Citation Nr: 23011908 Decision Date: 02/27/23 Archive Date: 02/27/23 DOCKET NO. 18-45 493 DATE: February 27, 2023 REMANDED Entitlement to service connection for a bilateral wrist disability is remanded. Entitlement to service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran had active duty service from February 1980 to July 1983. This appeal comes to the Board of Veterans' Appeals (Board) from a rating decision dated September 2017 issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran timely appealed. The appellant testified at a March 2022 video hearing with the undersigned Veterans Law Judge. A transcript of the hearing has been reviewed and associated with the claims file. The Veteran's appeal has previously been before the Board. In July 2022, the Board remanded the Veteran's claims to the Agency of Original Jurisdiction (AOJ) for additional development. 1. Entitlement to service connection for a bilateral wrist disability is remanded. The Veteran claims entitlement to service connection for a bilateral wrist disability. In his March 2022 hearing, the Veteran's attorney testified that he had a bilateral wrist disability due to being aboard a ship while in service. He contended that his bilateral wrist disability was due to the wear and tear of working on the flight line aboard the ship. He fell a couple of times on the hard surface of the ship. His injuries got to the point where he could not stand more than 10 to 15 minutes before he had to sit down. It had progressively gotten worse over time. He used braces on his wrists. A review of the Veteran's medical treatment records shows that a VA treatment record dated in March 2017 includes a Past Medical History of "Chronic OA (knees, wrists b/l)." In its remand, the Board referred to this record as potential evidence of a current disability of chronic osteoarthritis of the bilateral wrists sufficient to trigger the duty to obtain an examination. The Board remanded the Veteran's claim in July 2022 to obtain a VA medical opinion. Specifically, the examiner was asked to identify any bilateral wrist disability that had been present at any time since April 2016. For each bilateral wrist disability identified, the examiner was asked to address whether the disability began in service and if the disability was related to the Veteran's active duty service, to include the falls he sustained aboard the ship. Thereafter, in August 2022, an examiner determined that the Veteran's bilateral wrist disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reviewed the evidence of record and wrote, No radiologically confirmed wrist arthritis, and no physical exam of the wrist that would indicate the diagnosis for left wrist disability. Medical records from active duty period 1980 through 1983 do not show any evidence of wrist injury or chronic wrist pain, while they do document injury to the ankle and leg cramps, shortly before separation. There are no medical records from the period between separation in 1983, and 2015 when claimant had admitted for psychiatric reasons, and besides hypertension, no medical problems were mentioned. He had no pain of wrists and full range of motion in 2017. There are retrospective mentions of left hand surgery after separation in 1984- circumstances unclear. With no diagnosis, or evidence of chronic wrist pain, it is less likely than not that claimant's right or left wrist disability is sustained while in active duty. The Board finds an addendum opinion is necessary to ensure substantial compliance with its prior remand directive. The examiner's opinion accurately reflected the medical record when finding there is no current disability of the bilateral wrists, except it did not address the March 2017 VA treatment record with a Past Medical History of "Chronic OA (knees, wrists b/l)." It also did not address the Veteran's lay statements that he hurt his wrists falling aboard the ship in service and it has progressively worsened over time. Thus, the Board finds that remand is required to provide an in-person examination, including X-rays to establish whether the Veteran currently has osteoarthritis of the bilateral wrists and to take into consideration the Veteran's lay statements and testimony of the falls he sustained aboard the ship and progressively worsening symptoms over time. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided). 2. Entitlement to service connection for a right knee disability is remanded. The Veteran claims entitlement to service connection for a right knee disability. In a January 2018 NOD, the Veteran stated that his arthritis occurred from repeated activity aboard the ship and flight deck. In his March 2022 hearing, the Veteran's attorney testified that he had a right knee disability that was incurred in service. He contended that his right knee disability was due to the wear and tear of working on the flight line aboard the ship. He fell a couple of times on the hard surface of the ship. His injury got to the point where he could not stand more than 10 to 15 minutes before he had to sit down. It had progressively gotten worse over time. He wore a brace on his right knee. He also had fluid drained from his knee a few times. He took pain medication every day for treatment. He was recommended for a knee replacement. A review of the Veteran's medical treatment records shows that he has a current right knee disability, to include diagnoses of chronic osteoarthritis, arthralgia of the knees, and degenerative joint disease. In November 2015, the Veteran reported chronically recurring right knee pain. In March 2017, the Veteran reported chronic arthritis and a painful right knee. An X-ray of the Veteran's right knee in August 2017showed right knee degenerative joint disease. A September 2017 X-ray of the right knee showed osteoarthritis of the right knee, symptomatic. In March 2018, the Veteran reported arthritis of the right knee which flared up on occasion. The Board remanded the Veteran's claim in July 2022 to obtain a VA examination. Specifically, the examiner was asked to identify any right knee disability that had been present at any time since April 2016. For each right knee disability identified, the examiner was asked to address whether the disability began in service and if the disability was related to the Veteran's active duty service, to include the falls he sustained aboard the ship. Thereafter, in August 2022, an examiner determined that the Veteran's right knee disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. The examiner reviewed the evidence of record and wrote, MRI shows radiologically confirmed osteoarthritis, and meniscal injury of right knee, so presumptive diagnosis is right knee osteoarthritis and meniscal tear. Medical records from active duty period 1980 through 1983 do not show any evidence of knee injury or chronic knee pain, while they do document injury to the ankle and leg cramps, shortly before separation. There are no medical records from the period between separation in 1983 and 2015 when claimant had admitted for psychiatric reasons, and besides hypertension, no medical problems were mentioned. There are retrospective mentions in 2016 of right knee surgery after separation but without date- circumstances unclear. Claimant had knee pain documented in 2017. With no evidence of chronic knee pain, and possible knee surgery after separation, it is less likely than not that claimant's right knee disability is sustained while in active duty. The examiner, however, did not address the Veteran's lay statements and testimony of the falls that he sustained in service aboard the ship, or his testimony of progressive worsening over time. Thus, the Board finds that remand is required to obtain an addendum opinion from the August 2022 examiner addressing the Veteran's lay statements and testimony, to include the falls he sustained aboard the ship, and explaining whether they believe his current right knee disability is related to these falls. Accordingly, the matters are REMANDED for the following action: 1. Request a VA examination addressing the Veteran's bilateral wrist disability, to include an in-person examination that includes X-rays to establish whether osteoarthritis of the bilateral wrists is currently present. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following questions: (a.) Based on the results of the X-rays, has the Veteran had any bilateral wrist disability at any time since April 2016? If no current disability is found, please explain the significance of the March 2017 VA treatment record with a Past Medical History of "Chronic OA (knees, wrists b/l)." (b.) For any bilateral wrist disability identified in part (a): i. Did the disability begin in service? Why or why not? ii. Is the disability related to the Veteran's active duty service, to include the falls he sustained aboard the ship? Why or why not? If the examiner rejects the Veteran's lay evidence, there must be an explanation for why. 2. Request an addendum opinion from the August 2022 examiner addressing the Veteran's right knee disability. In-person examination is not necessary. Based upon a review of the entirety of the claims file, the examiner is requested to provide an opinion as to the following question: (a.) Please address the Veteran's lay statements and testimony, to include the falls he sustained aboard the ship, and progressive worsening over time. Please state whether his current right knee disability is related to these falls. Why or why not? If the examiner rejects the Veteran's lay evidence, there must be an explanation for why. (Continued on the next page) Explanations for all opinions must be provided. In providing the rationale, the examiner is asked to cite to the pertinent evidence of record, including clinical records and the Veteran's statements regarding the onset of his symptoms. LAURA E. COLLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Minock 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.