Citation Nr: 18140134 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 13-10 997 DATE: October 2, 2018 ORDER Entitlement to an initial 40 percent rating effective May 23, 2016, for peripheral neuropathy of the left upper extremity is granted. Entitlement to a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for degenerative joint disease of the right knee is denied. Entitlement to a temporary total disability rating based on surgical treatment necessitating convalescence for a service-connected right knee disability effective from August 23, 2012, through December 31, 2012, is granted. REMANDED Entitlement to a disability rating greater than 30 percent effective June 1, 2015, for residuals of a right total knee arthroplasty is remanded. Entitlement to a disability rating greater than 20 percent for a left shoulder disability is remanded. FINDINGS OF FACT 1. The record evidence shows that, prior to May 23, 2016, the Veteran’s service-connected peripheral neuropathy of the left upper extremity is manifested by, at worst, complaints of numbness and weakness of the left upper extremity, constant left arm pain, and decreased sensation. 2. The record evidence shows that, effective May 23, 2016, the Veteran’s service-connected peripheral neuropathy of the left upper extremity is manifested by, at worst, severe intermittent pain, paresthesias and/or dysesthesias, and numbness of the left upper extremity. 3. The record evidence shows that, prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, the Veteran’s service-connected degenerative joint disease of the right knee is manifested by, at worst, complaints of pain, knee swelling, giving way, and an antalgic and unstable gait. 4. The record evidence shows that the Veteran had right knee arthroscopic surgery on August 23, 2012. 5. The record evidence shows that the Veteran’s VA treating orthopedic surgeon concluded that his period of convalescence following arthroscopic surgery for a service-connected right knee disability extended through December 30, 2012; this is considered to be the end of his convalescence following right knee arthroscopic surgery on August 23, 2012. CONCLUSIONS OF LAW 1. The criteria for entitlement to an initial 40 percent rating effective May 23, 2016, for peripheral neuropathy of the left upper extremity have been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.124a, Diagnostic Code (DC) 8514 (2017). 2. The criteria for entitlement to a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for degenerative joint disease of the right knee have not been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.71a, DC 5003-5260 (2017). 3. The criteria for entitlement to a temporary total disability rating based on surgical treatment necessitating convalescence for a service-connected right knee disability effective from August 23, 2012, through December 31, 2012, have been met. 38 U.S.C. §§ 1155, 5107 (West 2012); 38 C.F.R. §§ 3.159, 4.30 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1976 to February 1979. This appeal has a long and complicated history. In an October 2013 rating decision, the Agency of Original Jurisdiction (AOJ) granted a temporary total disability rating based on the need for surgical treatment necessitating convalescence effective August 23, 2012, and a 10 percent rating effective October 1, 2012, for the Veteran’s service-connected right knee disability. In a July 2015 rating decision, the AOJ recharacterized the Veteran’s service-connected degenerative joint disease of the right knee as a service-connected right total knee arthoplasty and assigned a temporary total disability rating based on the need for surgical treatment necessitating convalescence effective April 2, 2014, for this disability. The AOJ also assigned a 30 percent rating effective June 1, 2015, for residuals of a service-connected right total knee arthoplasty. Having reviewed the record evidence, the Board finds that the issues on appeal should be characterized as stated above. Most recently, the Board remanded the currently appealed claims to the AOJ in February 2016 for additional development. A review of the claims file shows that there has been substantial compliance with the Board’s remand directives. The Board directed that the AOJ schedule the Veteran for appropriate examinations and obtained updated treatment records. The requested examinations occurred in May 2016 and the identified records subsequently were associated with the claims file. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141 (1999) (holding that another remand is not required under Stegall where the Board’s remand instructions were substantially complied with), aff’d, Dyment v. Principi, 287 F.3d 1377 (2002). A videoconference Board hearing was held in December 2015 before a Veterans Law Judge and a copy of the hearing transcript has been added to the record. After the Veterans Law Judge who held this hearing retired from the Board, the Veteran was provided an opportunity to request another hearing before a different Veterans Law Judge in July 2018 correspondence. He did not respond. See 38 C.F.R. § 20.704 (2017). Increased Rating The Veteran contends that his service-connected peripheral neuropathy of the left upper extremity is more disabling than currently (and initially) evaluated. He also contends that his service-connected degenerative joint disease of the right knee is more disabling than currently evaluated. He further contends that, because his convalescence following arthroscopic surgery for a service-connected right knee disability extended beyond October 1, 2012, he is entitled to an extension of the temporary total disability rating assigned for this disability following this surgery. Neither the Veteran nor his representative has raised any other issues nor have any other issues been reasonably raised by the record. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that Board not required to address issues unless specifically raised by claimant or reasonably raised by record evidence). 1. Entitlement to an initial rating greater than 20 percent for peripheral neuropathy of the left upper extremity The Board finds that the evidence supports assigning an initial 40 percent rating effective May 23, 2016, for peripheral neuropathy of the left upper extremity. The Veteran contends that this disability is more disabling than currently (and initially) evaluated. The record evidence supports his assertions, at least effective May 23, 2016. Prior to this date, the record evidence shows that the Veteran’s service-connected peripheral neuropathy of the left upper extremity is manifested by, at worst, complaints of numbness and weakness of the left upper extremity, constant left arm pain, and decreased sensation. For example, the Veteran’s available service treatment records show an in-service medical history of frequent outpatient treatment for left shoulder problems, including a left shoulder separation following an injury in July 1977 and surgical resection of the left distal clavicle in October 1978 (both of which were noted at the Veteran’s separation physical examination in February 1979). The post-service evidence also does not support assigning an initial rating greater than 20 percent prior to May 23, 2016, for the Veteran’s service-connected peripheral neuropathy of the left upper extremity. It shows instead that, throughout this time period, the Veteran’s service-connected peripheral neuropathy of the left upper extremity is manifested by, at worst, complaints of numbness and weakness of the left upper extremity, constant left arm pain, and decreased sensation (as seen on VA examination in November 2010). VA examination in November 2010 documented complaints of constant neck numbness which “travels all the way down the arm to the fingertips. He also gets a stiff neck.” The Veteran had difficulty with his activities of daily living, including bathing and dressing, due to his left upper extremity problems. He also adjusted how he slept due to his left upper extremity problems. The VA examiner reviewed the Veteran’s claims file, including his service treatment records and post-service VA treatment records. Physical examination showed “generalized muscle weakness of slight decrease in muscle strength against resistance” and no generalized muscle wasting or muscle atrophy. Neurological examination showed coordination within normal limits, motor function within normal limits, decreased sensation of the left upper extremity, and normal reflexes. The VA examiner opined that it was most likely that the Veteran’s peripheral neuropathy of the left upper extremity was related to his in-service left shoulder separation and arthritis. “The rationale is that bone spurs, irritation, and displacement of the bones can cause pinching of the nerves that run through the shoulder capsule causing neuropathy in the hand and arm.” The diagnoses included neuropathy of the left arm secondary to a left shoulder condition. Despite the Veteran’s assertions to the contrary, the record evidence shows that, prior to May 23, 2016, his service-connected peripheral neuropathy of the left upper extremity is manifested by, at worst, complaints of numbness and weakness of the left upper extremity, constant left arm pain, and decreased sensation (as seen on VA examination in November 2010). The Board acknowledges that the Veteran experienced a left shoulder separation and had left shoulder surgery while on active service. The Board also acknowledges that the November 2010 VA examiner related the Veteran’s current peripheral neuropathy of the left upper extremity to his in-service left shoulder problems. There is no indication that, prior to May 23, 2016, the Veteran experienced at least moderate incomplete paralysis of the musculospiral nerve (radial nerve) as is required for an initial rating greater than 20 percent for his service-connected peripheral neuropathy of the left upper extremity under DC 8514. See 38 C.F.R. § 4.124a, DC 8514 (2017). Instead, the record evidence (in this case, VA examination in November 2010) clearly shows that, prior to May 23, 2016, the Veteran’s service-connected peripheral neuropathy of the left upper extremity is, at worst, mildly disabling (i.e., a 20 percent rating under DC 8514). Id. The Veteran also has not identified or submitted any evidence demonstrating his entitlement to an initial rating greater than 20 percent prior to May 23, 2016, for his service-connected peripheral neuropathy of the left upper extremity. Thus, the Board finds that the criteria for an initial rating greater than 20 percent prior to May 23, 2016, for peripheral neuropathy of the left upper extremity have not been met. In contrast, the Board next finds that the record evidence supports assigning an initial 40 percent rating effective May 23, 2016, for peripheral neuropathy of the left upper extremity. VA peripheral nerves conditions Disability Benefits Questionnaire (DBQ) on May 23, 2016, demonstrates that the symptomatology attributable to the Veteran’s service-connected peripheral neuropathy of the left upper extremity worsened effective on that date. For example, at this examination, the Veteran’s complaints included that his “left arm goes to sleep a lot and he has tingling into his fingers and aching.” He also complained of constant tingling in his left fingertips. He was unable to hold his cane in the left hand. He was right-hand dominant. He had severe (usually dull) intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness of the left upper extremity. Physical examination showed 5/5 muscle strength throughout, no muscle atrophy, normal deep tendon reflexes throughout, normal sensation throughout, an antalgic gait which was “secondary to bilateral knee pathology,” and mild incomplete paralysis of the musculotaneous nerve of the left upper extremity. The Veteran stated that his “left arm condition prevents him from doing all kinds of things because he doesn’t want this to flare up.” The diagnosis was radiculopathy. The Veteran contends that his service-connected peripheral neuropathy of the left upper extremity is more disabling than currently (and initially) evaluated. The Board agrees with the Veteran’s assertions, at least effective May 23, 2016. VA examination conducted on that date showed that the symptomatology attributable to the Veteran’s service-connected peripheral neuropathy of the left upper extremity had worsened and resulted in severe (usually dull) intermittent pain, severe paresthesias and/or dysesthesias, and severe numbness of the left upper extremity. These examination findings reasonably suggest that the Veteran experiences severe incomplete paralysis of the musculospiral nerve (radial nerve) of the left upper extremity as is required for a 40 percent rating for the minor (non-dominant) side under DC 8514. See 38 C.F.R. § 4.124a, DC 8514 (2017). Taken together, the record evidence as a whole supports assigning a higher initial 40 percent rating effective May 23, 2016, for the Veteran’s service-connected peripheral neuropathy of the left upper extremity. Id. The evidence does not suggest, however, that the Veteran experiences complete paralysis of the musculospiral nerve (radial nerve) due to his service-connected peripheral neuropathy of the left upper extremity at any time during the appeal period as is required for a higher 60 percent rating under DC 8514. Id. Physical examination on May 23, 2016, showed 5/5 muscle strength throughout and no muscle atrophy. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that the criteria for an initial 40 percent rating effective May 23, 2016, for peripheral neuropathy of the left upper extremity have been met. See also 38 C.F.R. § 3.102 (2017). 2. Entitlement to a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for degenerative joint disease of the right knee The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for degenerative joint disease of the right knee. The Veteran essentially contends that his service-connected degenerative joint disease of the right knee is more disabling than currently evaluated during each of the time periods at issue in this appeal. The record evidence does not support his assertions either prior to August 23, 2012, when he had right knee arthroscopic surgery to treat his service-connected degenerative joint disease of the right knee, or between December 31, 2012, when his post-surgical convalescence ended and April 2, 2014, when he had a right total knee arthoplasty to treat his service-connected degenerative joint disease of the right knee. The Board notes initially that, because temporary total disability ratings were in effect for the Veteran’s service-connected degenerative joint disease of the right knee between August 23, 2012, and October 1, 2012, and between April 2, 2014, and June 1, 2015 (when this disability was recharacterized by the AOJ as a right total knee arthoplasty), increased ratings are not for consideration for either of these time periods. The Board also notes that, because it is granting an extension of the temporary total disability rating for the Veteran’s arthroscopic surgery to treat his service-connected right knee disability through December 31, 2012 (as outlined below), the appropriate time periods at issue here are prior to August 23, 2012, and from December 31, 2012, to April 2, 2014. The record evidence shows that, prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, the Veteran’s service-connected degenerative joint disease of the right knee is manifested by, at worst, complaints of pain, knee swelling, giving way, and an antalgic and unstable gait. For example, on VA examination in June 2010, the Veteran’s complaints included right knee weakness, stiffness, swelling, giving way, lack of endurance, locking, fatigability, deformity, tenderness and pain. He rated his right knee pain as 8/10 on a pain scale (with 10/10 being the worst imaginable pain). He experienced daily flare-ups of right knee pain which lasted for 10 hours at a time. He had difficulty standing or walking for more than 10 minutes. He was unable to run or walk very far, participate in sports or exercise, and squat or kneel. The VA examiner reviewed the Veteran’s claims file, including his service treatment records and post-service VA treatment records. Physical examination in June 2010 showed an antalgic and unstable gait “due to knee pain and lack of balance” and right knee tenderness. Range of motion testing of the right knee showed flexion to 110 degrees with pain beginning at 100 degrees and no additional limitation of motion due to any of the DeLuca factors. There was no ligament instability on the right knee. The Veteran used a cane for ambulation due to knee pain. X-rays showed degenerative arthritis. The diagnoses included degenerative arthritis of the right knee joint. On VA outpatient treatment on January 3, 2012, the Veteran’s complaints included right knee pain and feeling like his right knee is going to give way. Physical examination of the right knee showed moderate effusion, flexion to 110 degrees, and extension to 0 degrees. X-rays showed moderate tricompartmental degenerative joint disease and decreased medial joint space with lateral subluxation of the patella. The impression was degenerative joint disease of the right knee with medial and lateral meniscus tear. On January 31, 2012, the Veteran complained of right knee pain. He reported that an injection in his right knee had helped his pain for 1 week. Physical examination of the right knee showed moderate effusion, flexion to 110 degrees with pain and extension to 0 degrees. X-rays showed tricompartmental degenerative joint disease with minimal decrease in joint space in all 3 compartments. The impression was degenerative joint disease of the right knee with medial and lateral meniscus tear. In June 2012, the Veteran’s complaints included right knee pain. “He states that he is awaiting medical clearance for arthroscopic surgery on his right knee.” The assessment was knee pain. On VA orthopedic consult in July 2012, the Veteran complained of severe right knee pain. His pain had not been relieved by cortisone injections. He was using a cane on his right side. His right knee pain occurred when flexing and standing. He experienced constant pain from the lateral compartment of his right knee “shooting down the outside of his leg.” He also experienced right knee locking, swelling, and giving way. Physical examination of the right knee showed moderate effusion, flexion to 100 degrees with pain and extension to 0 degrees. X-rays were unchanged from January 31, 2012. The impression was unchanged from January 31, 2012. On VA outpatient treatment on August 20, 2012, the Veteran’s complaints included sharp right knee pain in the infrapatellar area “and sharp pains that shoot behind the knee,” giving way, swelling, and locking. A 30-year history of right knee pain, worse in the previous 10 years, was noted. He used a cane in his left hand. Physical examination of the right knee showed no edema, minimal effusion, flexion to 100 degrees with pain and tricompartmental crepitus, and extension to 0 degrees. An magnetic resonance imaging (MRI) scan taken in August 2011 was reviewed and showed a small right knee joint effusion. The assessment was right knee degenerative joint disease with posterior horn of the medial meniscus tear and posterior horn of the lateral meniscus tear. The plan was for the Veteran to undergo right knee surgery. The Veteran was advised that, because he had degenerative joint disease in the right knee, his “symptoms of pain may or may not improve.” The Veteran had right knee arthroscopic surgery on August 23, 2012. On VA outpatient treatment on October 23, 2012, the Veteran complained that his right knee swelled after exercise. He used a cane in his trailer. He requested an evaluation for a right total knee arthoplasty. Physical examination of the right knee showed minimal effusion, flexion to 90 degrees, extension to 0 degrees, and healed surgical portals. The impression was degenerative joint disease of the right knee. On December 23, 2012, the Veteran’s complaints were unchanged. Physical examination of the right knee showed no effusion, flexion to 110 degrees, extension to 0 degrees, and healed surgical portals. The impression was unchanged. In a treatment note dated on January 7, 2013, and included in his VA outpatient treatment records, the Veteran’s VA treating orthopedic surgeon stated that he was status-post right knee arthroscopy on August 23, 2012, and “his period of convalescence extends until Dec[ember] 30, 2012.” On VA outpatient treatment in April 2013, the Veteran complained that his right knee was painful. He reported that cortisone injections in his right knee lasted for a few weeks in treating his right knee pain. He used a cane in his trailer and rated his right knee pain as 7/10 on a pain scale. The Veteran did not want another injection in his knee but asked for a knee brace. Physical examination of the right knee was unchanged from December 23, 2012. The impression also was unchanged from December 23, 2012. The Veteran was advised that he could undergo a right total knee arthoplasty once his body mass index went down. In September 2013, the Veteran requested an injection of Kenalog in his right knee. He wore a knee brace on his right knee. Physical examination of the right knee showed minimal effusion, flexion to 90 degrees, extension to 0 degrees, healed surgical portals, and genu varum. The impressions included degenerative joint disease of the right knee. In February 2014, the Veteran complained of right knee pain. He reported that he had been unable to obtain care for his right knee from VA because his body mass index was too high. Physical examination showed tenderness over the right knee but no edema. The assessment was unchanged from September 2013. The Veteran had right total knee arthoplasty on April 2, 2014. Despite the Veteran’s assertions to the contrary, the record evidence shows that, prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, his service-connected degenerative joint disease of the right knee is manifested by, at worst, complaints of pain, knee swelling, giving way, and an antalgic and unstable gait. Prior to his arthroscopic surgery to treat his service-connected right knee disability on August 23, 2012, the record evidence shows that his gait was antalgic and unstable and his right knee flexion repeatedly was between 100 and 110 degrees with pain. X-rays repeatedly showed tricompartmental degenerative joint disease with minimal decrease in joint space in all 3 compartments. Mild to moderate right knee effusion also was noted on frequent VA outpatient treatment visits prior to August 23, 2012. The record evidence dated after his post-surgical convalescence ended on December 31, 2012, and April 2, 2014, when he had a right total knee arthoplasty to treat his service-connected right knee disability, also does not support assigning a disability rating greater than 10 percent for the Veteran’s service-connected degenerative joint disease of the right knee. His right knee flexion was between 90 and 110 degrees on VA outpatient treatment visits during this time period. The Veteran himself reported to his VA treating clinicians that cortisone injections in his right knee had treated his pain for several weeks at a time. He continued to receive these injections and wore a right knee brace during this time period. There is no indication of x-ray evidence of the involvement of 2 or more major joints or 2 or more minor joint groups with occasional incapacitating exacerbations (i.e., a 20 percent rating under DC 5003) or that the Veteran’s right knee flexion was limited to 30 degrees (i.e., a 20 percent rating under DC 5260) such that a disability rating greater than 10 percent is warranted either prior to August 23, 2012, or between December 31, 2012, and April 2, 2014, for his service-connected degenerative joint disease of the right knee. See 38 C.F.R. § 4.71a, DC 5003-5260 (2017). The Board observes that the Veteran had lumbar spine decompression surgery at a private hospital in January 2013. The Board also observes that most of his VA outpatient treatment visits between December 31, 2012, and April 2, 2014, related to post-surgical treatment for his non-service-connected lumbar spine. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for his service-connected degenerative joint disease of the right knee. In summary, the Board finds that the criteria for a disability rating greater than 10 percent prior to August 23, 2012, and from December 31, 2012, to April 2, 2014, for degenerative joint disease of the right knee have not been met. 3. Entitlement to a temporary total disability rating based on surgical treatment necessitating convalescence for a service-connected right knee disability beyond October 1, 2012 The Board finds that the evidence supports assigning a temporary total disability rating based on surgical treatment necessitating convalescence for a service-connected right knee disability from August 23, 2012, through December 31, 2012. The Veteran essentially contends that he is entitled to an extension of the temporary total disability rating assigned between August 23, 2012, the date of arthroscopic surgery to treat his service-connected degenerative joint disease of the right knee, and October 1, 2012, because his post-surgical convalescence extended beyond the latter date. The Board notes initially that a temporary total disability rating based on the need for convalescence following surgical treatment of a service-connected disability may be extended under 38 C.F.R. § 4.30(b)(1) for 1, 2, or 3 months beyond the initial 3 months. See 38 C.F.R. § 4.30(b)(1) (2017). The Board agrees with the Veteran’s assertions regarding his entitlement to an extension of a temporary total disability rating for a service-connected right knee disability beyond October 1, 2012. As noted elsewhere, following arthroscopic surgery to treat his service-connected degenerative joint disease of the right knee on August 23, 2012, the Veteran’s VA treating orthopedic surgeon concluded in a January 2013 treatment note that his post-surgical convalescence “extends until” December 30, 2012. The Board observes that VA benefits may not be paid until the first day of the calendar month following the month in which an award is effective. See generally 38 C.F.R. § 3.31 (2017). In other words, as it relates to this appeal, if the Veteran’s post-surgical convalescence “extends until” December 30, 2012, then he is entitled to an extension of a temporary total disability rating for surgical treatment necessitating convalescence for a service-connected right knee disability through December 31, 2012 (the end of the calendar month). Id. In summary, and after resolving any reasonable doubt in the Veteran’s favor, the Board finds that the criteria for a temporary total disability rating for surgical treatment necessitating convalescence for a service-connected right knee disability from August 23, 2012, through December 31, 2012 (the end of the calendar month in which his treating VA orthopedic surgeon concluded that his surgical convalescence had ended), have been met. See also 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to a disability rating greater than 30 percent effective June 1, 2015, for residuals of a right total knee arthroplasty and to a disability rating greater than 20 percent for a left shoulder disability are remanded. The Veteran contends that his service-connected residuals of a right total knee arthoplasty and left shoulder disability are both more disabling than currently evaluated. The Board acknowledges that these claims were remanded previously in February 2016. Having reviewed the record evidence, and although the Board is reluctant to contribute to "the hamster-wheel reputation of Veterans law" by remanding these claims again, additional development is required before the underlying claims can be adjudicated on the merits. Cf. Coburn v. Nicholson, 19 Vet. App. 427, 434 (2006) (Lance, J., dissenting) (finding that repeated remands "perpetuate the hamster-wheel reputation of Veterans law"). A review of the record evidence shows that the Veteran’s most recent VA examinations for residuals of a right total knee arthoplasty and left shoulder in May 2016 did not comply with Correia. For example, there is no indication in either the May 2016 VA knee and lower leg conditions DBQ or the May 2016 VA shoulder conditions DBQ whether the right knee or left shoulder ranges of motion obtained at these examinations are active or passive or in weight-bearing or non-weight-bearing, respectively. Accordingly, the Board finds that, on remand, the Veteran should be scheduled for updated VA examinations to determine the current nature and severity of his service-connected residuals of a right total knee arthoplasty and service-connected left shoulder disability. See also Southall-Norman v. McDonald, 28 Vet. App. 346 (2016) (finding 38 C.F.R. § 4.59 not limited to diagnostic codes involving range of motion and extending Correia to disabilities involving painful joint or periarticular pathology). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected residuals of a right total knee arthoplasty. 2. Schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected left shoulder disability. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel