Citation Nr: 18144317 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 15-35 620A DATE: October 24, 2018 REMANDED Entitlement to a rating in excess of ten percent for a left meniscal tear with tenosynovitis with limitation of motion (left knee limitation of motion) is remanded. Entitlement to a rating in excess of ten percent for a left meniscal tear with tenosynovitis with instability (left knee instability) is remanded. Entitlement to service connection for diabetes mellitus is remanded. Entitlement to service connection for sleep apnea is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1994 to March 2000. These matters come before the Board of Veterans' Appeals (Board) on appeal from October 2011, August 2013 and September 2014 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to a rating in excess of 10 percent for left knee limitation of motion. The Veteran’s left knee tenosynovitis was service connected in June 2000 with a rating of ten percent, effective March 5, 2000. The Veteran underwent knee surgery in October 2010. See August 2015 CAPRI at 11. The Veteran’s most recent VA examination occurred in June 2011. During his examination, the Veteran reported that his knee had become progressively worse since onset. The Veteran was noted to have crepitus, edema, tenderness, pain at rest, instability and weakness. See June 2011 VA Examination. Evidence suggests worsening of the Veteran’s disability since his 2011 examination. Specifically, the Veteran continues to endorse ongoing symptoms of pain, stiffness, weakness and fatigue in his February 2015 appeal. Further, October 2017 treatment records include active prescriptions for the Veteran’s ongoing knee pain. See July 2018 Medical Treatment Record Government Facility at 2. Accordingly, a new VA examination is warranted. Entitlement to a rating in excess of 10 percent for left knee instability. The Veteran’s left knee instability was service connected in October 2011, at rating of ten percent, effective October 28, 2010. As discussed above, the Veteran last underwent a VA examination for his knee in June 2011, however, treatment records note ongoing knee pain and the Veteran has alleged ongoing symptoms of stiffness, weakness and fatigue. Accordingly, a VA examination is warranted. Entitlement to service connection for diabetes mellitus. The Veteran was diagnosed with diabetes mellitus in April 2012. The Veteran alleges that his diabetes mellitus is secondary to his service-connected hypertension. See October 2015 Form 9. The Veteran was not afforded a VA examination for his diabetes. Further, the record does not contain an opinion regarding the etiology of the Veteran’s diabetes or whether it was caused or aggravated by the Veteran’s hypertension. Accordingly, a VA examination is warranted. Entitlement to service connection for sleep apnea. In his appeal to the Board, the Veteran alleges that his sleep apnea is secondary to his service-connected hypertension. See October 2015 Form 9. Treatment records show the Veteran has a current diagnosis of obstructive sleep apnea. The Veteran was not afforded a VA examination for his sleep apnea. Further the record does not contain an opinion regarding the etiology of the Veteran’s sleep apnea or whether it was caused or aggravated by the Veteran’s hypertension. Accordingly, a VA examination is warranted. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the Veteran’s service-connected left knee disabilities to include limitation of motion and instability. The examiner should provide a full description of the Veteran’s left knee disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must 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 recurrent subluxation or lateral instability and discuss the effect of the Veteran’s left knee 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). 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s diabetes. The examiner must opine whether it is at least as likely as not caused the Veteran’s military service. The examiner must also opine whether the Veteran’s diabetes is at least as likely as not (1) proximately due to the Veteran’s service-connected hypertension, or (2) aggravated beyond its natural progression by the Veteran’s service-connected hypertension. The examiner must explain why or why not. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of the Veteran’s obstructive sleep apnea. The examiner must opine whether it is at least as likely as not caused the Veteran’s military service. The examiner must also opine whether the Veteran’s sleep apnea is at least as likely as not (1) proximately due to the Veteran’s service-connected hypertension, or (2) aggravated beyond its natural progression by the Veteran’s service-connected hypertension. The examiner must explain why or why not. S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Wimbish, Associate Counsel