200428-80604
200428-80604
| Board of Vet. App. | Jun 30, 2021Background
- Veteran served in the U.S. Air Force Mar 2014–Apr 2016 with additional ACDUTRA/INACDUTRA; appealed a Jan 2020 rating decision under the AMA Direct Review lane.
- Claims on appeal: service connection for low back strain; left knee (ACL reconstruction); right knee condition; right foot neuropathy (including as secondary to a service‑connected right ankle).
- Prior development: service treatment records and private opinions show pre‑service left ACL repair and in‑service knee/back complaints; MRIs (Nov 2019 spine; Dec 2019 left knee) show degenerative changes and meniscal tear; June 2019 VA exams addressed back and knees but were found inadequate.
- Veteran reported in‑service fall during winter warfare drills (back), recurrent knee symptoms, and right foot numbness/tingling with weight bearing; RO has not provided copies of requested VA exams per the Veteran’s Feb 2020 request.
- Board found existing medical opinions insufficient (failure to address imaging, treatment records, aggravation analysis, and causation/aggravation separate findings) and ordered remand for new VA examinations and further development (including provision of records to examiner and to Veteran).
Issues
| Issue | Veteran's Argument | VA/RO's Argument | Held |
|---|---|---|---|
| Service connection — low back strain | Back pain began after in‑service fall and continued post‑service; MRI shows degenerative disease | June 2019 VA exam found no diagnosed back disorder related to service | Remanded for a new exam to determine nature and etiology; prior exam inadequate given later MRI and STRs |
| Service connection — left knee (ACL reconstruction) | Left knee symptoms and treatment in service aggravated pre‑service ACL repair | RO relied on pre‑service ACL repair and prior VA exam concluding no service‑connected aggravation | Remanded for new exam addressing STRs, private July 2012 opinion, imaging, and whether pre‑existing condition was clearly and unmistakably not aggravated in service |
| Service connection — right knee condition | Right knee MCL sprain and in‑service injury caused or began during service | June 2019 VA examiner said right MCL resolved and found no nexus; lacked explanatory rationale | Remanded for new exam to determine onset/relationship to service with rationale considering lay statements and treatment records |
| Service connection — right foot neuropathy (including secondary to right ankle) | Foot numbness/tingling worsens with weight bearing; may be secondary to service‑connected right ankle | No VA exam has been conducted for foot neuropathy; RO has provisional foot/ankle diagnoses in records | Remanded for VA exam to identify foot disabilities, opine on causation and/or aggravation by service‑connected ankle, and assess relation to service/ACDUTRA/INACDUTRA (separate analyses required) |
Key Cases Cited
- Saunders v. Wilkie, 885 F.3d 1356 (Fed. Cir. 2018) (pain can be a compensable impairment; disability based on pain may require showing functional impairment)
- McLendon v. Nicholson, 20 Vet. App. 79 (2006) (VA duty to assist may require a medical examination when evidence indicates a plausible link between current disability and service)
- Atencio v. O'Rourke, 30 Vet. App. 74 (2018) (causation and aggravation are separate concepts and require distinct findings and rationales)