Citation Nr: 22014597
Decision Date: 03/14/22	Archive Date: 03/14/22

DOCKET NO. 17-22 551
DATE: March 14, 2022

REMANDED

Entitlement to service connection for joint pain of the lower extremities is remanded.

REASONS FOR REMAND

The Veteran served on active duty in the United States Army from June 1969 to December 1970 and December 1990 to March 1991 with service in the Republic of Vietnam and Southwest Asia.

In February 2020, the Veteran testified at a video conference hearing before the undersigned.  A transcript of the hearing has been associated with the claims file.

1. Entitlement to service connection for joint pain of the lower extremities is remanded.

The Veteran's claim was remanded for a VA contract opinion in February 2020.  Two opinions were obtained in March 2020 and October 2020.  See VA-LHI opinions, March 2020, October 2020.  Both examiners concluded that the Veteran's current knee complaints were not related to service because there was no documented in-service knee complaints.  However, as the Veteran has medals indicating combat service for his second period of service, his reports of jumping off helicopters and self-medicating for knee pain while serving as a respiratory therapist are sufficient proof of in-service knee complaints.  38 U.S.C. § 1154(b).  The claim must be remanded for an addendum opinion that considers these contentions and whether they might be related to his current lower extremity symptoms.  

The matters are REMANDED for the following actions:

1. Send the Veteran's claims file to an appropriate examiner to provide an addendum opinion regarding the nature and etiology of his bilateral lower extremity disability, to include osteoarthritis of the bilateral knees.  The Veteran may be recalled for examination if deemed necessary.

a)	The examiner must state whether it is at least as likely as not that the Veteran's osteoarthritis of the bilateral knees, patellofemoral pain syndrome, or any other disability of the lower extremities is related to an in-service injury, event, or disease.  

b)	THE EXAMINER SHOULD SPECIFICALLY ADDRESS THE VETERAN'S CONTENTIONS THAT HE HAD TO CARRY HEAVY EQUIPMENT AS A RESPIRATORY THERAPIST, JUMP 10-12 FEET OUT OF HELICOPTERS WITH EQUIPMENT, AND THAT HE SELF-MEDICATED IN SERVICE.  THE EXAMINER IS ADVISED THAT THE VETERAN'S STATEMENTS OF SUCH CONDITIONS DURING HIS SECOND PERIOD OF SERVICE ARE SUFFICIENT PROOF THAT THEY OCCURRED.  

c)	Based on the Veteran carrying heavy equipment as a respiratory therapist, does the Veteran's current disability align with how the disability is known to develop. 

d)	Based on the Veteran jumping 10-12 feet out of helicopters with equipment, does the Veteran's current disability align with how the disability is known to develop. 

The term "at least as likely as not" does not mean "within the realm of medical possibility."  Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion.

2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL.

IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED.  

IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION.

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YVETTE R. WHITE

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board	M. Moore, 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.