Citation Nr: 18143195 Decision Date: 10/18/18 Archive Date: 10/18/18 DOCKET NO. 15-17 635 DATE: October 18, 2018 ORDER Entitlement to a compensable evaluation for vertigo is denied. Entitlement to a compensable evaluation for a surgical scar related to left knee arthroscopy is denied. REMANDED Entitlement to service connection for bilateral carpal tunnel syndrome is remanded. Entitlement to an evaluation in excess of 10 percent for a left knee disability, status post arthroscopy, is remanded. FINDINGS OF FACT 1. The Veteran’s service-connected vertigo does not manifest as occasional dizziness. 2. The Veteran’s surgical scar is not unstable or painful. CONCLUSIONS OF LAW 1. The criteria for entitlement to a compensable evaluation for vertigo have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.87, Diagnostic Code 6204 (2018). 2. The criteria for entitlement to a compensable evaluation for surgical scar related to left knee arthroscopy have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Codes 7804, 7805 (2018). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from May 2005 to August 2006. Following a May 2017 remand to afford the Veteran a hearing, the Veteran testified before the undersigned Veterans Law Judge in a May 2018 Video Conference Board Hearing. A transcript of that hearing is of record. 1. Entitlement to a Compensable Evaluation for a Left Knee Surgical Scar The Veteran contends that she is entitled to a compensable evaluation for a service-connected left knee scar. 38 C.F.R. § 4.118, Diagnostic Code (DC) 7805 provides that scars, to include linear scars and other effects of scars, be evaluated under diagnostic codes 7800, 7800, 7801, 7802, and 7804. DC 7804 provides one or two scars that are unstable or painful should be entitled as 10 percent disabling. The weight of the probative evidence is against a compensable evaluation for a linear left knee scar post arthroscopy. An October 2015 VA medical examination measured the linear scar from the Veteran’s left knee arthroscopy at 0.25 cm in length. It noted that the Veteran’s scar was not painful or unstable, and it did not have any functional impact on the Veteran’s ability to work. The Veteran similarly testified in May 2018 that the left knee scar was “fine” at the time of her hearing. Accordingly, the weight of the evidence is against entitlement to a compensable evaluation for a service-connected left knee scar. 2. Entitlement to a Compensable Evaluation for Vertigo The Veteran’s service-connected vertigo is evaluated as non-compensable under 38 C.F.R. § 4.87, Diagnostic Code (DC) 6204 effective November 16, 2015. DC 6204 provides a 10 percent evaluation for occasional dizziness and a 30 percent evaluation for dizziness and occasional staggering. The Veteran’s service-connected vertigo does not occur frequently enough to warrant a compensable evaluation for occasional dizziness. October 2015 VA treatment records document the Veteran’s complaints of vertigo while lying flat on her back, bent forward, or getting into or out of bed. The Veteran treated dizziness and spinning with meclizine. She underwent a series of canalith reposition procedures that provided some relief when the Veteran returned to a sitting position. Physical therapy was recommended to decrease her vertigo and return the Veteran to her prior level of functioning. November 2015 VA treatment records document that the Veteran felt off-balance, nauseous, and dizzy for approximately three days following treatment in October 2015. The Veteran reported that she felt okay since the few days immediately following treatment. Gaze without fixation test noted no spontaneous or gaze-evoked nystagmus, a Dix-Hallpike test was negative bilaterally, and a roll test was negative bilaterally. The examining physical therapist concluded that the Veteran’s benign paroxysmal positional vertigo had resolved. The Veteran was told to return for additional treatment if vertigo recurred. The Veteran testified that vertigo does not occur often and she initially could not “even put [a] time frame on it.” She said vertigo occurred occasionally, less frequently than once a month and perhaps once every two months. She described the most recent experience of spinning or feeling like she was going to fall over after a boat ride. She was not certain, however, if her feelings of dizziness and imbalance was due to the boat ride itself or whether the boat ride triggered vertigo. The Board concludes that the probative evidence weighs against finding that the Veteran is entitled to a compensable evaluation. The Veteran last received treatment for Vertigo in November 2015. Her most recent episode of dizziness or imbalance, by her own report, may or may not have been vertigo. The Veteran even testified that vertigo does not occur often. Because the weight of the probative evidence of record indicates that the Veteran experiences vertigo infrequently, she is not entitled to a compensable evaluation for vertigo. REASONS FOR REMAND 1. Entitlement to Service Connection for Bilateral Carpal Tunnel Syndrome January 2018 VA treatment records document a current diagnosis for bilateral carpel tunnel syndrome. In May 2018, the Veteran testified that her duties while deployed to Iraq from July 2005 to May 2006 involved a significant amount of typing. She was not certain when her symptoms had their onset, but she testified that she experienced weakness in her wrists during her deployment. There is evidence of a current disability and an in-service incident. However, the Veteran has not been provided a VA medical examination or opinion regarding the etiology of her bilateral carpal tunnel syndrome. There is no competent medical evidence of record sufficient to adjudicate the Veteran’s claim; thus, the Veteran should be afforded a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79, 81–84 (2006). 2. Entitlement to an Evaluation in Excess of 10 percent for a Left Knee Disability, Status Post Arthroscopy, Is Remanded While the mere passage of time does not render a VA examination inadequate, Palczewski v. Nicholson, 21 Vet. App. 174, 182 (2007), a new examination is necessary to determine the current severity of the Veteran’s service-connected left knee disability. The Veteran was last afforded a VA examination for her service-connected left knee disorder in October 2015. At her May 2018 hearing, the Veteran testified that her service-connected left knee disability had worsened since that examination. She testified that she experienced pain and instability for which she sought medical attention and received gel injections that have improved her symptoms. In light of the Veteran’s testimony, a new examination to determine the severity of the Veteran’s left knee disability is required. 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 her bilateral carpal tunnel syndrome. (a.) The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including the amount of typing associated with the Veteran’s duties while deployed to Iraq from July 2005 to May 2006. (b.) The examiner must opine whether bilateral carpal tunnel syndrome is at least as likely as not (1) proximately due to the Veteran’s service-connected cervical disc disease with intervertebral disc syndrome and degenerative joint disease, or (2) aggravated beyond its natural progression by the Veteran’s service-connected cervical disc disease with intervertebral disc syndrome and degenerative joint disease. 2. Schedule the Veteran for an examination of the current severity of her left knee disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s left knee disability alone and discuss the effect of the Veteran’s left knee disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Douglas M. Humphrey, Associate Counsel