Citation Nr: 22017530 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 16-00 001A DATE: March 25, 2022 REMANDED Entitlement to service connection for bilateral knee disability is remanded. Entitlement to service connection for neurological disability of the bilateral lower extremities is remanded. REASONS FOR REMAND The Veteran had honorable active duty service in the United States Marine Corps from June 1979 to October 1979, and from February 1982 to March 6, 1985, including 30 or more days of service at Camp Lejeune. He also had active service from March 7, 1985 to February 1987 characterized as under conditions other than honorable, and thus no Department of Veterans Affairs (VA) compensation benefits may be paid for disability due to injury or disease in this period of service. This matter is on appeal to the Board of Veterans' Appeals (Board) from a May 2012 rating decision issued by a VA Regional Office (RO). In January 2019, January 2021, and December 2021, this matter was remanded to the Agency of Original Jurisdiction (AOJ) for additional development, and it has since returned for further appellate review. Regrettably, as explained below, another remand is necessary prior to adjudication as there was not substantial compliance with the remand directives. See Stegall v. West, 11 Vet. App. 268 (1998). 1. Service Connection for Bilateral Knee Disability is Remanded. The Veteran contends that his bilateral knee disability was caused by his active duty service, including the cumulative impact of his duties working with and around armored vehicles. See March 2011 Correspondence. As part of the recent December 2021 remand, the Board instructed the AOJ to obtain an addendum VA medical opinion addressing whether the Veteran's knees were related to service, to include as due to the general rigors of service and to allow an examiner to address the medical literatures indicating that veterans are more likely to develop arthritic conditions at an earlier age. In January 2022, a VA medical opinion was given where the examiner concluded that his knees were not related to service. In support of this finding, the examiner stated that the Veteran's service treatment records were silent for any reports of knee problems, and there were no reports of knee problems until February 2011, more than 20 years after service. Regarding the medical literature submitted by the Veteran, the examiner noted that there were several other conditions that increase the risk for arthritis, including the Veteran's history of HIV and chronic cocaine abuse. However, a review of VA treatment records obtained from the Social Security Administration (SSA) indicates that the Veteran had reported bilateral knee pain as early as November 1994, which was prior to his HIV condition. His incarceration treatment records document report of arthritis and joint pain in July 2005, and a December 2010 private treatment records obtained from SSA show the Veteran reporting history of pain from the knees for the past few years. Based on the foregoing, the Board finds that an addendum VA medical opinion should be obtained to discuss these records which document the Veteran's earlier complaints of bilateral knee pain that are inconsistent with the examiner's findings. 2. Service Connection for Neurological Disability of the Bilateral Lower Extremities is Remanded. The Veteran contends that his neurological disability of the bilateral lower extremities was caused by active service. He asserted that he had neuropathy that is painful during the cold weather. See March 2011 Correspondence. In the December 2021 remand, the Board noted that an April 1983 report of medical history showed the Veteran's report of having cramps in his legs when exposed to cold weather. As a medical opinion had not been obtained to address the Veteran's contention, the Board directed the AOJ to obtain an addendum VA medical opinion addressing whether the Veteran's bilateral neurological disorder was due to service, to include his in-service reports of leg cramps. The Veteran was afforded a VA examination in January 2022 where the examiner, after evaluating the Veteran and reviewing the record, concluded that the Veteran does not have a current peripheral nerve condition or peripheral neuropathy. However, contrary to the examination findings, medical records obtained from SSA document history of peripheral neuropathy. See August 2010, December 2010 Treatment Records. A February 2011 VA treatment indicate the Veteran had unspecified idiopathic peripheral neuropathy. Incarceration treatment records from May 2016, July 2016, and November 2016 also show reports of peripheral neuropathy. In a July 2020 VA peripheral nerves examination, the Veteran was diagnosed with bilateral sciatica. The Board previously broadened and recharacterized the Veteran's claim to include any nerve disorder of the lower extremities. Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009). As the records reveal reports of a neurological disorders of the lower extremities, the Board finds that an addendum VA medical opinion must be obtained. The Board emphasizes that it is not determining whether or not the Veteran's statements that he has neurological symptoms in cold weather are credible at this time, as the additional development set forth in the directives below could impact that determination. Although the Board is requesting medical opinions regarding this contention, this is for thoroughness and not based on a finding that it is credible. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all outstanding treatment records relevant to his claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. If any records are not available, or the Veteran identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken, to include notifying the Veteran of the unavailability of the records. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether the current bilateral knee disability onset during service or is otherwise related to an in-service injury, event, or disease, to include the general rigors of service. In offering the opinion, the examiner is asked to consider the report of bilateral knee pain in a November 1994 VA treatment, incarceration treatment records documenting report of arthritis and joint pain in July 2005, and a December 2010 private treatment records obtained from SSA showing report of a history of pain from the knees for the past few years. In answering this question, the examiner must respond to the Veteran's representative's summary of medical literature as set forth in his December 2020 brief. Specifically, that Veterans are more likely to get arthritis and that the Arthritis Foundation also agrees that Veterans have more arthritis overall than the general public. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. 3. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to whether the current neurological disabilities of the bilateral lower extremities onset during service or is otherwise related to an in-service injury, event, or disease, to include his 1983 in-service complaints of leg cramping in cold weather. In offering the opinion, the examiner is asked to consider the Veteran's lay contention that he has neuropathy that is painful in the cold weather. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. D. Martz Ames Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Mathew 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.