Citation Nr: 18140525 Decision Date: 10/04/18 Archive Date: 10/03/18 DOCKET NO. 16-19 200 DATE: October 4, 2018 REMANDED Service connection for bilateral lower extremity rheumatoid arthritis is remanded. A rating in excess of 10 percent for a right heel disorder is remanded. A rating in excess of 10 percent for a left heel disorder is remanded. A rating in excess of 10 percent for a right knee disorder is remanded. A rating in excess of 10 percent for a left knee disorder is remanded.   REASONS FOR REMAND The Veteran served on active duty from May 1982 to June 1985. The case is on appeal from a June 2014 rating decision. The Veteran’s December 2015 statement of the case (SOC) included the five current issues listed above. In the January 2016 substantive appeal, she limited her appeal solely to the issue of service connection for bilateral lower extremity rheumatoid arthritis. However, in the substantive appeal, she also addressed the four increased rating claims and, in the April 2016 supplemental statement of the case (SSOC), the RO included all five claims. Thus, the service connection claim for rheumatoid arthritis, as well as the four increased rating claims are currently before the Board. See Evans v. Shinseki, 25 Vet. App. 7 (2011). The Board finds that additional development is warranted. In addition to the development detailed below, updated treatment records should be obtained. 1. Service connection for bilateral lower extremity rheumatoid arthritis. The Veteran submitted an October 2013 statement in which she indicated the problems she has had with her service-connected feet and knees have worsened with age and evolved into rheumatoid arthritis. She stated the skin on her lower extremities is shiny due to constant swelling and she suffers from swollen feet, toes and joint pain. The record currently supports a current diagnosis of rheumatoid arthritis. See February 2013 medical report. As such, a VA examination is necessary to assess the nature and etiology of any diagnosed rheumatoid arthritis of the lower extremities. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 2. Ratings in excess of 10 percent for right and left heel disorders. The Veteran contends increased ratings are warranted for her service-connected heel disabilities. She was most recently afforded a February 2016 VA examination in which the examiner concluded the Veteran does not have a current bilateral heel disability. However, the Veteran reported constant bilateral heel pain and symptoms of redness, heat, swelling and flare-ups due to prolonged walking. An additional VA examination is necessary to assess the current severity of the bilateral heel disabilities. The February 2016 examination report did not provide adequate rationale as to why there is no current diagnosis associated with the claimed heel conditions. Further, the examiner did not provide an adequate rationale with regard to potential additional functional loss during the reported flare-ups of the Veteran’s bilateral heel symptoms. On remand, the VA examiner is required to ascertain adequate information regarding the Veteran’s flare-ups and “estimate the functional loss that would occur during flares.” Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) (outlining VA examiners’ obligation to elicit information regarding flare-ups of a musculoskeletal disability if the examination is not conducted during such a flare-up, and to use this information to characterize additional functional loss during flare-ups). 3. Ratings in excess of 10 percent for right and left knee disorders. The February 2016 VA examination report indicated the Veteran does not have a current diagnosis associated with the claimed knee conditions. However, the Veteran was diagnosed previously with degenerative arthritis in both knees and during the examination she reported constant pain in the patella area, as well as flare-ups. While the examination report reflects range of motion testing, it does not reflect detailed range of motion findings compliant with the recent precedential decision of Correia v. McDonald, 28 Vet. App. 158 (2016) (instructing that VA orthopedic examinations should include testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing (if applicable) and, if possible, with the range of the opposite undamaged joint). Further, on remand, the examiner should elicit information regarding the Veteran’s flare-ups and characterize any additional functional loss during flares. Sharp, 29 Vet. App. at 33. The matters are REMANDED for the following action: 1. Obtain updated private and VA treatment records not already associated with the claims file. 2. Thereafter, schedule the Veteran for an appropriate VA examination to determine the nature and etiology of any current bilateral lower extremity rheumatoid arthritis. The examiner should clearly indicate if rheumatoid arthritis of the bilateral lower extremities is diagnosed on examination. If so, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the disorder is proximately due to or the result of the Veteran’s bilateral heel and knee disabilities. If not caused by the bilateral heel and knee disabilities, the examiner should address whether it is at least as likely as not (50 percent or greater probability) that the rheumatoid arthritis has been aggravated by the bilateral heel and knee disabilities. Aggravation is an increase in disability beyond a temporary flare-up or natural progress of the disease. Consideration should be given to the Veteran’s theory of a relationship between her rheumatoid arthritis and her service-connected heel and knee disorders. All opinions expressed should be accompanied by supporting rationale. 3. Schedule the Veteran for an appropriate VA examination to determine the current nature and severity of her service-connected bilateral heel disabilities. The examiner should report any heel diagnoses. If the examination is not conducted during a flare-up, the functional impact of a flare-up should be estimated based on the Veteran’s reports. If this cannot be done, the examiner should thoroughly explain why. 4. Schedule the Veteran for an appropriate VA examination to determine the current nature and severity of her service-connected bilateral knee disabilities. The examiner should report any knee diagnoses. The examiner should record the range of motion observed on clinical evaluation, in terms of degrees of extension and flexion. He or she should specifically test the knees for pain on both active and passive motion, and in weight bearing and nonweight-bearing. If the examination is not conducted during a flare-up, the functional impact of a flare-up should be estimated based on the Veteran’s reports. If this cannot be done, the examiner should explain why. (Continued on the next page)   All opinions expressed should be accompanied by supporting rationale. RYAN T. KESSEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Isaacs, Associate Counsel