Citation Nr: 18139644
Decision Date: 09/28/18	Archive Date: 09/28/18

DOCKET NO. 16-27 509
DATE:	September 28, 2018
REMANDED
Entitlement to service connection for a left knee disability, to include osteoarthritis, is remanded.
Entitlement to service connection for a right knee disability, to include osteoarthritis, is remanded.
Entitlement to service connection for hypertension is remanded.
INTRODUCTION
The Veteran served on active duty from November 1979 to August 1983, from January 1988 to June 1988, from June 2012 to November 2012, and from December 2012 to September 2013.  He had additional periods of active duty for training including from June 2008 to August 2008.
REASONS FOR REMAND
1. Entitlement to service connection for a bilateral knee disability
The Veteran seeks service connection for a bilateral knee disability, which he contends originated or was aggravated by his active service.  Specifically, he alleges he injured his knees during his Initial Active Duty for training in June 2008, which required daily and continuous use of the knees including regular force marches, sprints, and running without having the proper recovery time to allow his knees to heal correctly.  Additionally, the Veteran stated he injured the right knee during his annual training in July 2015, which was diagnosed as a right knee medial meniscus tear.
Service treatment records (STRs) reflect the Veteran was diagnosed with osteoarthritis of the bilateral knees in July 2008.  Further, he was given a permanent physical profile due to his bilateral knee condition. 
The Veteran was afforded a VA knee examination in January 2015.  The examiner confirmed the Veteran’s diagnosis of bilateral knee osteoarthritis.  However, the examiner did not provide a nexus opinion or otherwise address the nature and etiology of the Veteran’s bilateral knee disability.
The Board finds VA must provide an additional examination and secure an adequate opinion regarding the Veteran’s claim of service connection for a bilateral knee disability.
2. Entitlement to service connection for hypertension
The Veteran claims service connection for hypertension, which he contends originated during service and continues to the present.  Specifically, he alleges his hypertension was the result of the stress experienced during service, noting that his blood pressure was within acceptable ranges prior to service.
The Veteran’s STRs reflect multiple readings of elevated blood pressure throughout his military service, dating back to his initial period of active service.  Further, he was diagnosed with hypertension and given a physical profile for this condition in August 2011. 
The Veteran was afforded a VA hypertension exam in January 2015.  The examiner confirmed the Veteran’s diagnosis of hypertension.  However, the examiner did not provide a nexus opinion or otherwise address the nature and etiology of the Veteran’s hypertension.
In light of the foregoing, the Board finds VA must provide an additional examination and secure an adequate opinion regarding the Veteran’s claim of service connection for hypertension.
The matters are REMANDED for the following action:
1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims including any recent or additional treatment records related to the claimed disabilities.  If any requested records are not available, the file should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159(e).
2. Then, afford the Veteran a VA examination by a clinician with sufficient expertise to diagnose and determine the nature and etiology of the Veteran’s claimed hypertension and bilateral knee osteoarthritis.
All pertinent evidence of record must be made available to and reviewed by the examiner.  Any required studies should be performed, and all clinical findings should be reported in detail.
Based on a review of the evidence of record, lay statements, and examination results, the examiner should state an opinion with respect to:
•	Whether the Veteran’s hypertension was at least as likely as not (a 50 percent probability or greater) incurred in or aggravated by the Veteran’s active service, or is otherwise etiologically related to his active service.  In doing so, the examiner must specifically address the multiple readings of elevated blood pressure throughout the Veteran’s STRs.
•	Whether any diagnosed knee disability was at least as likely as not (a 50 percent probability or greater) incurred in or aggravated by the Veteran’s active service, or is otherwise etiologically related to his active service, to specifically include as result of his June 2008 and July 2015 knee injuries.
For the purposes of this opinion, the examiner should note that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including events and symptoms.  If there is a medical basis to support or doubt the history provided by the veteran, the examiner should provide a fully reasoned explanation.
The examiner must provide a complete rationale for all proffered opinions.  If the examiner cannot provide the required opinions without resorting to speculation, he or she shall provide a complete explanation as to why that is the case.  Further, the examiner must state whether the inability to provide the required opinions is based on a personal limitation or on a lack of knowledge among the medical community at large.
3. Finally, undertake any other development determined to be warranted, and readjudicate the issues on appeal.  If the benefits sought on appeal are not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished an appropriate Supplemental Statement of the Case and be afforded the requisite opportunity to respond.  Thereafter, if required, the case should be returned to the Board for further appellate action.
 
T. REYNOLDS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Martinez, Associate Counsel

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

For Cases & Decisions that Could Save Your VA Service-Connected Claims! Visit: VAClaims.org ~ A Non-Profit Non Governmental Agency


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