Citation Nr: 18141363 Decision Date: 10/10/18 Archive Date: 10/10/18 DOCKET NO. 16-18 330 DATE: October 10, 2018 ORDER A 10 percent rating for service-connected right foot plantar fasciitis is granted, subject to the laws and regulations governing the award of monetary benefits. A 20 percent rating for service-connected left foot plantar fasciitis is granted, subject to the laws and regulations governing the award of monetary benefits. Entitlement to service connection for herpes simplex virus is granted. REMANDED Entitlement to service connection for a left shoulder condition is remanded. Entitlement to service connection for sinusitis, pansinusitis, and nasal polyps, status-post rhinoplasty, is remanded. Entitlement to an initial evaluation in excess of 10 percent for right knee patellofemoral syndrome is remanded. Entitlement to an initial evaluation in excess of 10 percent for left ankle synovitis is remanded. FINDINGS OF FACT 1. The Veteran’s right foot plantar fasciitis is primarily manifested as heel pain, tenderness to palpation, and swelling, more nearly approximate to a moderate foot injury. 2. The Veteran’s left foot plantar fasciitis is primarily manifested as heel pain, tenderness to palpation, swelling and plantar fascial ablation with platelet-rich plasma of the left extremity surgery, more nearly approximate to a moderately severe foot injury. 3. The Veteran’s herpes simplex virus began during active service. CONCLUSIONS OF LAW 1. The criteria for a 10 percent rating, but no more, for service-connected right foot plantar fasciitis have been met. 38 U.S.C. §§ 1114, 5103, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a Diagnostic Code (DC) 5299-5284. 2. The criteria for a 20 percent rating, but no more, for service-connected left foot plantar fasciitis have been met. 38 U.S.C. §§ 1114, 5103, 5107; 38 C.F.R. §§ 4.1, 4.7, 4.71a DC 5299-5284. 3. The criteria for service connection for herpes simplex virus are met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1987 to June 2011. This matter comes before the Board on appeal from an August 2012 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent, as far as can practicably be determined, the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Pertinent regulations also provide that it is not necessary for all of the individual criteria to be present as set forth in the Rating Schedule, but that findings sufficient to identify the disability and level of impairment be considered. 38 C.F.R. § 4.21. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. Pursuant to 38 C.F.R. § 4.71a, Schedule of Ratings of the Musculoskeletal System involving the foot, DC 5276 provides ratings for acquired flatfoot. Moderate flatfoot with weight-bearing line over or medial to the great toe, inward bowing of the tendo achillis, pain on manipulation and use of the feet, bilateral or unilateral, is rated 10 percent disabling. Severe flatfoot, with objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities, is rated 20 percent disabling for unilateral disability, and is rated 30 percent disabling for bilateral disability. Pronounced flatfoot, with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement, and severe spasm of the tendo achillis on manipulation, that is not improved by orthopedic shoes or appliances, is rated 30 percent disabling for unilateral disability, and is rated 50 percent disabling for bilateral disability. 38 C.F.R. § 4.71a. Diagnostic Code 5277 provides ratings for bilateral weak foot. For symptomatic condition secondary to many constitutional conditions, characterized by atrophy of the musculature, disturbed circulation, and weakness, the underlying condition is to be rated, with a minimum rating of 10 percent. 38 C.F.R. § 4.71a. Diagnostic Code 5278 provides ratings for acquired claw foot (pes cavus). Acquired claw foot with the great toe dorsiflexed, some limitation of dorsiflexion at the ankle, definite tenderness under metatarsal heads, bilateral or unilateral, is rated 10 percent disabling. Acquired claw foot with all toes tending to dorsiflexion, limitation of dorsiflexion at the ankle to right angle, shortened plantar fascia, and marked tenderness under the metatarsal heads, is rated 20 percent disabling for unilateral involvement, and 30 percent disabling for bilateral involvement. Acquired claw foot with marked contraction of plantar fascia with dropped forefoot, all toes hammer toes, very painful callosities, marked varus deformity, is rated 30 percent disabling for unilateral involvement, and 50 percent disabling for bilateral involvement. 38 C.F.R. § 4.71a. Diagnostic Code 5279 provides a 10 percent disability rating for anterior metatarsalgia (Morton’s disease), whether unilateral or bilateral. 38 C.F.R. § 4.71a. Diagnostic Code 5280 provides ratings for unilateral hallux valgus. Unilateral hallux valgus that is severe, if equivalent to amputation of great toe, is rated 10 percent disabling. Unilateral hallux valgus that has been operated upon with resection of metatarsal head is rated 10 percent disabling. 38 C.F.R. § 4.71a. Diagnostic Code 5281 provides that unilateral severe hallux rigidus is to be rated as severe hallux valgus. A Note to Diagnostic Code 5281 provides that the rating for hallux rigidus is not to be combined with claw foot ratings. Diagnostic Code 5280 provides that severe unilateral hallux valgus, if equivalent to amputation of great toe, is to be rated 10 percent disabling. 38 C.F.R. § 4.71a. Diagnostic Code 5282 provides ratings based on hammer toes. Unilateral hammer toe of all toes, without claw foot, is rated 10 percent disabling. 38 C.F.R. § 4.71a. Diagnostic Code 5283 provides ratings based on malunion or nonunion of tarsal or metatarsal bones. Moderate malunion or nonunion of tarsal or metatarsal bones is rated 10 percent disabling; moderately severe malunion or nonunion of tarsal or metatarsal bones is rated 20 percent disabling; and severe malunion or nonunion of tarsal or metatarsal bones is rated 30 percent disabling. A Note to Diagnostic Code 5283 provides that malunion or non-union of tarsal or metatarsal bones with actual loss of use of the foot is rated 40 percent disabling. 38 C.F.R. § 4.71a. Diagnostic Code 5284 provides ratings for residuals of other foot injuries. Moderate residuals of foot injuries are rated 10 percent disabling; moderately severe residuals of foot injuries are rated 20 percent disabling; and severe residuals of foot injuries are rated 30 percent disabling. A Note to Diagnostic Code 5284 provides that foot injuries with actual loss of use of the foot are to be rated 40 percent disabling. 38 C.F.R. § 4.71a. Words such as “moderate”, “moderately severe” and “severe” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. In this appeal, the Veteran’s bilateral feet plantar fasciitis is evaluated as noncompensable, in accordance with the DCs 5299-5284. Because the Veteran’s bilateral feet plantar fasciitis is not specifically listed in the rating schedule, it is rated by analogy based upon the closest affected body system. When an unlisted condition is encountered, it is to be rated under a closely-related disease or injury similar in function and anatomical location. 38 C.F.R. § 4.20. When an unlisted disease is rated by analogy, the code is built by using the part of the rating schedule most closely related to the disability for the first 2 digits and “99” for the last 2 digits. See 38 C.F.R. § 4.27. Here, the RO determined that the closest rated disability is that of “foot injuries, other”. To the extent that the Veteran is diagnosed with other foot disabilities, he is not service connected for those disabilities. As such, the Board will discuss the signs/symptoms of the Veteran’s service-connected bilateral feet plantar fasciitis as contemplated by DC 5299-5284. 1. Entitlement to an initial compensable rating for right foot plantar fasciitis The Veteran contends that he is entitled to a higher rating for his service-connected right foot plantar fasciitis. Pursuant to DC 5284, a 10 percent rating is warranted for a moderate foot injury. Upon review of the record evidence, the Board finds that the Veteran’s right foot plantar fasciitis manifested as recurrent heel pain in the morning, and at night, with prolonged weight bearing activities, tenderness to palpation, swelling, and required the use of custom orthotics. As such, a 10 percent rating for moderate right foot plantar fasciitis is warranted. A February 2011 VA treatment note indicated that the Veteran was diagnosed with plantar fasciitis. The Veteran endorsed that his plantar fascia was tender to palpation, bilaterally. The examiner noted post-static dyskinesia (involuntary movement of a body part) that worsened with prolonged weight bearing activity. See http:// //medlineplus.gov/movementdisorders.html (10/04/2018). The Veteran reported that his planter fasciitis was aggravated by all weight bearing activities, including prolonged walking, standing and running. The Veteran denied any paresthesias. Previous treatment included supportive care, wearing wider shoes, over-the-counter (OTC) pain medication and limiting physical activities. In March 2011, the Veteran was afforded an in-service VA examination. His bilateral plantar fasciitis diagnosis was noted. The Veteran endorsed recurrent heel pain and pain in the bottom of his feet. The Veteran endorsed a burning sensation, aching and sharp pain rated an 8 out of 10. The Veteran reported that his feet were very painful in the morning, during the night and when sitting for prolonged periods of time. During prolonged resting periods, his feet would become stiff; but the Veteran denied any weakness, swelling or fatigue. The pain was reportedly exacerbated by physical activity, including standing and walking. The Veteran reported that his pain was alleviated by foot stretches, exercises and using orthotics; however, the pain “never completely went away”. Objective examination of the Veteran’s feet revealed tenderness at the planter fascial insertion into both heels. There were no signs of abnormal weight bearing or breakdown, callosities or any unusual shoe wear pattern. There was no evidence of disturbed circulation, edema, weakness, atrophy of the musculature, heat, redness, instability or signs of deformity. Bilateral feet x-rays were within normal limits. The Veteran walked with an antalgic gait due to ankle pain; regarding his tandem gait, the Veteran’s gait was normal. Treatment included steroid injections, “night socks”, electrodes and scrapping the bottom of his feet. The Veteran reported functional impairment due to abnormal feet movement and the inability to stand for extended periods of time. The Veteran did not require any assistive device for ambulation. The examiner noted that the effect on the Veteran’s occupation was painful feet with prolonged walking, standing, running, and climbing. A July 2011 VA treatment note indicated that the Veteran endorsed persistent pain rated a 6-7 out of 10 at worst, with prolonged sitting, rising to stand and initial walking, especially after rising from bed in the morning. The Veteran endorsed pain with bending, lifting, and “carrying”. The Veteran reported some relief with using orthotics. The examiner noted that the Veteran was flat footed with pronation B. The Veteran endorsed tenderness to palpation of the heel surface. In November 2011, VA diagnosed the Veteran with painful flat feet and plantar fasciitis. The Veteran endorsed pain on palpation of the feet. There was no evidence of edema. A March 2014 VA treatment note listed chronic foot pain on the Veteran’s medical problems list. An August 2015 VA treatment note listed foot pain (soft tissue) on the problems list. A March 2016 VA treatment note listed plantar fascial fibromatosis on the problems list. A February 2016 private treatment note indicated that the Veteran presented for consultation for custom orthotics. He endorsed bilateral heel pain. Examination revealed palpable pedal pulses bilaterally, immediate capillary refill and some swelling on the inferior heels. There was pain to palpation of the inferior aspect of the heel bilaterally, especially along the medial band of the planter fasciitis. The fascia was intact and there was no obvious fasciotomy. There was evidence of valgus hindfoot, bilaterally, with loss of medial arch. Treatment included stretching and rolling a ball under his feet. In the March 2016 substantive appeal (VA Form 9), the Veteran asserted that he experienced pain in his feet and that he used custom orthotics that did not completely alleviate his pain. Based on the foregoing evidence, the Board finds that the Veteran’s right foot plantar fasciitis manifested as symptoms more moderate in severity and more nearly approximate to symptoms contemplated by a 10 percent rating, under DC 5284. The clinical evidence indicates that during the appeal period, the Veteran consistently endorsed recurrent heel pain. The Veteran experienced heel pain in the morning, during the night, during prolonged weight bearing activities and during extended periods of rest. The February 2011 VA treatment noted indicated that the Veteran endorsed painful feet that was exacerbated by all weight bearing activities, including prolonged walking and standing, bending, lifting and carrying, what can be presumed as, heavy objects. The Veteran endorsed tenderness to palpation, occasional swelling, stiffness while resting, using custom orthotics and OTC treatments that did not completely alleviate his pain. During the March 2011 VA examination, the Veteran endorsed a painful burning sensation and aching in his feet rated an 8 out of 10. The VA examiner noted that the effect on the Veteran’s occupation was painful feet with prolonged walking, standing, running, and climbing. A February 2016 private treatment note indicated that the Veteran had pain to palpation of the inferior aspect of the heel bilaterally. In the March 2016 VA Form 9, the Veteran asserted that he had pain in his feet that was not completely alleviated with custom orthotics. Cumulatively, the medical and lay evidence of record suggests that the Veteran’s right foot plantar fasciitis manifested as symptoms more nearly approximate to a moderate foot injury contemplated by a 10 percent rating under DC 5284. The Board notes that the Veteran is competent to report on symptoms and he is sincere in his belief that he is entitled to a higher rating. His lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of the right foot impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA and private examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the clinical findings in regard to the type and degree of impairment of the Veteran’s right foot plantar fasciitis that supports a 10 percent rating for a moderate foot injury pursuant to DC 5284. The Board has considered whether the Veteran’s disability may be rated under another diagnostic code. The Board acknowledges that the Veteran was diagnosed with painful flat feet. However, to the extent that he is diagnosed with other foot disabilities, the Veteran is only service-connected for right foot plantar fasciitis. As such, the Board considered the extent and severity of the Veteran’s service-connected right foot plantar fasciitis. 2. Entitlement to an initial compensable rating for left foot plantar fasciitis The Veteran contends that he is entitled to a higher rating for his service-connected left foot plantar fasciitis. Pursuant to DC 5284, a 20 percent rating is warranted for a moderately severe foot injury. Upon review of the record evidence, the Board finds that the Veteran’s left foot plantar fasciitis manifested as heel pain in the morning, and at night, with prolonged weight bearing activities, tenderness to palpation, swelling, required the use of custom orthotics and required plantar fascial ablation surgery. As such, a 20 percent rating for moderately severe left foot plantar fasciitis is warranted. Again, as indicated in the February 2011, March 2011, July 2011, November 2011 and February 2016 VA and private treatment records, the Veteran’s complaints of plantar fasciitis symptoms primarily consisted of recurrent bilateral heel pain in the morning, during the night, during prolonged weight bearing activities and during extended periods of rest. The Veteran reportedly experienced post-static dyskinesia that worsened with prolonged weight bearing activity. The Veteran’s bilateral heel pain was exacerbated by all weight bearing activities, including prolonged walking, standing, bending, lifting and carrying, what can be presumed as, heavy objects. The Veteran experienced bilateral feet tenderness to palpation, occasional swelling and stiffness while at rest. The Veteran reported that his bilateral plantar fasciitis symptoms were not completely alleviated with foot stretching, exercises, using custom orthotics and OTC pain medication. However, the clinical evidence of record suggests that in some instances, the Veteran only complained of, and was treated for, plantar fasciitis symptoms affecting the left foot, which ultimately resulted in plantar fascial ablation surgery. For instance, a February 2011 left ankle magnetic resonance imaging (MRI) revealed mildly increased signal and thickening of the medial band of the plantar fascia at its insertion on the calcaneus. There was evidence of plantar fasciitis of the medial band. An April 2011 VA treatment record noted the Veteran’s plantar fasciitis, left foot, diagnosis. The Veteran’s pain and abnormal left ankle MRI were noted. There was negative Tinel sign over the medial heel or tarsal tunnel. The heel was rectus in stance and the heel raise test was normal. An April 2011 private pre-operative diagnosis was plantar fasciitis, left foot. The Veteran’s left foot was tender to palpation, vascular examination was +2 and there was no evidence of atrophy. On April 29, 2011, the Veteran underwent ankle scope and plantar fascial ablation with platelet-rich plasma of the left extremity surgery. The post-operative diagnosis was plantar fasciitis, left extremity. A controlled ankle movement (CAM) boot was used as an assistive device. The Veteran was instructed to not put weight on the operative foot. A June 2011 VA post-operative examination indicated that the Veteran’s left foot pain was tolerable and well controlled with medications. His pedal pulses were intact in the operative foot and he had normal capillary refill. The incision healed, the scar was normal in appearance and there was mild edema around the surgical site. A July 2011 VA treatment note indicated that the Veteran experienced left heel pain with prolonged course of treatment. His April 2011 left heel plantar fascial ablation surgery was noted. The Veteran’s left foot plantar flexion was to 42 degrees, the heel surface was tender to palpation and there was left calf atrophy. An August 2011 VA treatment note indicated that the Veteran only endorsed left heel pain, rated a 4-5 out of 10 in the morning upon rising from bed. The Veteran reported that occasionally, he did not experience any pain walking after getting out of bed. Examination showed that the left heel was not tender to palpation. The Veteran reported that stretching and other prescribed exercises were helpful. The examiner commented that the Veteran made “good progress towards reaching [his] pain goal”. An August 2012 private treatment record indicated that again, the Veteran only endorsed left foot pain. The Veteran complained of pain and swelling in the anterior and medial side of the left foot that worsened with physical activity. The Veteran reported that his left heel pain was diminished with stretching exercises and that previous foot injections provided minimal relief. A June 2015 private treatment note indicated that the Veteran was diagnosed with left foot pain; stress fracture of the metatarsals. The Veteran endorsed pain along the lateral left foot in the area of the 4th metatarsal and swelling. He used crutches for ambulation and a walking boot was recommend. The Board acknowledges that the Veteran is not service-connected for left foot stress fracture of the metatarsals. However, the Veteran is service-connected for left foot plantar fasciitis and has endorsed left foot pain associated with the disability. Based on the foregoing evidence, the Board finds that the Veteran’s left foot plantar fasciitis manifested as symptoms more moderately severe in severity and more nearly approximate to symptoms contemplated by a 20 percent rating, under DC 5284. The clinical evidence indicates that during the appeal period, the Veteran consistently endorsed recurrent heel pain. The Veteran experienced heel pain in the morning, during the night, during prolonged weight bearing activities and during extended periods of rest. The February 2011 VA treatment note indicated that the Veteran experienced post-static dyskinesia (involuntary movement of a body part) that worsened with prolonged weight bearing activity. The Veteran endorsed pain that was exacerbated by all weight bearing activities, including prolonged walking and standing, bending, lifting and carrying, what can be presumed as, heavy objects. The Veteran also endorsed tenderness to palpation, occasional swelling, stiffness while resting, using custom orthotics and OTC treatments that did not completely alleviate his pain. A March 2011 left ankle MRI revealed mildly increased signal and thickening of the medial band of the plantar fascia at its insertion on the calcaneus. There was plantar fasciitis of the medial band. During the March 2011 VA examination, the Veteran endorsed a painful burning sensation and aching in his feet rated an 8 out of 10. The VA examiner noted that the effect on the Veteran’s occupation was painful feet with prolonged walking, standing, running, and climbing. In April 2011, the Veteran underwent plantar fascial ablation surgery on the left foot. His post-operative diagnosis was plantar fasciitis, left extremity. In July 2011, the Veteran continued to endorse left heel pain with prolonged course of treatment. In August 2011, he continued to endorse only left heel pain, rated a 4-5 out of 10, in the morning when rising from bed. The Veteran reported that stretching and other prescribed exercises were helpful. Again, in August 2012, he only endorsed left foot pain and swelling in the anterior and medial side of the foot. According to the Veteran, his pain was diminished with stretching exercises; however, a foot injection provided little relief. Moreover, a June 2015 private treatment note indicated that the Veteran was diagnosed with left foot pain; stress fracture of the metatarsals. He endorsed pain and swelling. A February 2016 private treatment note indicated that the Veteran had pain to palpation of the inferior aspect of the heel bilaterally. In the March 2016 VA Form 9, the Veteran asserted that he has pain in his feet that is not completely alleviated with orthotics. Cumulatively, the medical and lay evidence suggests that the Veteran’s left foot plantar fasciitis manifested as symptoms more nearly approximate to a moderate severe foot injury contemplated by a 20 percent rating under DC 5284. The Veteran is competent to report on symptoms and he is sincere in his belief that he is entitled to a higher rating. His lay evidence, however, is outweighed by competent and credible medical evidence that evaluates the true extent of the left foot impairment based on objective data coupled with the lay complaints. In this regard, the Board notes that the VA and private examiners have the training and expertise necessary to administer the appropriate tests for a determination of the type and degree of the impairment associated with the Veteran’s complaints. For these reasons, greater evidentiary weight is placed on the clinical findings in regard to the type and degree of impairment of the Veteran’s left foot plantar fasciitis that supports a 20 percent rating for a moderately severe foot injury pursuant to DC 5284. The Board has considered whether the Veteran’s disability may be rated under another diagnostic code. The Board acknowledges that the Veteran was diagnosed with painful flat feet. However, to the extent that he is diagnosed with other foot disabilities, the Veteran is only service-connected for left foot plantar fasciitis. As such, the Board considered the extent and severity of the Veteran’s service-connected left foot plantar fasciitis. Service Connection Service connection is warranted where the evidence of record establishes that a particular injury or disease resulting in disability was incurred in the line of duty in active military service or, if preexisting such service, was aggravated thereby. 38 U.S.C. §§ 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). Generally, to establish entitlement to service connection, a veteran must show evidence of (1) a current disability, (2) in-service incurrence or aggravation of a disease or injury, and (3) a causal relationship between the current disability and an in-service injury or disease. All three elements must be proved. See generally Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). 3. Entitlement to service connection for herpes simplex virus The Veteran contends that his herpes simplex virus is related to service. The Board concludes that the Veteran has a current diagnosis of herpes simplex virus that began during active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran’s service treatment records (STRs) indicated that he was diagnosed with herpes simplex virus during active duty. An August 1992 STR indicated that the Veteran was diagnosed with herpes simplex virus, confirmed by diagnostic testing. The Veteran presented with a herpes scar/bump/lesion underneath the penal shaft. An April 1997 STR indicated that the Veteran was diagnosed with a sore throat with ulcers; etiology unknown. The Veteran presented with a red, swollen throat and his uvula was red with 3 ulcers on the tip. Ulcers were also present throughout his tonsils. A January 2006 STR indicated that the Veteran complained of groin pruritus. In January 2011, the Veteran sought emergency room (ER) treatment for mouth sores. He was diagnosed with gingivostomatitis, dehydration. The examiner noted that the sores generally resolved in 2-3 weeks with or without treatment. Another January 2011 STR indicated that the Veteran presented with severe mouth pain and was diagnosed with candidiasis oral thrush. The condition was assessed as a severe fungal infection. A February 2011 STR indicated that the Veteran was diagnosed with stomatitis; differential diagnosis included herpes simplex virus. He endorsed cold sores in the mouth, mild pain, tingling and burning for the preceding 3 days, and difficulty eating and drinking. Oral cavity examination showed that the mucosa of the left lower lip and tongue were abnormal. There was a circular mucosal ulcer inside his lower lip and a similar lesion on tip of his tongue. In February 2011, the Veteran was afforded an in-service VA examination. The examiner determined that the Veteran did not have a herpes simplex virus diagnosis because there was no pathology to render a diagnosis. The examiner explained that the dental examination was normal and that there was no loss of teeth due to loss of substance of body of maxilla and mandible. The examiner added that the Veteran’s dental condition did not cause any speech difficulties. A panoramic x-ray of the Veteran’s teeth was abnormal; the Veteran was missing several teeth. The examiner explained that the Veteran did not report an abscess (with drainage), difficulty chewing, swelling or pain. The Veteran endorsed difficulty opening his mouth and talking. The Veteran’s March 2011 separation examination indicated that the Veteran endorsed a gingivostomatitis diagnosis. On the Report of Medical History, he endorsed “no” for sexually transmitted diseases (syphilis, gonorrhea, chlamydia, genital warts, herpes, etc.). The Veteran’s post-service medical records indicated that in July 2012, the Veteran was diagnosed with resolving candidiasis; herpes simplex- possible active lesions lower lip mucosa and left lateral border of tongue. In a March 2016 statement, M. C., the Veteran’s wife asserted that she and the Veteran were married for 8 years. According to M. C., she noticed how the Veteran’s health changed “over the past 12 years”. M. C. averred that the Veteran suffered from severe cold sores and that she did not know the extent of the condition because he “functioned so well”. M. C. averred that the Veteran had countless cold sore outbreaks every 2-3 months and had a severe outbreak in 2011 with cold sores on his inner/outer lips and throat. After carefully reviewing the evidence of record, the Board finds that service connection for herpes simplex virus is warranted. STRs indicated that the Veteran was diagnosed with herpes simplex virus, gingivostomatitis, dehydration, and stomatitis during active duty. The Board notes that herpetic stomatitis is a viral infection of the mouth that causes sores and ulcers caused by the herpes simplex virus (HSV) or oral herpes. These mouth ulcers are not the same as canker sores, which are not caused by a virus, and there is no cure for cold sores. See https://Medlineplus.gov/ency/article/001383.htm (10/04/2018). In addition, medical literature indicates that “once someone is infected with herpes simplex, the virus goes into hiding and stays in the body for the rest of their lives. . . There is no cure for herpes. See https://newsinhealth.nih.gov/2018/06/herpes-can-happen-anyone (10/04/2018). It light of the foregoing, the Board is satisfied that the criteria for the establishment of service connection for herpes simplex virus have been met. 38 U.S.C. 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.310(a). REASONS FOR REMAND 1. Entitlement to service connection for a left shoulder condition is remanded. A February 1996 STR indicated that the Veteran was diagnosed with left shoulder tendonitis. The Veteran reported onset in the preceding 5 weeks before seeking medical treatment. A July 1996 left shoulder x-ray was normal. A March 2011 in-service VA examination indicated that the Veteran did not have left impingement syndrome. The Veteran reported that he was diagnosed with shoulder arthritis and that the condition existed since 2006. He endorsed weakness, tenderness and pain with lifting and overheard work. The Veteran also reported flare-ups that occurred as often as 4 times a month that lasted for an hour. A left shoulder x-ray was normal. The Veteran’s March 2011 separation examination indicated that his left shoulder was normal. On the Report of Medical History, the Veteran endorsed “yes” for painful a shoulder. His post-service medical records indicated that the Veteran was diagnosed with a left shoulder condition in close proximity to his separation from service. A March 2012 left shoulder MRI showed an extensive tear in the superior and posterior glenoid labrum. There was significant thickening and edema in the axillary recess of the glenohumeral joint compatible with adhesive capsulitis. There was also evidence of interstitial tendinosis in the long head of the biceps tendon. May 2012 and April 2013 private treatment notes indicated that the Veteran was diagnosed with adhesive capsulitis of shoulder, recurring. In light of the foregoing, an examination is needed to decide the appeal. The clinical evidence indicates that the Veteran was diagnosed with left shoulder tendonitis during active duty and x-ray findings were normal. The Veteran’s March 2011 separation examination indicated that the Veteran’s shoulder was normal. However, shortly after separation, a March 2012 MRI revealed findings compatible with adhesive capsulitis and interstitial tendinosis in the long head of the biceps tendon. Additionally, private treatment records indicated that the Veteran was diagnosed with adhesive capsulitis of shoulder, recurring. As such, a VA examination is needed to determine the etiology of the Veteran’s currently diagnosed left shoulder condition. 2. Entitlement to service connection for sinusitis, pansinusitis, and nasal polyps, status-post rhinoplasty, is remanded. A May 2000 STR indicated that the Veteran underwent nasal surgery. His post-operative diagnosis was tissue designated “right sided nasal polyps” and “left sided nasal polyps”, chronically inflamed respiratory mucosa and seromucous glands with viable lamellar bone. A June 2003 STR indicated that he was diagnosed with chronic cough, sinus congestion and asthma. The Veteran endorsed coughing and wheezing for the preceding 3 days and his past upper respiratory infection was noted. A March 2005 STR indicated that the Veteran was diagnosed with reactive airway disease. The examiner noted the Veteran’s 2-year medical history of asthma, usually controlled with prefrontal inhaler, and radiological findings showed sinusitis. A May 2005 treatment letter indicated that the Veteran’s sinus x-ray revealed left sinus haziness. The letter documented the Veteran’s pulmonary function test results and that he had a small airway reversibility that was well documented. An October 2007 STR indicated that the Veteran was diagnosed with sinusitis, acute. Radiological findings showed a history of allergy and sinusitis. A February 2008 CT scan showed significant interval improvement of his pansinus disease and intranasal polyposis. In May 2008, the Veteran underwent another nasal surgery. His post-operative diagnosis was chronic sinusitis with polyposis. A November 2008 STR indicated that the Veteran was diagnosed with status-post sinus surgery. There was no nasal obstruction and no evidence of polyps. The Veteran’s chronic sinusitis resolved and there were no problems related to a previous upper respiratory infection. In January 2009, the Veteran was diagnosed with nasal polyps, non-allergic, recurrent, with secondary hyposmia and sinusitis; and chronic sinusitis secondary to sinonasal polyposis. In August 2009, he was diagnosed with right and left nasal polyps and ethmoid sinus contents; and allergic fungal sinusitis. A January 2010 final pathology report showed fungal elements with allergic fungal rhinosinusitis (AFRS). However, pathology re-examination of the specimen was unable to discern the type (genus) of fungi present. A March 2010 STR indicated that the Veteran was diagnosed with nasal cavity polyps, no sign of recurrent disease; and rhinitis, chronic. In March 2011, the Veteran was afforded an in-service VA examination. In the examiner’s judgement, a diagnosis was not possible because there was an “intermittent condition” and there was no pathology to render a diagnosis. The Veteran reported that he was diagnosed with rhinitis, status post rhinoplasty with polypectomy and that the condition existed since 2001. The Veteran reported incapacitating episodes as often as twice a week that lasted for an hour. The Veteran endorsed difficulty breathing through his nose, sneezing and a runny nose that occasionally worsened and caused breathing problems. A March 2011 x-ray showed essentially normal-appearing paranasal sinuses. On the March 2011 separation examination report, the Veteran endorsed worsened sinus issues, chronic sinusitis and recurring nasal polyps. On the Report of Medical History, he endorsed “yes” for sinusitis; asthma or any breathing problems related to exercise, weather, pollen etc.; shortness of breath; bronchitis; wheezing or problems with wheezing; chronic cough or cough at night; and that he was prescribed or used an inhaler. He also listed his previous nasal surgeries. His post-service medical record dated September 2012 indicated that he complained of nasal congestion and frequent rhinorrhea. He denied seasonal allergies, perennial allergies, and frequent upper respiratory illnesses. A June 2015 CT scan revealed pansinusitis, most advanced in the frontal sinuses. In light of the foregoing evidence, an examination is needed to decide the appeal. The Veteran was diagnosed with sinusitis, acute; pansinus disease; intranasal polyposis and underwent 2 nasal surgeries during active duty. A November 2008 STR indicated that there was no nasal obstruction, no evidence of polyps and that the Veteran’s chronic sinusitis resolved. Conversely, a January 2009 STR indicated that the Veteran was diagnosed with nasal polyps, non-allergic, recurrent, with secondary hyposmia and sinusitis; and chronic sinusitis secondary to sinonasal polyposis. Yet, a March 2010 STR indicated that the Veteran was diagnosed with nasal cavity polyps, no sign of recurrent disease. The March 2011 VA examiner determined that a diagnosis was not possible because there was an “intermittent condition” and no pathology to render a diagnosis. The examiner did not identify the “intermittent condition” and STRs indicated that the Veteran was variously diagnosed with a sinus condition. The Veteran’s chronic sinusitis and nasal polyp diagnoses were noted at separation. Post-service medical records indicated that the Veteran continued to endorse nasal congestion and frequent rhinorrhea and a CT scan showed advanced pansinusitis. As such, an examination is needed to determine the etiology of the Veteran’s currently diagnosed sinus condition. 3. Entitlement to an initial evaluation in excess of 10 percent for right knee patellofemoral syndrome and entitlement to an initial evaluation in excess of 10 percent for left ankle synovitis are remanded. The Veteran was last provided a VA examination in conjunction with his service-connected right knee patellofemoral syndrome and left ankle synovitis in March 2011. The Court of Appeals for Veterans Claims (Court) held in Correia v. McDonald, 28 Vet. App. 158 (2016), 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. In addition, as relevant to the present case, the Court stated in Correia that knees were “undoubtedly weight-bearing.” Id. A review of the claims file reveals that the prior VA examination reports include only active range of motion findings and does 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, new examinations are necessary to decide the increased rating claim. An additional relevant opinion pertaining to flare-ups was also issued by the Court in Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left shoulder condition, including a tear in the superior and posterior glenoid labrum, adhesive capsulitis, and interstitial tendinosis noted on a March 2012 MRI. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any sinus condition, including sinusitis, pansinusitis, nasal polyps, chronic rhinitis, and status-post rhinoplasty. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease. 3. Schedule the Veteran for an appropriate VA examination to evaluate the service-connected right knee patellofemoral syndrome and left ankle synovitis. The Veteran’s claims folder must be reviewed by the examiner. (a) 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. (b) Pursuant to Correia v. McDonald, the examination should record the results of range of motion testing for pain in BOTH knees and ankles and on BOTH active and passive motion AND in weight-bearing and nonweight-bearing. If the knees and/or ankles cannot be tested on “weight-bearing,” then the examiner must specifically indicate that such testing cannot be done. (c) The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups assessed in terms of the degree of additional range of motion loss. In regard to flare-ups (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)) if the Veteran is not currently experiencing a flare-up, based on relevant information elicited from the Veteran, review of the file, and the current examination results regarding the frequency, duration, characteristics, severity, and functional loss regarding his flares, the examiner is requested to provide an estimate of the Veteran’s functional loss due to flares expressed in terms of the degree of additional range of motion lost, or explain why the examiner cannot do so. [The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran.] TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Taylor, Associate Counsel