Citation Nr: 18145309 Decision Date: 10/26/18 Archive Date: 10/26/18 DOCKET NO. 17-59 292 DATE: October 26, 2018 REMANDED The claim of entitlement to service connection for a left hip disorder, claimed as secondary to service-connected disability, is remanded. The claim of entitlement to service connection for a right hip disorder, claimed as secondary to service-connected disability, is remanded. The claim of entitlement to service connection for a left knee disorder, claimed as secondary to service-connected disability, is remanded. The claim of entitlement to service connection for a right knee disorder, claimed as secondary to service-connected disability, is remanded. The claim of entitlement to a compensable rating for right ankle tendonitis is remanded. The claim of entitlement to a total disability rating based on individual unemployability due to service connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1985 to January 1987. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision. Service connection for bilateral hip and knee disorders The Veteran claims entitlement to service connection for bilateral hip and knee disorders, to include secondary to multiple service connected disorders. VA is obligated to provide a medical examination when the record contains competent evidence that a claimant has a current disability or symptoms of a current disability, the record indicates that a current disability or symptoms of a current disability may be associated with active service, and the record does not contain sufficient information to decide the claim. McLendon v. Nicholson, 20 Vet. App. 79, 81-83 (2006). See also 38 C.F.R. § 3.159(c)(4). A June 2015 VA thoracolumbar spine examination report indicated the Veteran has reduced bilateral hip flexion and reduced bilateral knee extension. In statements submitted to VA, the Veteran, citing an abnormal gait, related her claimed bilateral hip and knee disorders to service-connected back and ankle disabilities. In support of this contention, the Veteran cited the June 2015 examination report’s finding that the Veteran has an abnormal gait and uses assistive devices, including a walker and a wheelchair. Under these circumstances, the claims of entitlement to service connection for bilateral hip and knee disorders will be remanded to arrange for VA examination. Increased rating for right ankle tendonitis The Veteran was most recently afforded a VA examination in June 2015 to assess the severity of her right ankle tendonitis. However, in a letter submitted with her November 2017 substantive appeal, the Veteran indicated this disorder had increased in severity since the June 2015 examination. Accordingly, the Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of her right ankle disability.   Individual unemployability The Board finds that the claim of entitlement to a total disability rating based on individual unemployability due to service connected disabilities is inextricably intertwined with the remanded issues. As such, adjudication of this issue is deferred. The matters are REMANDED for the following action: 1. Associate with the claims folder all VA treatment records for the Veteran dated from June 2017 to the present. This specifically includes all pertinent records from the VA Medical Center in Ann Arbor. If the RO cannot locate such records, it must specifically document the attempts that were made to locate them, and explain in writing why further attempts to locate or obtain any government records would be futile. The RO must then: (a) notify the claimant of the specific records that it is unable to obtain; (b) explain the efforts VA has made to obtain that evidence; and (c) describe any further action it will take with respect to the claims. The claimant must then be given an opportunity to respond. 2. Thereafter, schedule the Veteran for VA examination to determine the nature and etiology of any diagnosed left hip, right hip, left knee, and/or right knee disorder. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. Following examination, the examiner must opine as to whether it is at least as likely as not (50 percent or greater possibility) that any diagnosed left hip, right hip, left knee, and/or right knee disorder had its onset in service; whether the disorder is etiologically related to service; or whether the disorder is caused or aggravated by a service-connected disability to include residuals of a L1 burst fracture with spinal fusion, bilateral lower extremity radiculopathy, and bilateral ankle tendonitis. A complete and fully explanatory rationale must be provided for any opinion offered. If any opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge, i.e., no one could respond given medical science and the known facts, or by a deficiency in the record or the examiner, i.e., additional facts are required, or the examiner does not have the needed knowledge or training. 3. After completing directive one, schedule the Veteran for a VA examination to ascertain the current severity and manifestations of her right ankle tendonitis. The examiner must be provided access to the appellant’s VBMS and Virtual VA/Legacy files. The examiner is to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare, the examiner must have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees. If there is no pain and/or no limitation of function, such facts must be noted in the report. The examiner must address whether there is any medical reason to accept or reject the Veteran’s description of reduced range of motion during flares or repetitive use. Further, the VA examination must include range of motion testing in active motion, passive motion, weight-bearing, and nonweight-bearing. Range of motion findings reported in degrees must be provided in the examination report. The degree at which pain begins must be documented. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The VA examiner should provide a complete rationale for any opinions provided. DEREK R. BROWN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Rasool