Citation Nr: 22012257 Decision Date: 03/03/22 Archive Date: 03/03/22 DOCKET NO. 18-37 614 DATE: March 3, 2022 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty from September 2006 to April 2012. In October 2021, the Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing is associated with the record. 1. Entitlement to service connection for a right knee disability is remanded. The Veteran's August 2005 entrance examination documents that the Veteran's right knee disability clearly and unmistakably preexisted service. He received a medical waiver to enlist. The Veteran testified at his October 2021 Board hearing that he injured his knees after carrying heavy equipment up and down stairwells during active service. However, there is no VA examination in the record whether the Veteran's preexisting right knee disability was aggravated by his active service. On remand, a VA examination of the right knee is warranted. 2. Entitlement to service connection for a left wrist disability is remanded. The May 2020 VA examination is inadequate because the VA examiner appears to impermissible rely on a lack of records in rendering a negative opinion. Service treatment records (STRs) document that the Veteran sought medical attention for a left wrist sprain in October 2009. The examiner reported that there is no objective evidence of a chronicity of care following the initial injury and therefore there are no residuals. Additionally, the examiner opined that the Veteran's left wrist pain is at least as likely as not (50 percent or greater probability) caused by post service overuse. The rationale provides no explanation on what evidence the examiner relied upon for this conclusion. Since the May 2020 VA examination is inadequate a new examination is warranted. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Ask the Veteran to identify any providers who treated him for right knee or left wrist complaints since s since July 2017. Take all appropriate action to obtain records from identified providers. 2. Take all appropriate action to obtain all VA treatment records since July 2017. 3. After completion of the above, forward copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the likely etiology of the right knee disability. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. service connection claim for a right knee disability that clearly and unmistakably preexisted his service. The examiner is asked to answer the following questions: Is it at least as likely as not (probability of at least 50 percent) that any currently diagnosed right knee disability has been aggravated beyond its natural progression by the Veteran's service? The examiner is asked to review and discuss the Veteran's October 2021 Board testimony that he experienced pain during service as a result of duties that required carrying heavy equipment up and down stairwells during active service. The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to 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 the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. 4. Forward copies of all pertinent records to an appropriate VA examiner to obtain a medical opinion on the likely etiology of the left wrist disability. If the examiner determines that an opinion cannot be provided without an examination, one should be scheduled. The examiner is asked to answer the following: Is it at least as likely as not (50 percent probability) that any currently diagnosed left wrist condition was incurred in or is otherwise related to service? The examiner is asked to review and discuss the Veteran's October 2021 Board testimony that he injured his left wrist after carrying heavy equipment up and down stairwells during active service. The examiner is advised that the Veteran is competent to provide evidence of symptomatology readily apparent to him, regardless of whether the symptoms are noted in the service medical records or on the date of examination. The examiner may NOT rely on the absence of a medical record or evidence of medical treatment as the sole rationale for any negative medical nexus opinion. A complete rationale must be provided for all opinions, citing to supporting factual data and medical literature, as appropriate. If the examiner cannot provide an opinion without resort to 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 the examiner (does not have the knowledge or training) and note what, if any, additional evidence would permit such an opinion to be made. M.E. Larkin Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Perkins, 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.