Citation Nr: 22011121 Decision Date: 02/25/22 Archive Date: 02/25/22 DOCKET NO. 18-21 066 DATE: February 25, 2022 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a bilateral knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from October 2002 to March 2007. During active duty, he served in Iraq. See service treatment records and Board Hearing Tr. at 8. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a December 2017 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied the Veteran service connection for a low back and bilateral knee disability. A Board hearing was held in October 2021. A transcript is of record. The Veteran has explained that he has pain in his low back and bilateral knees that reduces range of motion and impacts his physical activity, to include walking and standing. See Board Hearing Tr. at 6-7. He contends that his disabilities are the result of a fall into a ditch during a firefight while serving in Afghanistan. See Board Hearing Tr. at 3, April 2018 Form 9, and February 2018 Notice of Disagreement. Alternatively, he contends that the disability was caused by a roll down a hill wherein he fell 30-40 meters. See Board Hearing Tr. at 5. The Veteran served in Iraq during active service. His alleged disabilities relate to muscle and/or joint pain. As such, the record reasonably raises the issue of presumptive service connection through 38 C.F.R. § 3.317. He has not been afforded a VA examination. Consistent with VA's duty to assist, VA must provide a medical examination when there is evidence of (1) a current disability; (2) an in-service injury; (3) some indication that the claimed disability may be associated with the established injury; and (4) insufficient competent evidence of record for VA to make a decision. See McLendon v. Nicholson, 20 Vet. App. 79, 84 (2006). The third prong, which requires evidence that the claimed disability or symptoms "may be" associated with the established event, has a low evidentiary threshold. Id. There is insufficient medical evidence of record to determine whether the Veteran's disabilities are related to his service, or otherwise subject to presumptive service connection. Therefore, the low evidentiary standard is met, and a VA examination is necessary to determine if the Veteran's current disabilities are related or attributable to his time on active duty. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his low back and bilateral knee disabilities that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After the above development is completed, schedule the Veteran for an examination to determine the nature and etiology of his low back and bilateral knee pain. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The examination must include a notation that this record review took place. After the record review and examination of the Veteran, the examiner should identify all low back and bilateral knee disabilities present. For each identified disability, the examiner is asked to respond to the following inquiries: A. As to any diagnosed disability, is the etiology OR pathophysiology of the condition not understood AT ALL as to the Veteran? C. As to any diagnosed disability, if BOTH the etiology AND pathophysiology of the condition is understood AT ALL as to the Veteran, is it at least as likely as not that the diagnosed condition is attributable to service, to include a fall into a ditch during a firefight and a 40-meter fall downhill therein? In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Strickland 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.