Citation Nr: 18131292
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 10-22 344A
DATE:	August 31, 2018
REMANDED
Entitlement to service connection for a left knee disability is remanded.
Entitlement to service connection for a back disability is remanded.
Entitlement to service connection for a left eye disability is remanded.
REASONS FOR REMAND
The Veteran served on active duty from September 1976 to November 1988.  This matter comes before the Board of Veterans’ Appeals (Board) on appeal from May 2008 and June 2009 rating decisions.  The Veteran testified at an October 2012 videoconference hearing.  In October 2012, the Board sent the Veteran a letter informing him that it was unable to produce a written transcript of the October 2012 hearing and asked him to indicate whether he wanted to attend a new hearing.  The Veteran responded that he did not wish to have another hearing.  In December 2015, the Board issued a decision, which denied service connection for left eye, back, and bilateral knee disabilities.  Unsatisfied with these denials, the Veteran appealed to the United States Court of Appeals for Veterans Claims, which, in a February 2018 memorandum decision, vacated that part of the Board’s December 2015 decision denying service connection for back, left knee, and left eye disabilities and remanded these matters to the Board for further development.
1. Entitlement to service connection for a left knee disability is remanded.
The Veteran underwent a VA knee examination in July 2015.  The examination report indicates a negative history for tibial conditions, including stress fractures.  This finding is inconsistent with the evidence of record, specifically with a February 1988 physical therapy note showing a finding of left tibial stress fracture.  As the April 2015 VA examination does not show adequate consideration of the relevant evidence, a new VA examination is required.  See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007).  The VA examiner should provide an opinion that shows adequate consideration of the Veteran’s left knee medical history.  On remand, the VA examiner should also address whether the Veteran’s in-service left ischial tuberosity band injury (see September 1979 service treatment note) is at least as likely as not related to his current left knee disability.
2. Entitlement to service connection for a back disability is remanded.
In May 2013, the Board remanded for a VA examination to determine whether the appellant has a thoracic or lumbosacral condition that was related to service.  The examiner was required to acknowledge and comment on the Veteran’s head injury in service in May 1979.  Consequently, in November 2013, the Veteran underwent a VA thoracolumbar spine examination.  The examiner concluded that the Veteran’s diagnosis of degenerative joint disease of the lumbar spine is less likely as not related to service.  The examiner’s opinion acknowledged the May 1979 head injury, but did there is no comment about this incident.  As the November 2013 VA opinion does not show substantial compliance with the Board’s remand directive, a remand is required.  See Stegall v. West, 11 Vet. App. 268, 271 (1998).  
3. Entitlement to service connection for a left eye disability is remanded.
The Veteran underwent a VA eye examination in July 2015.  The examiner diagnosed severe vision loss of the left eye from a 2008 retinal detachment.  The examiner noted on the Veteran’s reports of hypertension since 2006 and that the medical history showed that a hemiretinal occlusion occurred in the left eye in July 2007.  The examiner opined that the Veteran’s vision loss was less likely as not caused by or related to trauma during service.  The examiner concluded that vision loss is caused by retinal detachment from nonclearing vitreous hemorrhage and vein occlusion, adding that vein occlusion and vitreous hemorrhage are often associated with hypertension.  Regarding the Veteran’s cataracts, the examiner indicated that the cataracts noted during the eye examination were consistent with aging and with ocular retinal surgery, adding that cataracts associated with trauma have a stellate appearance.  The July 2015 VA opinion is inadequate because the examiner failed to support his conclusion that the Veteran’s nonclearing vitreous hemorrhage and vein occlusion were not caused by the Veteran’s in-service head trauma.  Although the examiner appears to relate these conditions to hypertension based on the relative closeness in time of diagnoses, no explanation was provided as to why the causes of the Veteran’s retinal detachment were not related to in-service head trauma.  Unlike the examiner’s rationale regarding the Veteran’s cataracts, i.e., that cataracts associated with trauma would a different appearance than the Veteran’s condition, no reason was given for the causes of the retinal detachment.  As such, remand is required for VA to provide an eye examination that contains an adequate rationale for any determinations made.  See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (concluding that a medical opinion is not entitled to any weight if it contains only data and conclusions).
The matters are REMANDED for the following action:
1. Schedule the Veteran for a VA examination to determine the etiology of any current left knee disability.  
For each current left knee disability identified (i.e. any left knee disability diagnosed since August 2002), the examiner shall answer the following questions:
(a.) Is it at least as likely as not (50 percent or greater probability) that any left knee disability diagnosed since August 2002 had its onset in service, had its onset in the year immediately following service (in the case of any currently diagnosed arthritis), is related to the Veteran’s treatment for a knee injury in October 1987, or is otherwise the result of a disease or injury in service?  The VA examiner should discuss a February 1988 physical therapy note showing a finding of left tibial stress fracture.  The VA examiner should also discuss whether the Veteran’s in-service left ischial tuberosity band injury (see September 1979 service treatment note) is at least as likely as not related to his current left knee disability.  
The examiner must provide an adequate rationale for any determinations made.  He or she should consider all relevant evidence, to include recently received treatment records.  In this regard, the Board notes that, in April 2018, the Veteran submitted a private medical statement from Dr. R.G.V., indicating that the Veteran’s hip and left knee pain are secondary to the injury suffered in service.  See VBMS: 04/11/2018, Medical Treatment Record - Non-Government Facility, at 2.
2.  Schedule the Veteran for a VA examination to determine the etiology of his current back disability.  
For each current back disability identified (i.e. any thoracic or lumbar spine disability diagnosed since February 2007), the examiner shall answer the following question:
(a.) Is it at least as likely as not (50 percent or greater probability) that the current back disability had its onset in service, had its onset in the year immediately following service (in the case of any current arthritis), is related to the Veteran’s back problems in service in March 1979 and June 1986, is related to his head injury in service in May 1979, or is otherwise the result of a disease or injury in service?
In formulating the above opinion, the examiner must acknowledge and comment on all back disabilities diagnosed since February 2007, all instances of treatment for back problems in the Veteran’s service treatment records (including the treatment for back pain in March 1979 and June 1986), and the Veteran’s head injury in service in May 1979.  
The examiner must provide an adequate rationale for any determinations made.  He or she should consider all relevant evidence, to include recently received treatment records.  In this regard, the Board notes that, in February 2017, the Veteran submitted a private medical statement from Dr. K.R., indicating that Veteran’s back disability was likely incurred in service.  See VBMS: 02/08/2017, Medical Treatment Record - Non-Government Facility, at 9; see also prior October 2012 medical statement from Dr. K.R., in VBMS: 06/04/2015, Medical Treatment Record - Non-Government Facility, at 4.
3.  Schedule the Veteran for a VA eye examination to determine the etiology of any current left eye disability.
For each current left eye disability identified (i.e., any left eye disability diagnosed since February 2007), the examiner shall answer the following questions:
(a.) Is it at least as likely as not (50 percent or greater probability) that the current left eye disability had its onset in service, is related to the Veteran’s head injury in service in May 1979, or is otherwise the result of a disease or injury in service?
(b.) Which diagnosed eye conditions, if any, are refractive errors not caused by acquired disability?
The examiner must provide an adequate rationale for any determinations made.  He or she should consider all relevant evidence, to include recently received treatment records.  In this regard, the Board notes that, in June 2018, the Veteran submitted a private medical statement from Dr. D.F.M., indicating that the Veteran’s loss of vision is likely related to earlier traumatic brain injury.  See VBMS: 06/15/2018, Medical Treatment Record - Non-Government Facility, at 3.

 
JAMES L. MARCH
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	P. López, Associate Counsel