees). Furthermore, an August 1978 service treatment record indicates that the Veteran complained of left knee pain two days after a quarter-ton jeep that he was driving rolled over two times. To date, no medical opinion has been obtained that addresses whether the Veteran's degenerative arthritis of the bilateral ankles is related to or caused by service. Therefore, remand is warranted to obtain an etiology opinion for the degenerative arthritis of the bilateral ankles. In August 2020, a VA examiner opined that the Veteran's gout and rheumatoid arthritis of the bilateral knees is less likely than not etiologically related to service. The VA examiner noted that the Veteran contends that his gout began in service and that the October 1986 VA examination report noted that the Veteran had knee pain with cold weather. The VA examiner also explained that joint pain has multiple causes, and that gout occurs when there is an increase in urate crystals (from uric acid) in the joints. The increase in uric acid levels is largely influenced by diet; however, other risk factors include obesity, certain medications, family history of gout, age, and sex. Rheumatoid arthritis is an autoimmune disease, which means the cause (antibody) is innate in the body. The VA examiner concluded that these risk factors are less likely to be impacted by active service. However, the VA examiner did not address the Veteran's competent lay statements that he had been diagnosed with and treated for gout since 1986. See July 2014 notice of disagreement; December 2014 statement. Therefore, the October 2020 VA medical opinion is inadequate as to this issue, and remand is required to obtain an adequate opinion as to the nature and etiology of the Veteran's gout. 2. Entitlement to service connection for gout and rheumatoid arthritis of the bilateral ankles, bilateral feet, right hand, and right wrist is remanded. In August 2020, a VA examiner opined that the Veteran's gout and rheumatoid arthritis of the ankles, feet, right hand, and right wrist is less likely than not etiologically related to service. However, the VA examiner did not address the Veteran's competent lay statements that he had been diagnosed with and treated for gout since 1986. See July 2014 notice of disagreement; December 2014 statement. Therefore, the October 2020 VA medical opinion is inadequate as to this issue, and remand is required to obtain an adequate opinion as to the nature and etiology of the Veteran's gout. 3. Entitlement to service connection for degenerative arthritis of the bilateral ankles is remanded. The record indicates that the Veteran has been diagnosed with degenerative arthritis of the bilateral ankles. See December 2019 VA ankle examination report; September 2011 VA x-ray report. Furthermore, an August 1980 service treatment record indicated that the Veteran complained of right ankle pain after he twisted his ankle while playing football. A December 1982 service treatment record indicated that the Veteran complained of left ankle pain after an unspecified trauma. A March 1982 service treatment record indicated that the Veteran was diagnosed with an inversion sprain of the left ankle. A January 1984 service treatment record indicated that the Veteran had twisted his ankle. An October 1984 service treatment record indicated that the Veteran complained of left ankle pain after being stepped on the day before while playing basketball. To date, no medical opinion has been obtained that addresses whether the Veteran's degenerative arthritis of the bilateral ankles is related to or caused by service. Therefore, remand is warranted to obtain an etiology opinion for the degenerative arthritis of the bilateral ankles. 4. Entitlement to service connection for degenerative arthritis of the right hand is remanded. The record indicates that the Veteran has been diagnosed with degenerative arthritis of the bilateral ankles. See November 2010 VA x-ray report (noting mild degenerative changes of the interphalangeal joints of the right hand and mild degenerative changes of the first carpometacarpal joint). Furthermore, an undated service treatment record indicates that he fell on his outstretched right hand and complained of pain and swelling of the right hand and right ring finger. To date, no medical opinion has been obtained that addresses whether the Veteran's degenerative arthritis of the right hand is related to or caused by service. Therefore, remand is warranted to obtain an etiology opinion for the degenerative arthritis of the right hand. 5. Entitlement to service connection for degenerative arthritis of the right wrist is remanded. A June 2011 private x-ray report transcription indicates that the Veteran had been diagnosed with mild degenerative changes (arthritis) of the right wrist. To date, no medical opinion has been obtained that addresses whether the Veteran's degenerative arthritis of the right wrist is related to or caused by service. Therefore, remand is warranted to obtain an etiology opinion for the degenerative arthritis of the right wrist. The matters are REMANDED for the following action: 1. Obtain an addendum medical opinion from the August 2020 VA examiner, or a suitable substitute, as to the etiology of the Veteran's diagnosed gout and rheumatoid arthritis of the bilateral knees, ankles, feet, right hand, and right wrist. The entire claims file, including a copy of this Remand, should be made available to, and be reviewed by, the examiner. Another examination is not required; however, if the examiner indicates that he or she cannot respond to the Boards questions without examination of the Veteran, another examination should be afforded to the Veteran. After review of the record, the examiner is asked to provide an opinion as to whether the Veteran's diagnosed gout and rheumatoid arthritis of the bilateral knees, ankles, feet, right hand, and right wrist is related or caused by service. The examiner should specifically address the following evidence: **The Veteran's competent statements that he was diagnosed with and treated for swollen ankles and left knee in January 1986 and April 1986, at which time the doctor drained a fluid from both ankles and diagnosed the Veteran with gout. The examiner should provide a complete rationale for all opinions. 2. Obtain an addendum medical opinion(s) from the December 2019 VA examiner, or a suitable substitute, as to the etiology of the Veteran's diagnosed degenerative arthritis of the bilateral knees, bilateral ankles, right wrist, and right hand. After review of the record, the examiner is asked to provide the following opinions: a) For EACH diagnosis of degenerative arthritis, including degenerative arthritis of the bilateral knees, ankles, feet, right hand, and right wrist, provide an opinion as to whether such degenerative arthritis is related or caused by service. The examiner should consider the following evidence: ** An August 1978 service treatment record indicating that the Veteran complained of left knee pain two days after a quarter-ton jeep that he was driving rolled over two times. **An August 1980 service treatment record indicating that the Veteran complained of right ankle pain after he twisted his ankle while playing football. **A December 1982 service treatment record indicating that the Veteran complained of left ankle pain after an unspecified trauma. **A March 1982 service treatment record indicating that the Veteran was diagnosed with an inversion sprain of the left ankle. **A January 1984 service treatment record indicating that the Veteran had twisted his ankle. **An October 1984 service treatment record indicating that the Veteran complained of left ankle pain after being stepped on the day before while playing basketball. **An undated service treatment record indicating that the Veteran fell on his outstretched right hand and complained of pain and swelling of the right hand and right ring finger. The examiner should provide a complete rationale for all opinions. 3. Then, readjudicate the issues on appeal. Megan R. Thomas Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dawn A. Leung, 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.