Citation Nr: 18142601 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 16-14 104 DATE: October 16, 2018 ORDER Service connection for a skin disability, claimed as impetigo and folliculitis is denied. Entitlement to higher initial ratings for posttraumatic stress disorder (PTSD), currently rated as 50 percent disabling prior to March 16, 2016, and 70 percent thereafter, is denied. Entitlement to an initial rating in excess of 10 percent for tinnitus is denied. Entitlement to an initial compensable rating for bilateral hearing loss is denied. Entitlement to an initial compensable rating for allergic rhinitis is denied. Entitlement to an effective date prior to January 23, 2014 for the grants of service connection for PTSD, back strain, right shoulder strain, tinnitus, bilateral hearing loss, bilateral plantar fasciitis, left hip strain, right knee strain, left knee strain, and allergic rhinitis is denied. REMANDED Entitlement to an initial rating in excess of 20 percent for fibromyalgia is remanded. Entitlement to an initial rating in excess of 20 percent for right shoulder strain is remanded. Entitlement to an initial rating in excess of 20 percent for back strain is remanded. Entitlement to an initial compensable rating for left hip strain is remanded. Entitlement to an initial compensable rating for right knee strain is remanded. Entitlement to an initial compensable rating for left knee strain is remanded. Entitlement to an initial compensable rating for bilateral plantar fasciitis is remanded. FINDINGS OF FACT 1. The Veteran does not have impetigo/folliculitis. 2. The Veteran’s tinnitus is assigned the maximum schedular rating. 3. The Veteran’s hearing loss is manifested by level II hearing in each ear. 4. Throughout the period on appeal, there is no evidence that the Veteran’s allergic rhinitis was manifested by greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side. At no time have nasal polyps been shown. 5. Prior to March 16, 2016, the Veteran’s PTSD was manifested by occupational and social impairment with reduced reliability and productivity. 6. Since March 16, 2016, the Veteran’s PTSD has been manifested by symptoms that cause occupational and social impairment with deficiencies in most areas, but not total occupational and social impairment. 7. The Veteran’s claims for service connection for PTSD, back strain, right shoulder strain, tinnitus, bilateral hearing loss, bilateral plantar fasciitis, left hip strain, right knee strain, left knee strain, and allergic rhinitis were received on January 22, 2014, within one year of his separation from service. CONCLUSIONS OF LAW 1. The criteria for service connection for impetigo/folliculitis have not been met. 38 U.S.C. §§ 1110, 5107, 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for an initial disability rating in excess of 50 percent for PTSD prior to March 16, 2016, and in excess of 70 percent thereafter, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1-4.3, 4.21, 4.126, 4.130, Diagnostic Code 9411. 3. The criteria for an initial rating in excess of 10 percent for tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.3, 4.7, 4.85, 4.86, Diagnostic Code 6260. 4. The criteria for an initial compensable rating for a bilateral hearing loss disability have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 6100. 5. The criteria for an initial compensable rating for allergic rhinitis have not been met. 38 U.S.C. §§ 1155, 5107(b); 38 C.F.R. §§ 4.1, 4.2, 4.7, 4.10, 4.97, Diagnostic Code 6522. 6. The criteria for effective dates prior to January 23, 2014 for the grants of service connection for PTSD, back strain, right shoulder strain, tinnitus, bilateral hearing loss, bilateral plantar fasciitis, left hip strain, right knee strain, left knee strain, and allergic rhinitis have not been met. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2)(i). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 6, 1997 to October 28, 1997, from January 27, 2000 to August 12, 2000, and from February 1, 2002 to January 22, 2014. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision of a Department of Veterans Affairs (VA) Regional Offices (RO). 1. Service connection for a skin disability, claimed as impetigo and folliculitis Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. “To establish a right to compensation for a present disability, a veteran must show: ‘(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service’-the so-called ‘nexus’ requirement.” Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004)). Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). In the absence of proof of a present disability there can be no valid claim. Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). The requirement of a current disability is satisfied when the Veteran has a disability at the time he files his service connection claim or during the pendency of that claim, even if the disability resolves prior to adjudication of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). However, when the record contains a recent diagnosis of disability prior to the Veteran’s filing of a claim for benefits based on that disability, the report of the diagnosis is relevant evidence that the Board must address in determining whether a current disability existed at the time the claim was filed or during its pendency. Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). The United States Court of Appeals for the Federal Circuit has held that “[l]ay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional.” Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d at 1337 (“[T]he Board cannot determine that lay evidence lacks credibility merely because it is unaccompanied by contemporaneous medical evidence”). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b) (West 2014). During service in May 2004 the Veteran was treated for impetigo of the left cheek. In August 2004, impetigo/folliculitis was noted. On the report of medical history completed by the Veteran in October 2013, he reported having a “blister that comes out on my left cheek every 3 months.” The service separation examination in October 2013 noted normal face and skin examinations. On VA examination in May 2014, the Veteran reported that he developed a patchy rash on his left cheek in service after being bitten by a bug. He reported having recurrence of the rash three to four times per year, each lasting about seven days and then resolving. Currently, the rash was not present. On examination, there was no rash present on the left cheek and the Veteran had no other skin complaints. The examiner diagnosed rash-resolved. The VA treatment records do not show any findings related to the Veteran’s impetigo/folliculitis. In the absence of proof of present disability, there can be no valid claim for service connection. Gilpin v. West, 155 F.3d 1353 (Fed. Cir. 1998); Brammer v. Derwinski, 3 Vet. App. 223, 225 (1992). There is no diagnosis of impetigo and/or folliculitis by a medical professional at any time since service, and the Veteran is not shown to be competent to diagnose such disability. The service separation examination and the May 2014 VA examination found no evidence of impetigo/folliculitis, and the May 2014 examiner stated that the condition had resolved. The preponderance of the evidence is against the claim for service connection for impetigo/folliculitis; there is no doubt to be resolved; and service connection is not warranted. 38 U.S.C. § 5107 (b). Increased Rating Disability evaluations are determined by comparing a veteran’s symptoms with criteria set forth in VA’s Schedule for Rating Disabilities, which are based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher of the two evaluations is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Veteran’s entire history is reviewed when making disability evaluations. See generally 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The Board must also fully consider the lay assertions of record. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Where, as here, the question for consideration is the propriety of the initial evaluations assigned, consideration of the evidence since the effective date of the award of service connection and consideration of the appropriateness of staged ratings are required. Fenderson v. West, 12 Vet. App. 119, 126 (1999). 2. Entitlement to an initial rating in excess of 10 percent for tinnitus The Veteran seeks an initial rating higher than 10 percent for his service connected tinnitus. The tinnitus has already been assigned the maximum schedular rating available under 38 C.F.R. § 4.87, DC 6260. There is no legal basis upon which to award more than a 10 percent rating. Accordingly, the Veteran’s appeal must be denied. Sabonis v. Brown, 6 Vet. App. (1994). There are no additional expressly or reasonably raised issues on the record. Entitlement to an initial compensable rating for bilateral hearing loss The Veteran contends that he is entitled to a compensable disability rating for his bilateral hearing loss. Hearing loss is rated under Diagnostic Code 6100. The assigned evaluations for hearing loss are determined by mechanically, so nondiscretionarily, applying the rating criteria to certified test results. See Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). Hearing loss ratings range from noncompensable to 100 percent based on organic impairment of hearing acuity, as measured by controlled speech discrimination tests in conjunction with average hearing thresholds determined by puretone audiometric testing at frequencies of 1000, 2000, 3000 and 4000 cycles per second. “Puretone threshold average” is the sum of the puretone thresholds at 1000, 2000, 3000 and 4000 Hertz divided by four. This average is used in all cases (including those in §4.86) to determine the Roman numeral designation for hearing impairment from Table VI or VIA. 38 C.F.R. § 4.85, Diagnostic Code 6100. A VA examination was conducted in April 2014. Pure tone thresholds, in decibels, were as follows:   HERTZ 1000 2000 3000 4000 RIGHT 45 35 35 40 LEFT 40 45 40 40 Speech audiometry revealed speech recognition ability of 88 percent in each ear. Applying the results from the April 2014 VA examination to Table VI in 38 C.F.R. § 4.85 yields a finding of Level II hearing loss in the right ear and Level II hearing loss in the left ear. When both ears have Level II hearing loss, a zero percent (noncompensable) rating is assigned under Table VII. 38 C.F.R. § 4.85. The Veteran has reported that he has trouble understanding speech when in crowds, when using the telephone at work, and when his wife is speaking from another room. The Board does not discount the difficulties the Veteran has with his hearing acuity, however as noted above, schedular disability ratings for hearing loss are based on the results of the audiological studies of record. Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The Veteran’s hearing difficulties with everyday speech and in noisy environments are acknowledged; however, the rating criteria for hearing loss contemplate the functional effects of decreased hearing and difficulty understanding speech in an everyday work environment as these are the effects that VA’s audiometric tests are designed to measure. Doucette v. Shulkin, 28 Vet. App. 377 (2017). In reaching this decision, the Board considered the doctrine of reasonable doubt. However, since the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). There are no additional expressly or reasonably raised issues presented on the record. 3. Entitlement to an initial compensable rating for allergic rhinitis Under Diagnostic Code 6522, a 30 percent rating is provided for allergic or vasomotor rhinitis with polyps. Without polyps, but with greater than 50-percent obstruction of nasal passages on both sides or complete obstruction on one side a 10 percent rating is provided. 38 C.F.R. § 4.97, Diagnostic Code 6522. When the schedule does not provide a zero percent evaluation for in a Diagnostic Code, a zero percent evaluation will be assigned when the requirements for a compensable evaluation are not met. 38 C.F.R. § 4.31. On VA examination in May 2014, the examiner stated that there was not 50 percent or greater obstruction on nasal passage on both sides or complete obstruction on one side. There were no nasal polyps and no permanent hypertrophy of the nasal turbinates. There was no indication of nasal obstruction of greater than 50 percent on both sides on the examination of record. Nor was there showing of complete obstruction on one side. Thus, the Veteran’s symptoms do not rise to the level of a 10 percent rating under Diagnostic Code 6522. The preponderance of the evidence is against a compensable rating for the Veteran’s allergic rhinitis. 38 U.S.C. § 5107 (b). 4. Entitlement to higher initial ratings for PTSD, currently rated as 50 percent disabling prior to March 16, 2016, and 70 percent thereafter The Veteran’s service connected PTSD is currently rated as 50 percent disabling prior to March 16, 2016, and 70 percent from that date; the 70 percent rating was granted in a September 2017 rating decision. Under the General Rating Formula for Mental Disorders, Diagnostic Code 9411, a 50 percent rating contemplates occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; and difficulty in establishing and maintaining effective work and social relationships. The criteria for a 70 percent rating are occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood, due to such symptoms as: suicidal ideation; obsessional rituals which interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting the ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships. Finally, the criteria for a 100 percent rating are total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation, or own name. 38 C.F.R. § 4.130, Diagnostic Code 9411. Ratings are assigned according to the manifestation of particular symptoms, but the use of the term “such as” in the General Rating Formula demonstrates that the symptoms after the phrase are not intended to constitute an exhaustive list, but rather are to serve as examples of the type and degree of the symptoms, or their effects, that would justify a particular rating. Mauerhan v. Principi, 16 Vet. App. 436 (2002). On VA examination in April 2014, the examiner diagnosed PTSD and noted that it resulted in occupational and social impairment with occasional decrease in work efficiency and intermittent periods of inability to perform occupational tasks, although he was generally functioning satisfactorily, with normal routine behavior, self-care and conversation. The Veteran was noted to be married and to have an infant daughter. He was noted to be working and to be pursuing a degree in architecture. The Veteran reported sleep difficulties, anxiety, and depression. The examiner also noted symptoms of mild memory loss, difficulty in understanding complex commands, impaired abstract thinking, disturbances in motivation and mood, difficulty in establishing and maintaining effective work and social relationships, difficulty in adapting to stressful circumstances (including work or a work-like setting), and inability to establish and maintain effective relationships. On a June 2015 neuropsychiatric consultation, the Veteran was oriented in all spheres. He denied the presence or history of suicidal or homicidal ideation. There was no reported history of perceptual abnormalities, including auditory, visual, or tactile hallucinations, and no presence of delusional thinking. The Veteran reported general satisfaction with his current marriage, although there were some tensions attributed to re-integrating into a non-military lifestyle. The Veteran had a strong personal investment in his role as a father to his young daughter. His hobbies included painting figurines, drawing, school, and learning about military weapons. He was currently a full-time student at the Academy of Art. He also assisted his father in a home remodeling business. On examination, the Veteran was oriented to person, place, time, and situation. His grooming and hygiene were intact. Gross attention and concentration abilities were intact. There were no sensory-perceptual impairments that interfered with his ability to understand questions posed to him, or to respond independently without cues. Thought process was linear and goal directed. There were no perceptual abnormalities reported, or observed, including auditory of visual hallucinations. There was no indication of fixed delusional belief system reflective of a psychotic process. He persisted well through tasks. The examiner noted that the Veteran reported symptoms consistent with both PTSD and Depression, and symptoms of both conditions were significantly interfering with functioning in a variety of life areas. Attention and concentration and memory problems were noted to be features of both psychiatric conditions. Clinically significant symptoms of PTSD and depression were also affecting relational functioning. The Veteran remarked about how he had secured a perimeter for his home, and was constructing a fence with motion detector lights. Additionally, there were significant adjustment-related stressors associated with recent military separation, adjusting to life at home as a husband and father, and simultaneously trying to move forward in academic and vocational domains. On VA PTSD Disability Benefits Questionnaire (DBQ) dated March 16, 2016, the examiner stated that the Veteran’s PTSD caused occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking, and/or mood. The Veteran continued to live with his wife and child. He reported that he was socially isolated and withdrawn. He was taking college classes online. The examiner noted symptoms of depressed mood; anxiety; suspiciousness; near continuous panic or depression effecting the ability to function independently, appropriately and effectively; chronic sleep impairment; mild memory loss; impairment of short and long term memory; memory loss for names; flattened affect; difficulty in understanding complex commands; gross impairment of thought processes or communication; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; difficulty in adapting to stressful circumstances (including work or a work-like setting); inability to establish and maintain effective relationships; neglect of personal appearance and hygiene; and intermittent ability to perform activities of daily living (including maintenance of minimal personal hygiene). On examination, the Veteran’s attention was normal and concentration variable. He struggled with remembering basic information. His speech flow was normal, but he was brief with information offered. His thought content was appropriate for the circumstances. His organization of thought was goal-directed. There was no report of overt hallucinations. Fund of knowledge and judgment were average. The Veteran’s mood was anxious and nervous and his affect was restricted. The examiner stated that the Veteran could not sustain the stress from a competitive work environment or be expected to engage in gainful activity due to his PTSD. He was currently enrolled in college classes (he took four online courses at a time) and had difficulty concentrating. The Veteran described not getting enough restful sleep and feeling fatigued nearly every day. He had difficulty maintaining and sustaining a steady mood and this led to problems in his social and work life. The Veteran stated that he had not been able to have meaningful occupational or social relationships and he could not let others into his life because of issues with trust. In January 2017 a VA social worker noted that the Veteran was married and had two children, ages 3 and 9 months. He was currently a full-time student attending the Academy of Arts University (online) to obtain his Master’s degree in interior architectural design. The Veteran also reported that he was employed full time as a warehouse manager for a furniture company. The VA social worker noted that the Veteran sounded alert and oriented on the phone. His behavior was appropriate and he was cooperative and polite. His speech was normal, rate, rhythm and tone. His thoughts were clear and no odd or unusual behavior was noted. On a June 2017 treatment record, the Veteran noted an irritable mood. He no longer trusted people and felt that the world was unsafe. He reported yelling/anger outbursts but denied physical violence. His mood was “distant.” He denied suicidal or homicidal ideation. The Veteran was noted to be a warehouse manager and to live with his wife and two children. Rating Prior to March 16, 2016 During this period, the Veteran’s disability picture most closely approximated that of a 50 percent rating for PTSD. He did not have deficiencies in most areas. He was employed and taking college classes, he pursued hobbies, and he could maintain personal hygiene; he did not have near-continuous panic or depression that affected his ability to function independently or appropriately, as would suggest a higher 70 percent rating. The Veteran was married and lived with his wife and daughter. His PTSD symptoms were relatively consistent and stable throughout this time period. For example, the Veteran consistently denied suicidal ideation, and there is no indication that suicidal ideation significantly interfered with the Veteran’s occupation or social functioning. As such, there is also not sufficient evidence that the Veteran’s symptoms were of the severity and frequency to cause the level of occupational and social impairment associated with a higher disability rating. See Bankhead v. Shulkin, No. 15-2404, slip op. at 10 (U.S. Vet. App. Mar. 27, 2017); Vazquez-Claudio v. Shinseki, 713 F.3d 112, 115 (Fed. Cir. 2013). Consequently, a rating in excess of 50 percent for PTSD is not warranted. Rating Since March 16, 2016 The currently assigned 70 percent rating for this time period contemplates PTSD that results in occupational and social impairment, with deficiencies in most areas, such as work, school, family relations, judgment, thinking, or mood. The March 2016 examiner endorsed near continuous panic or depression effecting the ability to function independently, appropriately and effectively; memory loss for names; disturbances of motivation and mood; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships; neglect of personal appearance and hygiene. These symptoms most closely approximate a 70 percent rating. A higher 100 percent rating would require a disability picture with evidence such gross impairment in thought processes or communication, persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others, disorientation to time or place, or memory loss for names of close relatives, own occupation, or own name. While the March 2016 examiner endorsed some of the symptoms associated with a 100 percent rating (memory loss for names and intermittent ability to perform activities of daily living, including maintenance of minimal personal hygiene), the Board finds that the overall disability picture is not consistent with those findings. The January 2017 and June 2017 treatment records note that the Veteran was working fulltime and continuing to pursue a Master’s degree. He has continued to live with his wife and children. The Veteran has consistently denied hallucinations and suicidal ideation. The evidence does not demonstrate total occupational and social impairment. Consequently, a rating in excess of 70 percent for PTSD is not warranted. 5. Entitlement to an effective date prior to January 23, 2014 for the grants of service connection for PTSD, back strain, right shoulder strain, tinnitus, bilateral hearing loss, bilateral plantar fasciitis, left hip strain, right knee strain, left knee strain, and allergic rhinitis On his notice of disagreement in March 2015 the Veteran indicated that he disagreed with the effective dates of the awards of service connection for PTSD, back strain, right shoulder strain, tinnitus, bilateral hearing loss, bilateral plantar fasciitis, left hip strain, right knee strain, left knee strain, and allergic rhinitis. The effective date assigned in the August 2014 rating decision on appeal for each of the service connection awards is January 23, 2014, the day following the Veteran’s separation from active service. The Veteran has not made any argument as to why he thinks earlier effective dates are warranted. Generally, except as otherwise provided, the effective date of an evaluation and award of pension, compensation, or dependency and indemnity compensation based on an original claim, a claim reopened after final disallowance, or a claim for increase will be the date of receipt of the claim, or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400. The effective date of an original award of direct service connection is the day following separation from active service or the date entitlement arose if the claim is received within one year after separation from service; otherwise, date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2)(i). Here, the Veteran’s claim for service connection was received within one year of his separation from service in January 2014, and the effective dates of the service connection awards are properly January 23, 2014, the day following his separation from service. As there is no basis for an earlier effective date, the claims for earlier effective dates must be denied. 38 U.S.C. § 5110 (b); 38 C.F.R. § 3.400 (b)(2)(i). REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 20 percent for fibromyalgia is remanded. In a March 2016 rating decision, the RO granted an initial 20 percent rating for service connected fibromyalgia. The Veteran filed a notice of disagreement with respect to that decision in August 2016. No statement of the case (SOC) has been issued with respect to the Veteran’s notice of disagreement. Moreover, the RO has not acknowledged receipt of the notice of disagreement in the VA Central Office Locator System (VACOLS) so that the Board can be sure that the RO is presently working on getting an SOC to the Veteran. The appropriate Board action in such a case is to remand the issue to the AOJ for issuance of an SOC. Manlincon v. West, 12 Vet. App. 238 (1999). 2. Entitlement to an initial rating in excess of 20 percent for right shoulder strain is remanded. 3. Entitlement to an initial rating in excess of 20 percent for back strain is remanded. 4. Entitlement to an initial compensable rating for left hip strain is remanded. 5. Entitlement to an initial compensable rating for right knee strain is remanded. 6. Entitlement to an initial compensable rating for left knee strain is remanded. 7. Entitlement to an initial compensable rating for bilateral plantar fasciitis is remanded. The only VA examination of the Veteran’s service connected back, right shoulder, feet, left hip, and left and right knee disabilities were conducted in May 2014. In Correia v. McDonald, 28 Vet. App. 158 (2016), the United States Court of Appeals for Veterans Claims (Court) held that to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of 38 C.F.R. § 4.59. Thirty-eight C.F.R. § 4.59 states that “[t]he joints involved should be tested for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” As such, pursuant to Correia, an adequate VA joints examination must, wherever possible, include range of motion testing on active and passive motion and in weight-bearing and nonweight-bearing conditions. The examinations of record do not include such testing. In Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the Court addressed the adequacy of “mere speculation” opinions. The Court explained that case law and VA guidelines do not require direct observation of functional impairment after repetitive use or during a flare-up as a prerequisite to offering a DeLuca opinion. Indeed, it is not expected that such observation will usually occur; therefore, VA examiners should offer opinions based on estimates derived from information procured from all relevant sources, including the lay statements of veterans. If a non-speculative opinion still cannot be offered, the VA examiner must explain the basis for this conclusion. It must be apparent that the inability to provide an opinion without resorting to speculation reflects the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. The May 2014 VA examinations noted the Veteran’s report of flare-ups; however, the detailed findings contemplated by the Sharp case were not included. Remand for new VA examinations to address the Correia and Sharp standards are required. 38 C.F.R. § 4.2. The matters are REMANDED for the following action: 1. Issue the Veteran a SOC addressing the issue of entitlement to an initial rating in excess of 20 percent for fibromyalgia, to include notification of the need to timely file a substantive appeal to perfect his appeal on the issue. 2. Schedule the Veteran for VA examinations to assess the current severity of his service connected back, right shoulder, bilateral feet, left hip, and left and right knee disabilities. The examiners must review the claims file in conjunction with the examinations. The joints involved should be tested for pain on both active and passive motion and in weight-bearing and nonweight-bearing. These findings are required by VA regulations as interpreted by courts. If for any reason the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, or is not medically appropriate, in this case; he or she should clearly explain why that is so. The examiners should also express an opinion as to whether pain, weakness, fatigability, or incoordination cause additional functional impairment on repeated use over time or during flare-ups. The examiners should assess the additional functional impairment in terms of the degree of additional range-of-motion loss, if possible, for the specific joints. If the Veteran is not being observed after repetitive use or during a flare-up, the examiners should still estimate any additional functional loss during flare-ups or on repeated use, based on the Veteran’s description of his flares’ severity, frequency, duration, and/or functional loss manifestations. If it is not feasible to determine the extent to which the Veteran experiences additional functional loss on repeated use over time or during flare-ups, without resorting to speculation, each examiner must provide an explanation for why this is so. The examiners are further advised that the inability to provide an opinion without resorting to speculation must be based the limitation of knowledge in the medical community at large and not a limitation - whether based on lack of expertise, insufficient information, or unprocured testing - of the individual examiner. A complete rationale must be provided for all opinions expressed. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel