Citation Nr: 18140806 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 15-26 056 DATE: REMANDED Entitlement to a disability evaluation in excess of 10 percent for residuals of wound to the right wrist and hand is remanded. Entitlement to a compensable disability evaluation for scars of the right hand and wrist is remanded. Entitlement to an initial disability evaluation in excess of 70 percent for posttraumatic stress disorder (PTSD) is remanded. Entitlement to a disability evaluation in excess of 10 percent for Osgood-Schlatter's Disease of the right knee is remanded. Entitlement to a disability evaluation in excess of 10 percent for Osgood-Schlatter's Disease with degenerative arthritis of the left knee is remanded. Entitlement to a total disability evaluation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from August 1988 to December 1996. The Veteran appeared at a hearing before the undersigned Veterans Law Judge in September 2017. A transcript of the hearing is of record. Residuals of Wound to the Right Wrist and Hand At his September 2017 hearing, the Veteran testified as to a worsening of his symptoms as it related to his right wrist and hand since the time of his prior examination. He indicated that he had numbness, tingling, and pain in the right wrist/hand area. VA is obligated to afford a veteran a contemporaneous examination where there is evidence of an increase in the severity of the disability. VAOPGCPREC 11-95 (1995). Moreover, the Veteran is competent to provide an opinion that his disability has worsened. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board notes that the last VA examination afforded the Veteran occurred in November 2014. In addition, the Court, in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Thus, the Court's holding in Correia establishes additional requirements that must be met prior to finding that a VA examination is adequate. A review of the claims file reveals that the previous VA examination reports include only active range of motion findings and do not include range of motion findings for passive range of motion. They also do not specify whether the results are weight-bearing or nonweight-bearing. As the previous examination reports do not fully satisfy the requirements of Correia and 38 C.F.R. § 4.59, a new examination is necessary to decide the claim. Scars of the Right Wrist and Hand As it relates to the scars on the hand and wrist, the Board notes that the Veteran, at the time of his September 2017 hearing, indicated that he had throbbing and pain around the scar areas along with swelling and that the scars were painful to the touch. The Board observes that the last VA examination afforded the Veteran was in November 2014. Based upon the Veteran’s testimony he should be afforded a new VA examination to determine the current severity of the scars. PTSD At the time of his September 2017 hearing, the Veteran testified that his PTSD symptoms had worsened over the last several years. He also testified that he was continuing to seek treatment for his PTSD at the VAMC. As noted above, the Veteran is competent to provide an opinion that his disability has worsened. Proscelle v. Derwinski, 2 Vet. App. 629 (1992). The Board notes that the last VA examination afforded the Veteran occurred in November 2014. Furthermore. VA is deemed to have constructive knowledge of documents which are generated by VA agents or employees. Bell v. Derwinski, 2 Vet. App. 611,612-13 (1992). If those documents predate a Board decision on appeal, are within VA's control, and could reasonably be expected to be part of the record, then "such documents are, in contemplation of law, before the Secretary and the Board and should be included in the record." Id. at 613. If such material could be determinative of the claim, a remand for readjudication is in order. Dunn v. West, 11 Vet. App. 462, 466 (1998); see also 38 C.F.R. § 3.159(c)(2). Right and Left Knee As it relates to both the left and right knee disorders, the Board notes that the Veteran, at the time of his September 2017 hearing, testified as to a worsening of his left and right knee symptoms, as it related to instability and motion. He also testified as to having fallen on numerous occasions and as to his knees giving out on him. The Veteran also reported that he was continuing to receive treatment for his left and right knee disorders at the VAMC. Given the foregoing, the Veteran should be afforded a VA examination to determine the severity of his service-connected right and left knee disorders. TDIU The Court has held that, in the case of a claim for TDIU, the duty to assist requires that VA obtain an examination which includes an opinion on what effect the service-connected disabilities have on a Veteran's ability to work. Friscia v. Brown, 7 Vet. App. 294, 297 (1994). As such, a medical opinion is needed. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. After all available records have been associated with the claims file, the Veteran should be scheduled for an appropriate VA examination so as to determine the current nature and extent of all impairment due to his service-connected left and right knee and right wrist and hand disabilities. The entire record must be made available to and reviewed by the examiner in conjunction with the examination. The examiner should note in the examination report that the entire record has been reviewed. All indicated tests should be performed and all findings should be reported in detail. In order to comply with the Court's recent precedential decision in Correia v. McDonald, 28 Vet. App. 158 (2016), the examiner must test and record the range of motion for BOTH wrists/hands and knees in active motion, passive motion, weight-bearing, and nonweight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. The extent of any weakened movement, excess fatigability, and incoordination on use should also be described by the examiner. The examiner should assess the additional functional impairment due to weakened movement, excess fatigability, or incoordination in terms of the degree of additional range of motion loss. The examiner is reminded that he/she should specify the degree of additional functional loss/motion due to pain, to include during flare-ups, or state why it was not feasible to provide such information, as required for an adequate examination. Additionally, as it relates to the left and right knees, the examiner should determine whether the Veteran has ankylosis of the knee; instability or subluxation of the knee; nonunion of the tibia and fibula with loose motion and requiring knee braces; dislocated semilunar cartilages with frequent episodes of locking, pain, and effusion; or severe painful motion or weakness in either knee. If subluxation/instability is present the examiner should indicate whether it is slight, moderate, or severe in nature. To the extent possible, the examiner is asked to provide retrospective commentary on the Veteran's level of the left and right knee and right wrist/hand disabilities during the appeal period, to include the prior VA examinations performed in conjunction with this claim, and to comment on the range of motion movements that would be painful on passive use, in weight-bearing and non-weight-bearing. As to the right wrist/hand, the examiner is to also comment on any neurological involvement, and, if present, the severity of the neurological impairment. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. 3. Schedule the Veteran for a VA examination to ascertain the current nature and severity of his right hand and wrist scars. The examiner must review the claim file. All indicated studies should be performed. The examiner should identify all symptoms and impairments associated with the right hand and wrist scars, noting the frequency, severity of symptoms, size, characteristics, and limitation of function of the scars. 4. The Veteran should be afforded a VA psychiatric examination to determine the severity of his PTSD. All appropriate tests and studies, including psychological testing, should be performed and all findings should be reported in detail. The entire record must be made available to the examiner and the examiner should note such review in the report. The examiner is also requested to discuss the impact of the Veteran's PTSD on his employability. 5. Schedule the Veteran for a VA examination to obtain evidence as to the functional effects of his service-connected disabilities on his ability to obtain or maintain substantially gainful employment in light of his work history and level of education. 6. Review the claims file. If any development is incomplete, including if the examination report does not contain sufficient information to respond to the questions posed, take corrective action before readjudication. See Stegall v. West, 11 Vet. App. 268 (1998). K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S. Kelly, Counsel