Citation Nr: 18140678 Decision Date: 10/05/18 Archive Date: 10/04/18 DOCKET NO. 14-28 310 DATE: October 5, 2018 REMANDED Entitlement to service connection for a low back disability is remanded. Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to a compensable rating for residuals of left third finger injury is remanded. Entitlement to a compensable rating for scar, residual of left third finger injury, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1969 to May 1970 and from March 9, 1974 to March 10, 1974. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran contends that he has disabilities of both knees, his right hip, and his back, all of which he believes are secondary to (i.e., caused or aggravated by) his service-connected disability of right ankle arthritis. He contends that his right ankle disability has caused him to alter his gait in such a way as to cause impairment to the knees, right hip, and low back. The Veteran’s representative avers that the VA examinations in July 2012 and June 2014 addressing these contentions were not adequate. The Board agrees that these examination reports did not adequately describe the nature of the current service-connected right ankle disability (they referred instead to a right ankle sprain in service) and did not fully address the causation and aggravation claims for each claimed disability. Accordingly, the Board finds that the opinions of record are inadequate. The Court has held in this regard that, when VA undertakes to provide an examination or opinion, it must provide an adequate one. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). As such, the Board finds that, on remand, the Veteran should be afforded new VA examinations to determine the nature and etiology of his right knee, left knee, right hip, and back disabilities. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Veteran’s representative has specifically indicated that the Veteran’s service-connected left hand disabilities have worsened since the most recent VA examinations in June 2014. Specifically, he contends that the service-connected left third finger injury residuals are now affecting other fingers/other parts of the hand. VA’s duty to assist requires affording the Veteran a new VA examination to accurately assess the current level of impairment when there is evidence that the disability may have worsened. Snuffer v. Gober, 10 Vet. App. 400, 402-03 (1997). The claim is thus remanded for an examination to assess the current severity of the Veteran’s service-connected left third finger disabilities. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records not already of record in the claim file. 2. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the nature and etiology of his current low back, right hip, right knee, and left knee disabilities. The entire record must be reviewed by the examiner. The examiner is to conduct all necessary tests and studies. a) Provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that any current low back, right hip, right knee, and/or left knee disability had onset during service or is otherwise related to service. b) Provide an opinion as to whether it is at least as likely as not that any current low back, right hip, right knee, and/or left knee disability is proximately caused by or aggravated by the Veteran’s service-connected right ankle disability (arthritis). Answering this question requires two separate opinions: one for proximate causation and a second for aggravation. The term ‘aggravation’ means a permanent worsening of the disorder beyond its natural progression. If aggravation is found, then, to the extent possible, the examiner should attempt to establish a baseline level of severity of the low back, right hip, right knee, and/or left knee disability prior to its aggravation by the service-connected right ankle disability. The examination report must include a complete rationale for all opinions expressed. 3. Arrange for the Veteran to have an examination with an appropriate examiner to determine the current severity of the Veteran’s left third finger disability injury residuals and left hand third finger scar. All necessary examinations and tests should be performed. The examiner should fully describe the disability symptoms and impairment caused by the Veterans left third finger injury and scar conditions, to include any associated disability of any other fingers/parts of the left hand. (Continued on the next page)   If there is functional impairment of any of the relevant joints due to pain, an assessment of the degree of impairment should be provided. The examiner should state whether pain, weakness, or excess fatigability significantly limits functional ability during any flare-ups or when the relevant joints are used repeatedly. If these circumstances result in further limitation of the range of motion of any relevant joint, the examiner should provide an estimate of this further limitation of motion in terms of degree, to the extent that this is medically possible. If such an estimate is not possible, the examiner should explain why such an estimate is impossible to arrive at without resort to speculation. The examiner should describe whether there is any pain associated with the left third finger scar. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel