Citation Nr: 1321603 Decision Date: 07/05/13 Archive Date: 07/12/13 DOCKET NO. 09-23 210A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Atlanta, Georgia THE ISSUES 1. Entitlement to service connection for a right knee disorder. 2. Entitlement to service connection for a left knee disorder. 3. Entitlement to service connection for a right ankle disorder. 4. Entitlement to service connection for a left ankle disorder. 5. Entitlement to a compensable initial rating for extensor tendon sprain of the right index finger. 6. Entitlement to a compensable initial rating prior to July 5, 2011, for degenerative joint disease of the lumbosacral spine. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD L. Barstow, Counsel INTRODUCTION The Veteran had active military service from November 1985 to November 2008. This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 2009 and July 2012 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO) Columbia, South Carolina and the Appeals Management Center (AMC) in Washington, District of Columbia, respectively. Due to the location of the Veteran's residence, jurisdiction of his appeal is with the RO in Atlanta, Georgia. In December 2010, the Veteran testified at a hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. The case was remanded in May 2011 to obtain additional treatment records and to afford the Veteran a VA examination. Except for the issues of service connection for right and left knee disorders discussed in the remand below, review of the record indicates substantial compliance. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Following the requested development, the AMC issued a rating decision dated in July 2012 granting service connection for degenerative joint disease of the lumbosacral spine with a zero percent evaluation assigned effective the date after the Veteran retired from service, December 1, 2008. A 20 percent rating was assigned from July 5, 2011. A statement from the Veteran received in August 2012 expressed disagreement with the initial zero percent disability rating assigned. He did not disagree with the 20 percent evaluation effective July 5, 2011, but only indicated that the 20 percent rating was warranted from the date of service connection, December 1, 2008. Therefore, the Board has characterized the issue as set forth on the title page. Since the last supplemental statement of the case (SSOC), additional evidence has been received, without a waiver, in the form of a statement from the Veteran. Normally, absent a waiver from the Veteran, a remand is necessary when evidence is received by the Board that has not been considered by the RO. Disabled Am. Veterans v. Sec'y of Veterans Affairs, 327 F.3d 1339 (Fed. Cir. 2003). Here, however, the statement, while pertinent to the issues, is merely cumulative or duplicative of information already in the claims file and therefore, considered by the RO. Consequently, a remand is not necessary. The issues of service connection for right and left knee disorders and for a compensable initial rating prior to July 5, 2011, for degenerative joint disease of the lumbosacral spine being remanded are addressed in the REMAND portion of the decision below and are REMANDED to the RO via the AMC, in Washington, DC. FINDINGS OF FACT 1. The Veteran has not had a right ankle disorder at any time since filing his claim for compensation. 2. The Veteran has not had a left ankle disorder at any time since filing his claim for compensation. 3. The extensor tendon sprain of the right index finger has not resulted in a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible or extension limited by more than 30 degrees. CONCLUSIONS OF LAW 1. A right ankle disorder was not incurred or aggravated in service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 2. A left ankle disorder was not incurred or aggravated in service. 38 U.S.C.A. §§ 1101, 1110, 1131, 5107 (West 2002); 38 C.F.R. §§ 3.102, 3.303, 3.304 (2012). 3. The criteria for a compensable rating for extensor tendon sprain of the right index finger have not been met. 38 U.S.C.A. §§ 1155, 5107 (West 2002); 38 C.F.R. §§ 3.159, 3.321, 4.3, 4.7, 4.71a Diagnostic Code (DC) 5229(2012). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS I. The Veterans Claims Assistance Act of 2000 (VCAA) The VCAA describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103, 5103A, 5107, 5126 (West 2002 & Supp. 2012); 38 C.F.R. §§ 3.102, 3.156(a), 3.159 & 3.326(a) (2012). Upon receipt of a complete or substantially complete application for benefits, VA is required to notify the claimant and his representative of any information, and any medical or lay evidence, that is necessary to substantiate the claim. 38 U.S.C.A. § 5103(a); 38 C.F.R. § 3.159(b); Quartuccio v. Principi, 16 Vet. App. 183 (2002). The VCAA notice must inform the claimant of any information and evidence not of record (1) that is necessary to substantiate the claim; (2) that VA will seek to provide; and (3) that the claimant is expected to provide. VCAA notice should be provided to a claimant before the initial unfavorable agency of original jurisdiction (AOJ) decision on a claim. Pelegrini v. Principi, 18 Vet. App. 112 (2004). The Veteran was notified in a letter dated in November 2008 regarding the type of evidence necessary to establish his claims. He was instructed how to establish service connection. The Veteran was notified of what evidence and/or information was already in the RO's possession, what additional evidence and/or information was needed from the Veteran, what evidence VA was responsible for getting, and what information VA would assist in obtaining on the Veteran's behalf. The letter also notified the Veteran of the criteria for assigning a disability rating and an effective date. See Dingess/Hartman v. Nicholson, 19 Vet. App. 473 (2006). The Board notes that the Veteran's claim for an initial compensable rating for extensor tendon sprain of the right index finger arises from his disagreement with the initial rating following the grant of service connection. Courts have held that once service connection is granted the claim is substantiated, additional notice is not required and any defect in the notice is not prejudicial. Hartman v. Nicholson, 483 F.3d 1311 (Fed. Cir. 2007); Dunlap v. Nicholson, 21 Vet. App. 112 (2007). Regardless, the November 2008 letter informed the Veteran of the criteria for assigning an effective date. See Dingess/Hartman, 19 Vet. App. 473. Regarding VA's duty to assist, VA obtained the Veteran's service treatment records (STRs) and post-service medical records. Pertinent VA examinations were obtained in November 2008 and July 2011. 38 C.F.R. § 3.159(c)(4). The VA examinations obtained in this case are sufficient, as the examiners conducted complete examinations, recorded all findings considered relevant under the applicable law and regulations, and offered well supported opinions based on consideration of the full history of the disorders. The Board finds that VA's duty to assist the Veteran with respect to obtaining a VA examination concerning the issues adjudicated herein has been met. 38 C.F.R. § 3.159(c)(4). VA has no duty to inform or assist that was unmet. The Veteran has not identified any additional pertinent medical records that have not been obtained and associated with the claims folder. The Veteran was also provided with a hearing related to his present claims. In Bryant v. Shinseki, 23 Vet. App. 488 (2010), the United States Court of Appeals for Veterans Claims (Court) held that 38 C.F.R. § 3.103(c)(2) requires the VLJ who chairs a hearing fulfill two duties to comply with the above the regulation. These duties consist of (1) the duty to fully explain the issues and (2) the duty to suggest the submission of evidence that may have been overlooked. In this case, the VLJ explained the issues on appeal, but did not suggest the submission of any additional evidence. This was not necessary, however, because the Veteran fully described why he believed service connection was warranted for right and left ankle disorders and also described his right index finger symptomatology. He also reported being treated by VA and those records were obtained. Accordingly, the Veteran is not shown to be prejudiced on this basis. The Veteran has not asserted that VA failed to comply with 38 C.F.R. § 3.103(c)(2), nor has he identified any prejudice in the conduct of the Board hearing. As such, the Board finds that, consistent with Bryant, the hearing complied with the duties set forth in 38 C.F.R. § 3.103(c)(2). II. Analysis A. Service Connection Service connection may be granted for disability resulting from disease or injury incurred or aggravated during active military service. 38 U.S.C.A. §§ 1110, 1131. Generally, service connection requires (1) the existence of a present disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004). The Board notes that "Congress specifically limits entitlement for service-connected disease or injury to cases where such incidents have resulted in a disability. See 38 U.S.C.A. §§ 1110, 1131. In the absence of proof of present disability there can be no valid claim." Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992); Degmetich v. Brown, 104 F.3d 1328 (1997); Wamhoff v. Brown, 8 Vet. App. 517, 521 (1996). Lay assertions may serve to support a claim for service connection by supporting the occurrence of lay-observable events or the presence of disability or symptoms of disability subject to lay observation. 38 U.S.C.A. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); see Buchanan v. Nicholson, 451 F. 3d 1331, 1336 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The Veteran contends that he has right and left ankle disorders that are related to his military service. He contends that after incurring sprains in-service, he has continued problems with his ankles twisting. See, e.g., March 2009 notice of disagreement. The Board has conducted a careful review of the record, and concludes that the record is without sufficient evidence supportive of a finding that the Veteran has current disabling right and left ankle disorders. In this case, no competent medical evidence has been presented to show that the Veteran has current right and left ankle disabilities that are the result of an in-service injury. The Veteran's service records show left ankle discomfort with X-rays showing considerable swelling of the soft tissues in December 1995 and a left ankle sprain in January 1996. Examinations in December 1997 and March 2003 revealed clinically normal lower extremities. His December 1997 report of medical examination showed that he denied arthritis, rheumatism or bursitis; and bone, joint or other deformity. The March 2003 report of medical examination showed that he answered yes to arthritis, rheumatism or bursitis; and denied bone, joint or other deformity. The Veteran did not report having ankle problems. Records dated from July 2005 through March 2008 show diagnoses of compression arthralgia of the ankle/foot. An examination in May 2008 revealed normal lower extremities; no diagnosis of a bilateral ankle disorder was shown. In his May 2008 report of medical examination, the Veteran answered yes to any need to use corrective devices; in addition to knee braces, he reported having a right ankle brace. Post-service treatment records do not reflect any bilateral ankle complaints or any diagnosis of a disability. While a fee-based examination in November 2008 reflected the Veteran's report of being diagnosed with bilateral ankle sprains as well as his condition existing since 1995, no right or left ankle disorder was diagnosed. After examining the Veteran, the examiner specifically opined that there was no diagnosis because there was no pathology to render a diagnosis. X-rays of both ankles were negative. The Veteran again reported in-service ankle sprains at a July 2011 VA examination. He also reported that if he made the slightest misstep, he could sprain the ankle and then he would have pain for a short period of time. He would shake it lose and the ankle would return to normal. Following an examination, the examiner diagnosed the Veteran with normal right and left ankles. He had a normal examination and no X-ray abnormalities and no disability. It was the examiner's opinion that there was no objective disease in either ankle. Regarding the Veteran's report of a tendency to twisting the ankle, the examiner indicated that that was not necessarily an abnormality. The Veteran had those ankle twists and he recovered from them uneventfully quite speedily. Treatment records and statements from the Veteran fail to show the presence of right and left ankle disorders. While the Veteran is competent and credible to report that his ankles twist, the July 2011 examiner specifically indicated that that was not necessarily an abnormality. Even when taking into account such complaints, no ankle disabilities were diagnosed. As such, the Board concludes that the evidence of record does not show the presence of current right and left ankle disorders. Without a recognized injury or disease entity, VA is not authorized to award compensation for reported symptomatology. 38 U.S.C.A. §§ 1110, 1131; 38 C.F.R. § 3.303(a) (Service connection is awarded for "a particular injury or disease resulting in disability"); see also Sanchez-Benitez v. West, 13 Vet. App. 282, 285 (1999); aff'd Sanchez-Benitez v. Principi, 259 F.3d 1356, 1363 (Fed. Cir. 2001) (The Court held that symptoms alone, without a diagnosed or identifiable underlying malady or condition, does not in and of itself constitute a disability for which service connection may be granted.) The Board has considered McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) which held that the requirement that there be evidence of a current disability in a service connection claim is satisfied by evidence showing that the Veteran had such a disability at the time he filed claim for compensation, or during the pendency of that claim, and that a claimant may be granted service connection even though the disability resolves prior to the Board's adjudication of the claim. The Board again notes, however, that no other evidence of record reflects the presence of a diagnosed disability during that time frame. Although lay persons are competent to provide opinions on some medical issues, see Kahana v. Shinseki, 24 Vet.App. 428, 435 (2011), as to the specific issue in this case, the diagnosis of right and left ankle disorders falls outside the realm of common knowledge of a lay person. See Jandreau at 1377 n.4 (lay persons not competent to diagnose cancer). The Veteran's own assertions as to diagnosis have no probative value. Accordingly, service connection must be denied because there is no competent evidence of a diagnosis of right and left ankle disabilities. See 38 U.S.C.A. §§ 1110, 1131; Brammer at 225; Degmetich, 104 F.3d 1328; Wamhoff at 521. Based on this evidentiary posture, the Board concludes that the preponderance of the evidence is against the Veteran's claims for right and left ankle disorders. As the preponderance of the evidence is against these issues, the benefit-of-the-doubt rule does not apply, and the Veteran's claims of entitlement to service connection for right and left ankle disorders are denied. See 38 U.S.C.A §5107 (West 2002 & Supp. 2012). B. Initial Rating Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities. 38 C.F.R. Part 4. The Board determines the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, and the assigned rating is based, as far as practicable, upon the average impairment of earning capacity in civil occupations. 38 U.S.C.A. § 1155; 38 C.F.R. §§ 4.1, 4.10. Where there is a question as to which of two ratings should be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Court has indicated that a distinction must be made between a Veteran's dissatisfaction with original ratings and dissatisfaction with determinations on later filed claims for increased ratings. See Fenderson v. West, 12 Vet. App. 119, 125-26 (1999). Consequently, the Board will evaluate the Veteran's right finger disability as a claim for a higher evaluation of the original award. Also, when an original rating is appealed, consideration must be given as to whether an increase or decrease is warranted at any time since the award of service connection, a practice known as "staged" ratings. Id. The Veteran's service-connected extensor tendon sprain of the right finger is rated as zero percent or noncompensably disabling under 38 C.F.R. § 4.71a, DC 5229, which evaluates impairment from limitation of motion of the index or long finger. As the Veteran is right handed, the criteria for the major hand apply. Although service connection for the right index finger was granted, the Veteran has contended that it is actually his middle or long finger that is affected. See, e.g., December 2010 Hearing Transcript (T.) at 3. However, in an August 2012 statement, the Veteran indicated that it was his right index finger instead of his middle or long finger, consistent with his October 2008 claim seeking service connection for the index finger. As the evidence does not affirmatively show that it is not the right index finger, the Board considers the right index finger to be service-connected. Regardless, the rating criteria for the index and middle or long fingers is the same and the VA examinations show findings for both fingers. Pursuant to DC 5229, a zero percent or noncompensable rating is warranted with a gap of less than one inch (2.5 cm.) between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, and; extension is limited by no more than 30 degrees. 38 C.F.R. § 4.71a, DC 5229. A 10 percent rating is warranted with a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible, or; with extension limited by more than 30 degrees. Id. Based on the evidence of record, the Board concludes that an initial compensable rating is not warranted at any time during this appeal period. The pertinent evidence of record fails to show that the Veteran's right index finger range of motion has approximated the criteria for a compensable rating. In this case, the Veteran's range of motion has not resulted in a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible or extension limited by more than 30 degrees. At a November 2008 fee-based examination, the Veteran denied any functional impairment. His right hand fingertips could approximate the proximal transverse crease of the palm. With the thumb attempting to oppose the fingers, the measurement between the tip of the right thumb and the tip of the index and long fingers was zero cm. With the thumb attempting to oppose the fingers, the measurement between the pad of the right thumb and the index and long fingers was also zero cm. His right hand strength was within normal limits. Ranges of motion of both his right index and long fingers were flexion to 70 degrees of the distal interphalangeal (DIP) joint; flexion to 110 degrees of the proximal interphalangeal (PIP) joint; and flexion to 90 degrees of the metacaropophalangeal (MP) joint. Joint function was not additionally limited by pain, fatigue, weakness, lack of endurance or incoordination after repetitive use. The findings shown on this examination do not equate to a compensable rating. There were zero cm. between the fingertips and the proximal transverse crease of the palm, while a 10 percent rating contemplates a gap of one inch (2.5 cm.) or more. Furthermore, examination did not reveal that extension was limited by more than 30 degrees. Therefore, a compensable rating based on the results of this examination is not warranted. At his December 2010 hearing, the Veteran demonstrated that his finger could not be straightened. T. at 4. He testified that he had difficulty writing and was embarrassed by the deformity. Id. At a VA examination in July 2011, the Veteran was found to have a swan neck deformity of the middle finger. He also had swan neck deformities in his ring finger and to some extent in his index and small fingers. Thus, that was the way his fingers were built; namely, that his swan neck deformities were part of the way his tendon balance was. It was noted that in the left hand, there was a tendency to swan neck deformities, but they were not as severe as the right. He had full range of motion of the right middle and index fingers; there were no limits in extension. When he completed a fist, his pulps of the index and ring fingers touched the crease of the palm. Hence, there was no proximal transverse crease of the palm with the fingers flexed. He has also had no pain in the fingers. In an addendum, the examiner noted that as the Veteran was able to complete a fist and his fingertip met the palmar crease, there was no disability or abnormality relative to the fingers. X-rays showed hyperextension at the PIP joint. This examination also does not show that a compensable rating is warranted as the Veteran's limitation of motion did not equate to that contemplated for by a 10 percent rating. None of the Veteran's pertinent treatment records, VA examinations or his contentions, indicate that he has a gap of one inch (2.5 cm.) or more between the fingertip and the proximal transverse crease of the palm, with the finger flexed to the extent possible or extension limited by more than 30 degrees. Thus, the evidence does not indicate that an initial compensable rating is warranted at any time during this appeal. In reaching this conclusion, the Board has considered whether the Veteran has painful motion that contributes to the actual limitation of motion such that an increased rating is warranted. Here, the Veteran has not contended having pain on use or that any pain experienced would warrant an increased rating. See 38 C.F.R. § 4.40 (a little used part of the musculoskeletal system due to pain may be expected to show evidence of disuse, either through atrophy, the condition of the skin, absence of normal callosity, or the like). The VA examinations and the Veteran's treatment records fail to show evidence of disuse. Furthermore, the Veteran denied functional impairment at the November 2008 examination while the July 2011 examiner specifically noted that the Veteran had no pain in the fingers. Accordingly, the criteria for an initial compensable rating for limitation of motion for the Veteran's service-connected extensor tendon sprain of the right index finger have not been met. 38 C.F.R. § 4.71a, DC 5229. Furthermore, the rating schedule is primarily a guide in the evaluation of disability resulting from all types of diseases and injuries encountered as a result of or incident to military service. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and their residual conditions in civil occupations. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the disability. 38 C.F.R. § 4.1. The Board notes that in exceptional cases where evaluations provided by the rating schedule are found to be inadequate, an extraschedular evaluation may be assigned which is commensurate with the veteran's average earning capacity impairment due to the service-connected disorder. 38 C.F.R. § 3.321(b). However, the Board believes that the regular schedular standards applied in the current case adequately describe and provide for the Veteran's right index finger symptoms and disability level. Although the Veteran has reported difficulty with writing and being embarrassed by his finger, marked interference with employment beyond that contemplated by the schedular criteria has not been shown. Furthermore, the July 2011 examiner indicated that the swan neck deformity was not due to the Veteran's service-connected disability, but was the way his hand was as evidenced by his other fingers having the same deformity. The record does not reflect a disability picture that is so exceptional or unusual that the normal provisions of the rating schedule would not adequately compensate the Veteran for his service-connected disability. The evidence does not show that the Veteran's right index finger disability has resulted in interference with employment or activities of daily life which would warrant a compensable rating for this disability. Moreover, as the Veteran has not contended, nor does the evidence show that his disability renders him unemployable, the issue of entitlement to a total disability rating based on individual unemployability has not been raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009); Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001). ORDER Entitlement to service connection for a right ankle disorder is denied. Entitlement to service connection for a left ankle disorder is denied. Entitlement to a compensable initial rating for extensor tendon sprain of the right index finger is denied. REMAND A remand is necessary for the Veteran's remaining claims. Regarding the Veteran's claims for right and left knee disorders, these issues were remanded in May 2011 to afford the Veteran a VA examination. The examiner was directed to comment on the significance of abnormalities found on a November 2004 MRI scan of the left knee and on the abnormalities found on a January 2010 MRI scan of both knees. The Veteran was afforded a VA examination in July 2011; the examiner diagnosed the Veteran with normal right and left knees. The rationale was that he had a normal examination and normal X-rays and no disability. In reviewing the Veteran's claims file, the examiner noted the January 2010 MRI, but did not note a review of the November 2004 MRI. The examiner did not comment on the significance of abnormalities found on the November 2004 and January 2010 MRI scans as directed by the Board. In this regard, the Board is unclear as to how the examiner opined that the Veteran had normal knees when abnormalities were shown on the January 2010 MRI scan. Where the remand orders of the Board or the Court are not complied with, the Board errs as a matter of law when it fails to ensure compliance, and further remand will be mandated. Stegall v. West, 11 Vet. App. 268 (1998). As such, the Board finds that the Veteran's claims for service connection for right and left knee disorders must be remanded again for an adequate opinion. As for the Veteran's initial lumbar spine rating claim, as noted in the Introduction, in a July 2012 rating decision, the AMC granted service connection for degenerative joint disease of the lumbosacral spine with a zero percent evaluation assigned effective the date after the Veteran retired from service, December 1, 2008. A 20 percent rating was assigned from July 5, 2011. A statement from the Veteran received in August 2012 expressed disagreement with the initial zero percent disability rating assigned. He did not disagree with the 20 percent evaluation effective July 5, 2011, but only indicated that the 20 percent rating was warranted from the date of service connection, December 1, 2008. The Board observes that no statement of the case (SOC) has been issued as to this initial rating claim. The claim must be remanded to allow the RO to provide the Veteran with an SOC on this issue. Manlincon v. West, 12 Vet. App. 238, 240-41 (1999); see also Godfrey v. Brown, 7 Vet. App. 398, 408-410 (1995); Archbold v. Brown, 9 Vet. App. 124, 130 (1996); VAOPGCPREC 16-92 (O.G.C. Prec. 16-92). However, the issue will be returned to the Board after issuance of the statement of the case only if perfected by the filing of a timely substantive appeal. See Smallwood v. Brown, 10 Vet. App. 93, 97 (1997); Archbold, 9 Vet. App. at 130. Accordingly, the case is REMANDED for the following action: 1. Obtain an addendum medical opinion from the July 2011 VA examiner (or, if unavailable, from a medical professional with appropriate expertise). The Veteran's claims file, including a copy of this remand, must be made available to the examiner for review in connection with the examination. A notation to the effect that this review has taken place should be made in the evaluation report. The examiner is requested to review the record, and offer an opinion reconciling the abnormal findings shown on November 2004 and January 2010 MRI scans with the diagnosis of normal knees. The examiner should explain why the Veteran was diagnosed with normal knees on examination when MRI scans show abnormalities. If the examiner concludes that the Veteran does in fact have right and left knee disorders, then they should opine as to whether it is more likely than not (i.e., probability greater than 50 percent), at least as likely as not (i.e., probability of approximately 50 percent), or less likely than not (i.e., probability less than 50 percent) that any diagnosed right and left knee disorders are related to the Veteran's military service. A complete rationale should be given for all opinions and conclusions expressed. If the examiner must resort to speculation to render the requested opinion, he/she must state what reasons, with specificity, that this question is outside the scope of a medical professional conversant in VA practices. 2. Ensure that the addendum report complies with (answer the questions posed in) this Remand. If the report is insufficient, it should be returned to the examiner for corrective action, as appropriate. 3. Provide the Veteran with a statement of the case as to the issue of an initial compensable rating prior to July 5, 2011, for degenerative joint disease of the lumbosacral spine. The Veteran should be informed that he must file a timely and adequate substantive appeal in order to perfect an appeal of this issue to the Board. See 38 C.F.R. §§ 20.200, 20.202, and 20.302(b). If a timely substantive appeal is not filed, the claim should not be certified to the Board. 4. Then, readjudicate the issues of service connection for right and left knee disorders remaining on appeal. If any benefit remains denied, the Veteran and his representative should be provided a supplemental statement of the case and given an appropriate opportunity to respond. The case should then be returned to the Board for further consideration. The Veteran has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). ______________________________________________ MICHAEL MARTIN Veterans Law Judge, Board of Veterans' Appeals Department of Veterans Affairs