Citation Nr: 22012104 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 19-26 753 DATE: March 2, 2022 REMANDED The following issues are remanded for further development: (1) entitlement to service connection for a left hamstring disability, to include as secondary to lumbosacral strain and/or right lower extremity radiculopathy; (2) entitlement to service connection for a left knee disability; (3) entitlement to service connection for a right knee disability; (4) entitlement to service connection for a left wrist disability; and (5) entitlement to service connection for a right foot disability, to include as secondary to a right ankle disability. REASONS FOR REMAND The Veteran served on active duty from August 2014 to August 2018 in the United States Marine Corps. These matters are before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Jurisdiction of the Veteran's claims file currently resides with the Philadelphia, Pennsylvania RO. In October 2021, the Veteran testified at a Board hearing before the undersigned. A transcript of the hearing is of record. 1. Service Connection for Left Hamstring, Left Knee, Right Knee, and Left Wrist Disabilities Regarding the Veteran's claims for service connection for left hamstring, bilateral knee, and left wrist disabilities, he was provided VA examinations in September 2018. After reviewing the Veteran's claims file and conducting physical examinations, the September 2018 VA examiner concluded that the Veteran's left hamstring, knees, and left wrist were normal, and that any complaints of pain or limitations were subjective only. Accordingly, etiological opinions were not provided as the September 2018 examinations reports specified that the Veteran did not experience any current disabilities. In Saunders v. Wilkie, the United States Court of Appeals for the Federal Circuit (Federal Circuit) held that pain, when causing functional impairment, may constitute a "disability" for VA compensation purposes, even if the pain is not with an accompanying diagnosis. 886 F.3d 1356, 1368 (Fed. Cir. 2018). In this case, the Board finds that the Veteran's left hamstring, bilateral knee, and left wrist pain, and any additional symptoms, may constitute current disabilities for VA compensation purposes if such symptoms cause functional impairment. See also Wait v. Wilkie, 33 Vet. App. 8, 17 (2020) (holding that to establish the presence of a disability for compensation purposes, "there must be competent evidence specific to the claimant tending to show that his or her impairment rises to a level affecting earning capacity, which may include showing manifestations of a similar severity, frequency, and duration as those VA has determined by regulation would cause impaired earning capacity in an average person."). Applying Saunders to the instant case, the Board finds that remand for additional clarifying medical opinions is warranted to (1) ascertain whether the Veteran's current left hamstring, knee, and left wrist symptoms cause functional impairment and, if so, (2) determine whether these symptoms which cause functional impairment may be etiologically related to service. In addition, specific to his claim for service connection for a left hamstring disability, if the Veteran's left hamstring symptoms cause functional impairment, the clinician providing the opinion on remand must address whether such impairment was caused or aggravated by his already service-connected lumbar spine disability and/or right lower extremity sciatica. See September 2018 VA Hip and Thigh Conditions Examination Report (noting that the Veteran experienced mild pain with some range of motion which could be related to his lumbar strain and right-sided sciatica). 2. Service Connection for a Right Foot Disability Similarly, regarding the issue of service connection for a right foot disability, the Board finds that remand is warranted for the provision of an additional VA examination. Specifically, the Board concludes that an additional examination is necessary to determine whether the Veteran has a current right foot disability or whether his current reports of right foot pain are merely symptoms of his already service-connected right ankle disability and/or right lower extremity sciatica. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records and associate them with the claims file, particularly those dated since December 2021. If no such records exist, the claims file should be annotated to reflect as such, and the Veteran notified as such. 2. After Item (1) has been completed to the extent possible, schedule the Veteran for a VA examination with an appropriate clinician to determine the nature and etiology of any current right foot condition. The Veteran's claims file should be made available to and be reviewed by the examiner in conjunction with the examination. All indicated tests and studies should be performed and the results reported in detail. The examiner should then address the following: (a.) Please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's reported right foot pain is a symptom of his service-connected right ankle disability and/or right lower extremity radiculopathy or is a distinctive disability. (b.) If the symptom is reflective of a distinctive disability, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the disability was caused by, incurred in, or is otherwise related to service. (c.) If the symptom is reflective of a distinctive disability, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the disability was caused by the Veteran's service-connected right ankle disability. (d.) If the symptom is reflective of a distinctive disability, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the disability was aggravated (worsened beyond natural progression, even temporarily) by the Veteran's service-connected right ankle disability. The examiner should consider medical and lay evidence dated both prior to and since the filing of the claim (June 2018). The examiner must provide a complete rationale for any opinion rendered. If the examiner cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 3. After Item (1) has been completed to the extent possible, send the Veteran's claims file to an appropriate VA clinician for the issuance of a medical opinion regarding the Veteran's claim for service connection for a left hamstring disability. The clinician should review the Veteran's entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. If the clinician determines that a physical examination is necessary, one should be provided. Thereafter, the clinician should address the following: (a.) Please state whether the Veteran's symptoms of left hamstring pain, swelling, weakness, and tightness are reflective of or associated with an underlying, diagnosable condition. (b.) If, in response to part (a), the left hamstring symptoms are related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the identified condition was caused by, incurred in, or is otherwise related to service. (c.) If, in response to part (a), the left hamstring symptoms are NOT related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's the left hamstring symptoms caused any functional impairment. For the purposes of providing a response to part (c), "any functional impairment" means any impact in earning capacity. (d.) If, in response to part (c), the left hamstring symptoms caused functional impairment, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the functional impairment was caused by, incurred in, or is otherwise related to service. The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim (June 2018). The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 4. After Item (1) has been completed to the extent possible, send the Veteran's claims file to an appropriate VA clinician for the issuance of a medical opinion regarding the Veteran's claim for service connection for disabilities of the knees. The clinician should review the Veteran's entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. If the clinician determines that a physical examination is necessary, one should be provided. Thereafter, the clinician should address the following: (a.) Please state whether the Veteran's symptoms of right and left knee pain, grinding, swelling, and loss of motion are reflective of or associated with an underlying, diagnosable condition. (b.) If, in response to part (a), the knee symptoms are related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the identified condition was caused by, incurred in, or is otherwise related to service. (c.) If, in response to part (a), the knee symptoms are NOT related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's knee symptoms caused any functional impairment. For the purposes of providing a response to part (c), "any functional impairment" means any impact in earning capacity. (d.) If, in response to part (c), the knee symptoms caused functional impairment, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the functional impairment was caused by, incurred in, or is otherwise related to service. The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim (June 2018). The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). 5. After Item (1) has been completed to the extent possible, send the Veteran's claims file to an appropriate VA clinician for the issuance of a medical opinion regarding the Veteran's claim for service connection for a left wrist disability. The clinician should review the Veteran's entire claims file and any relevant studies, tests, and evaluations deemed necessary should be performed. If the clinician determines that a physical examination is necessary, one should be provided. Thereafter, the clinician should address the following: (a.) Please state whether the Veteran's symptoms of left wrist pain, weakness, and a popping sensation, are reflective of or associated with an underlying, diagnosable condition. (b.) If, in response to part (a), the left wrist symptoms are related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the identified condition was caused by, incurred in, or is otherwise related to service. (c.) If, in response to part (a), the left wrist symptoms are NOT related to an underlying, diagnosable condition, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the Veteran's the left wrist symptoms caused any functional impairment. For the purposes of providing a response to part (c), "any functional impairment" means any impact in earning capacity. (d.) If, in response to part (c), the left wrist symptoms caused functional impairment, please state whether it is at least as likely as not (the favorable and unfavorable evidence is in approximate balance or is nearly equal) that the functional impairment was caused by, incurred in, or is otherwise related to service. The clinician should consider medical and lay evidence dated both prior to and since the filing of the claim (June 2018). The clinician must provide a complete rationale for any opinion rendered. If the clinician cannot provide an opinion without resorting to speculation, he or she should explain why an opinion cannot be provided (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). (Signature on Next Page) S.C. KREMBS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board N.S. Pettine, 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.