Citation Nr: 21042755 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 15-21 587 DATE: July 13, 2021 REMANDED Entitlement to an initial disability rating in excess of 10 percent for left knee chondromalacia patella is remanded. Entitlement to an initial disability rating in excess of 10 percent for right knee chondromalacia patella is remanded. Entitlement to a disability rating in excess of 10 percent for residuals of a right wrist injury is remanded. Entitlement to service connection for left wrist carpal tunnel syndrome is remanded. Entitlement to service connection for hypertension is remanded. Entitlement to service connection for gastroduodenitis is remanded. Entitlement to service connection for diverticulitis is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1973 to March 1985. In September 2018, he testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of the proceeding is in the record. This matter was most recently before the Board in October 2020.There has not been substantial compliance with the remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268 (1998). In a March 2021 rating decision, the service connection was granted and initial ratings assigned for left shoulder glenohumeral joint and acromioclavicular joint osteoarthritis, right shoulder impingement syndrome with acromioclavicular joint osteoarthritis status post rotator cuff repair, and right wrist carpal tunnel syndrome. As such, these issues have been resolved in full and are no longer before the Board. 1. Entitlement to an initial disability rating in excess of 10 percent for left knee chondromalacia patella is remanded. 2. Entitlement to an initial disability rating in excess of 10 percent for right knee chondromalacia patella is remanded. 3. Entitlement to a disability rating in excess of 10 percent for residuals of a right wrist injury is remanded. The Veteran underwent VA examinations in March 2021 to evaluate the severity of his bilateral knee and right wrist disabilities; however, the examination reports do not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158 (2016). Specifically, the examination reports do not contain range of motion findings for the respective joints on weight-bearing and without weight-bearing. The examiner provided no explanation for the absence of the relevant range-of-motion findings. Remand is needed to obtain new VA examinations for the respective disabilities with more thorough findings preferably from an orthopedic surgeon. 4. Entitlement to service connection for left wrist carpal tunnel syndrome is remanded. The Board remanded this claim to obtain an addendum VA opinion on the etiology of the disability. In March 2021, a VA examiner provided a negative nexus opinion that was based exclusively on the absence of documentation of treatment for a left wrist disability in service. Remand is needed to obtain afford the Veteran a new VA examination with opinion that considers and addresses the Veteran's contentions. 5. Entitlement to service connection for hypertension is remanded. The Board remanded the claim to obtain an adequate medical opinion that considered the Veteran's contentions, as well as service treatment records showing the Veteran experienced high blood pressure during active service. The March 2021 VA examiner's opinion is inadequate to decide the claim because the negative nexus opinion is based on an incorrect factual premise. The examiner's opinion states both that there is "[n]o evidence of hypertension or recurrent elevated blood pressure readings during active duty service" and later states that the Veteran's records mention a history of elevated blood pressure readings on induction. The examiner's opinion failed to address this discrepancy in his own statements or evaluate the relevance of the records showing evidence of high blood pressure during service. Remand is needed to obtain a more responsive VA examiner's opinion. 6. Entitlement to service connection for gastroduodenitis 7. Entitlement to service connection for diverticulitis The Board remanded these claims to obtain an addendum VA opinion on the etiology of the respective disabilities. In March 2021, a VA examiner provided negative nexus opinions that were nearly identical to the January 2020 VA opinions the Board previously determined were inadequate to adjudicate the above two service connection claims. The examiner again failed to provide any meaningful evaluation of the Veteran's central contention that he developed stomach problems as a result of exposure to various chemicals while working as an airplane repair technician during service. A remand is needed to obtain a more thoroughly reasoned addendum VA opinion preferably from a gastroenterologist. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician preferably an orthopedic surgeon to determine the current severity of his service-connected bilateral knee chondromalacia and right wrist disabilities. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's respective disabilities under the rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. The examiner must also test and provide full range-of-motion findings for each respective joint on active motion, passive motion, in weight-bearing and without weight-bearing. The examiner must complete the corresponding VA disability benefits questionnaire (DBQ), provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or a deficiency in the examiner's knowledge or training. 2. Schedule the Veteran for a VA examination to determine the current nature and likely etiology of his left wrist carpal tunnel syndrome. Copies of all pertinent records should be made available to the examiner for review. Based on the examination and review of the record, the clinician should answer the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran's left wrist carpal tunnel syndrome had its onset during service or is otherwise related to active duty service? The examiner is asked to specifically address the Veteran's contentions as to the onset and progression of his disability. A complete rationale must be provided for all opinions. 3. Forward the claims file to a VA clinician to obtain an addendum opinion to determine the nature and likely etiology of the Veteran's hypertension. If the examiner determines that an opinion cannot be provided without an examination one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). Following review of the record, the clinician should answer the following question: Is it at least as likely as not (50 percent probability or greater) that the Veteran's hypertension had its onset during service or is otherwise related to active duty service? The examiner is asked to specifically evaluate the Veteran's lay statements maintaining that the stresses of active duty service aggravated his hypertension. The examiner should also evaluate the significance of service treatment records indicated the Veteran needed multiple retests of his blood pressure readings upon induction, as well as service treatment records including a March 1985 Report of Medical History which documented the Veteran's reports of a history of high blood pressure. A complete rationale must be provided for all opinions. 4. Forward the claims file to a VA clinician preferably a gastroenterologist to obtain addendum opinions regarding the likely etiology of the Veteran's diagnosed gastroduodenitis and diverticulosis. If the examiner determines that an opinion cannot be provided without an examination one should be scheduled (or telehealth interview, review of the record, etc., if an in-person examination is not feasible). Following review of the record, the clinician should answer the following questions: (a.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed gastroduodenitis had its onset during service or is otherwise related to active duty service? (b.) Is it at least as likely as not (50 percent probability or greater) that the Veteran's diagnosed diverticulosis had its onset during service or is otherwise related to active duty service? The examiner is asked to specifically evaluate the likelihood that the Veteran's diagnosed conditions are the result of exposure to chemicals as part of his job responsibilities as an airplane repair technician. A complete rational must be provided for all opinions. 5. Please review the respective examination reports and opinions to ensure that they actually comply with the remand directives stated above. Specifically, if range-of-motion measurements are not provided by the examiner in compliance with Correia or if commentary on the evidence of flare-ups is not provided in compliance with Sharp, the examination must be returned to obtain complete medical findings. M. E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Komperda, 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.