Citation Nr: 18145545 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 16-03 844A DATE: October 29, 2018 ORDER Entitlement to service connection for arthritis is denied. Entitlement to service connection for a left shoulder condition is denied. Entitlement to service connection for a right shoulder condition is denied. Entitlement to service connection for a left wrist condition is denied. Entitlement to service connection for high blood pressure is denied. Entitlement to service connection for a condition to account for penis deformity with loss of erectile power is denied. Entitlement to a rating in excess of 10 percent disabling for service-connected tinnitus is denied. Entitlement to an effective date prior to April 22, 2004, for the grant of service connection for left knee degenerative arthritis is dismissed. Entitlement to an effective date prior to July 31, 2000, for the grant of service connection for left knee instability is dismissed. Entitlement to an effective date prior to July 31, 2000, for the grant of service connection for left ankle fracture is dismissed. Entitlement to an effective date prior to October 15, 2013, for the grant of service connection for left knee scars is denied. Entitlement to an effective date prior to September 8, 2014, for the grant of service connection for bilateral sensorineural hearing loss is denied. Entitlement to an effective date prior to September 8, 2014, for the grant of service connection for tinnitus is denied. Entitlement to an effective date prior to September 8, 2014, for the grant of service connection for major depressive disorder, anxiety disorder not otherwise (NOS) specified and alcohol abuse in remission is denied. REMANDED Entitlement to service connection for degenerative arthritis of the thoracic spine, to include as secondary to service connected degenerative arthritis of the left knee is remanded. Entitlement to service connection for degenerative arthritis of the right knee to include as secondary to service-connected degenerative arthritis of the left knee is remanded. Entitlement to service connection for degenerative arthritis of the right ankle, to include as secondary to service-connected degenerative arthritis of the left knee is remanded. Entitlement to service connection for a right ankle condition, to include as secondary to service-connected degenerative arthritis of the left knee is remanded. Entitlement to service connection for a condition to account for shortening of the left lower extremity, to include as secondary to service-connected degenerative arthritis of the left knee is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected left knee instability is remanded. Entitlement to a rating in excess of 10 percent disabling for service-connected left knee degenerative arthritis status post medial and lateral meniscectomy is remanded. Entitlement to a compensable rating for service-connected bilateral sensorineural hearing loss is remanded. Entitlement to a compensable rating for service-connected left knee scars is remanded. Entitlement to a rating in excess of 70 percent disabling for service-connected major depressive disorder, anxiety disorder NOS and alcohol abuse in remission is remanded. Entitlement to a total disability rating due to individual unemployability as a result of service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s records document a history of arthritis, a left shoulder condition, a right shoulder condition, a left wrist condition, high blood pressure, and penis deformity with loss of erectile power but, even conceding a clinical diagnoses of such disabilities, the Veteran has not advanced any specific allegations regarding them; there is no evidence of complaints, treatment, or diagnoses related to such disabilities in service or any indication or allegation that such disabilities are caused or aggravated by another service-connected disability. 2. The 10 percent rating assigned for the Veteran’s tinnitus is the maximum schedular rating provided; factors warranting extraschedular consideration are neither alleged nor shown by the record. 3. The RO granted service connection for degenerative arthritis of the left knee in a May 2004 rating decision assigning an effective date of April 22, 2004. The Veteran did not perfect an appeal of this rating decision; nor has he asserted clear and unmistakable error in this decision. 4. The RO granted service connection for left knee instability in a July 2001 rating decision assigning an effective date of July 31, 2000. The Veteran did not perfect an appeal of this rating decision; nor has he asserted clear and unmistakable error in this decision. 5. The RO granted service connection for left ankle fracture in a July 2001 rating decision assigning an effective date of July 31, 2000. The Veteran did not perfect an appeal of this rating decision; nor has he asserted clear and unmistakable error in this decision. 6. VA received the Veteran’s original claim of service connection for left knee scars on October 15, 2013; the first rating decision addressing that matter was the August 2014 decision on appeal. 7. VA received the Veteran’s original claim of service connection for bilateral sensorineural hearing loss on September 8, 2014; the first rating decision addressing that matter was the January 2015 decision on appeal. 8. VA received the Veteran’s original claim of service connection for tinnitus on September 8, 2014; the first rating decision addressing that matter was the January 2015 decision on appeal. 9. VA received the Veteran’s original claim of service connection for major depressive disorder, anxiety disorder (NOS) and alcohol abuse in remission on September 8, 2014; the first rating decision addressing that matter was the February 2015 decision on appeal. CONCLUSIONS OF LAW 1. The criteria for service connection for arthritis have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 2. The criteria for service connection for a left shoulder condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 3. The criteria for service connection for a right shoulder condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 4. The criteria for service connection for a left wrist condition have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 5. The criteria for service connection for high blood pressure have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 6. The criteria for service connection for a condition to account for penis deformity with loss of erectile power have not been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.304, 3.310. 7. The criteria for a rating in excess of 10 percent disabling for service-connected tinnitus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.85, Code 6260. 8. The Veteran’s freestanding claim seeking an effective date prior to April 22, 2004, for the grant of service connection for left knee degenerative arthritis lacks legal merit. 38 U.S.C. §§ 5109A, 7105; 38 C.F.R. § 20.101; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 9. The Veteran’s freestanding claim seeking an effective date prior to July 31, 2000, for the grant of service connection for left knee instability lacks legal merit. 38 U.S.C. §§ 5109A, 7105; 38 C.F.R. § 20.101; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 10. The Veteran’s freestanding claim seeking an effective date prior to July 31, 2000, for the grant of service connection for left ankle fracture lacks legal merit. 38 U.S.C. §§ 5109A, 7105; 38 C.F.R. § 20.101; Rudd v. Nicholson, 20 Vet. App. 296 (2006). 11. An earlier effective date for the award of service connection for left knee scars is not warranted. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 12. An earlier effective date for the award of service connection for bilateral sensorineural hearing loss is not warranted. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 13. An earlier effective date for the award of service connection for tinnitus is not warranted. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. 14. An earlier effective date for the award of service connection for major depressive disorder, anxiety disorder (NOS) and alcohol abuse in remission is not warranted. 38 U.S.C. §§ 5101, 5110; 38 C.F.R. §§ 3.151, 3.155, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Navy from October 1976 to October 1980. The Board notes that the Veteran in his substantive appeal (via VA Form 9) both indicated that he wished to appeal all of the issues discussed in all statements of the case (SOCs) and supplemental statements of the case (SSOCs) that had been issued, but also appeared to indicate that he wished to limit his appeal. Therefore, while it is unclear if the Veteran wished to pursue all of his earlier effective date claims or only those in regard to his service-connected bilateral hearing loss, tinnitus, left knee scars, and mental health conditions, out of an abundance of caution, the Board has adjudicated all issues listed in the issued SOCs. The Board notes that the issue of entitlement to a TDIU was raised by the record. While the RO has not adjudicated the issue, the Board notes that, in pursuing claims for higher ratings, the Veteran has alleged that such render him unable to work. Consequently, the matter of entitlement to a TDIU rating is reasonably raised by the record in the context of the increased rating claims. See Rice v. Shinseki, 22 Vet. App. 447, 455 (2009). Furthermore, as the Board is remanding such claims, no prejudice will befall the Veteran and the AOJ will have ample opportunity to adjudicate the claim. Service Connection Service connection may be granted for disabilities due to disease or injury incurred in or aggravated by active military service. 38 U.S.C. §§ 1110; 38 C.F.R. § 3.303. Service connection may be granted for any disease initially diagnosed after discharge when the evidence establishes that disability was incurred in service. 38 C.F.R. § 3.303 (d). Service connection may be established by showing continuity of symptomatology after discharge. 38 C.F.R. § 3.303 (b). To substantiate a claim of service connection, there must be evidence of: (1) a current disability (for which service connection is sought); (2) incurrence or aggravation of a disease or injury in service; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-1167 (Fed. Cir. 2004). The determination as to whether these requirements are met is based on an analysis of all evidence of record and an evaluation of its credibility and probative value. Baldwin v. West, 13 Vet. App. 1 (1999); 38 C.F.R. § 3.303 (a). When there is an approximate balance of positive and negative evidence regarding the merits of an issue, the benefit of the doubt shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. If the preponderance of the evidence is against the claim, the claim is to be denied. Gilbert v. Derwinski, 1 Vet. App. 49, 55 (1990). Entitlement to service connection for arthritis, a right shoulder condition, a left shoulder condition, a left wrist condition, high blood pressure, and a condition to account for penis deformity with loss of erectile power. The Veteran’s service treatment records are silent for complaints, treatment, or diagnoses related to arthritis, a right shoulder condition, a left shoulder condition, a left wrist condition, high blood pressure or a condition to account for penis deformity with loss of erectile power. A review of the post-service records shows a clear history of complaints of bilateral shoulder and wrist pain, high blood pressure and impotence. Crucially, however, the Veteran has not advanced any theory of entitlement for his claimed conditions. Consequently, even conceding that the Veteran has current, clinical diagnoses of his claimed conditions, there is no basis for awarding service connection either as related to service-as there is no evidence or allegation of an event or injury in service to which such disabilities could be related-or as secondary to another service-connected disability-as there is no allegation or evidence suggesting such a relationship even exists. Therefore, there is simply no basis upon which either direct or secondary service connection may be awarded. Accordingly, the Board finds the preponderance of the evidence is against the Veteran’s claims seeking service connection for arthritis, a right shoulder condition, a left shoulder condition, a left wrist condition, high blood pressure, and a condition to account for penis deformity with loss of erectile power, the benefit of the doubt rule does not apply, and the appeal in these matters must be denied. Increased Rating Disability ratings are assigned in accordance with VA’s Schedule for Rating Disabilities and are intended to represent the average impairment of earning capacity resulting from a disability. See 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321 (a), 4.1. When a question arises as to which of two ratings shall be applied under a particular diagnostic code, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for the higher rating; otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Where, as here, the rating appealed is the initial rating assigned with a grant of service connection, the entire appeal period is for consideration, and separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” See Fenderson v. West, 12 Vet. App, 119 (1999). Entitlement to a rating in excess of 10 percent disabling for service-connected tinnitus. The Veteran seeks an increased rating for tinnitus, which is currently assigned a 10 percent rating (the maximum available rating under the relevant criteria, regardless of whether perceived in one ear, both ears, or in the head). See 38 C.F.R. § 4.87, Code 6260, Note 2. In Smith v. Nicholson, 451 F.3d 1344 (Fed. Cir. 2006), the Federal Circuit affirmed VA’s interpretation of Code 6260 as authorizing only a single 10 percent rating for tinnitus, whether perceived as unilateral or bilateral, explaining that an agency’s interpretation of its own regulations was entitled to substantial deference by the courts as long as that interpretation was not plainly erroneous or inconsistent with the regulations. Id. at 1350-51. Finding that there was a lack of evidence in the record suggesting that VA’s interpretation of Code 6260 was plainly erroneous or inconsistent with the regulations, the Federal Circuit concluded that VA’s interpretation of a single 10 percent rating being the maximum available for tinnitus was reasonable. Consequently, the Board concludes that the Veteran’s tinnitus has been assigned the maximum schedular rating available for tinnitus under 38 C.F.R. § 4.87, Code 6260, and any claim for a higher (or separate) rating under that Code must be denied. Finally, the Veteran’s tinnitus is not shown (or alleged) to have manifestations or cause impairment not encompassed by the schedular criteria. The Veteran’s reports of ringing are the basis for the 10 percent rating for tinnitus assigned. Therefore, the schedular criteria are not inadequate, and referral for extraschedular consideration is not necessary. In addition, the matter of entitlement to a TDIU rating is addressed in the remand below. Effective Date The Veteran contends that the effective date for the grant of service connection for tinnitus, bilateral hearing loss, and major depressive disorder with anxiety disorder NOS and alcohol abuse in remission should be earlier than September 8, 2014. He has also asserted that the effective date for his service-connected left knee instability and left ankle fracture should be earlier than July 31, 2001, the effective date for his service-connected degenerative arthritis of the left knee should be earlier than April 22, 2004, and the effective date for his left knee scars should be earlier than October 15, 2013. 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. See 38 U.S.C. § 5110; 38 C.F.R. § 3.400. An exception to that rule provides that the effective date of an award of an increase shall be the earliest date as of which it is ascertainable that an increase in disability had occurred, if application is received within one year from such date. 38 U.S.C. § 5110 (b)(2), 38 C.F.R. § 3.400 (o)(2); see also Harper v. Brown, 10 Vet. App. 125 (1997). A “claim” is defined broadly to include a formal or informal communication in writing requesting a determination of entitlement to a benefit. 38 C.F.R. § 3.1 (p). Any communication indicating an intent to apply for a benefit under the laws administered by the VA may be considered an informal claim provided it identifies, but not necessarily with specificity, the benefit sought. See 38 C.F.R. § 3.155 (a). An informal claim must identify the benefits sought; and upon receipt of an informal claim, if a formal claim has not been filed, an application form will be forwarded to the claimant for execution. If received within one year from the date it was sent to the claimant, it will be considered filed as of the date of the receipt of the informal claim. Id. The mere presence of medical evidence does not establish intent on the part of the Veteran to seek service connection for a disability. Brannon v. West, 12 Vet. App. 32, 35 (1998). The effective date of service connection is not based on the date of the earliest medical evidence demonstrating a causal connection, but rather, on the date the application was filed with VA. Lalonde v. West, 12 Vet. App. 377, 382 (1999). A rating decision becomes final and binding if the Veteran does not timely perfect an appeal of the decision. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104 (a), 3.160(d), 20.200, 20.302, 20.1103. Previous determinations that are final and binding, including decisions of service connection, will be accepted as correct in the absence of collateral attack by showing the decision involved clear and unmistakable error (CUE). 38 C.F.R. § 3.105 (a). The Court held in Sears v. Principi, 16 Vet. App. 244, 248 (2002) that, “[t]he statutory framework simply does not allow for the Board to reach back to the date of the original claim as a possible effective date for an award of service-connected benefits that is predicated upon a reopened claim.” In order for the Veteran to be awarded an effective date based on an earlier claim, he has to show CUE in the prior denial of the claim. Flash v. Brown, 8 Vet. App. 332, 340 (1995). Moreover, there is no basis for a free-standing earlier effective date claim from matters addressed in a final and binding rating decision. See Rudd v. Nicholson, 20 Vet. App. 296 (2006). Entitlement to an effective date prior to April 22, 2004 for the grant of service connection for left knee degenerative arthritis, to an effective date prior to July 31, 2009, for the grant of service connection for left knee instability, and to an effective date prior to December 4, 2003, for the grant of service connection for left ankle fracture. Left knee degenerative arthritis The RO originally granted service connection for left knee degenerative arthritis in a May 2004 rating decision, assigning a 10 percent evaluation with an effective date of April 22, 2004. The Veteran did not file a timely notice of disagreement to the effective date and the rating assigned. As the Veteran failed to perfect an appeal of the May 2004 rating decision, it is not subject to revision in the absence of CUE. 38 U.S.C. §§ 5109A, 7105; see Rudd, 20 Vet. App. 296 (2006). Because the Veteran has not submitted a motion for CUE in the May 2004 rating decision that assigned the effective date for service connection for left knee degenerative arthritis, the Board finds that the present assertions for entitlement to an effective earlier than April 2, 2004 for the grant of service connection for left knee degenerative arthritis are attempts to establish a freestanding claim for an earlier effective date, which is not permitted under Rudd. Accordingly, this matter is dismissed. Left knee instability The RO originally granted service connection for left knee strain in a July 2001 rating decision, assigning a 10 percent evaluation with an effective date of July 31, 2001. The Veteran did not file a timely notice of disagreement to the effective date and the rating assigned. As the Veteran failed to perfect an appeal of the July 2001 rating decision, it is not subject to revision in the absence of CUE. 38 U.S.C. §§ 5109A, 7105; see Rudd, 20 Vet. App. 296 (2006). Because the Veteran has not submitted a motion for CUE in the July 2001 rating decision that assigned the effective date for service connection for left knee instability, the Board finds that the present assertions for entitlement to an effective earlier than July 31, 2000 for the grant of service connection for left knee instability are attempts to establish a freestanding claim for an earlier effective date, which is not permitted under Rudd. Accordingly, this matter is dismissed. Left ankle fracture The RO originally granted service connection for left ankle fracture in a July 2001 rating decision, which assigned a noncompensable evaluation with an effective date of July 31, 2000. In a subsequent rating decision issued in May 2004, the RO increased the Veteran’s evaluation to 10 percent effective December 4, 2003. The Veteran did not file a timely notice of disagreement to the effective date and the rating assigned. As the Veteran failed to perfect an appeal of the July 2001 or the May 2004 rating decisions, they are not subject to revision in the absence of CUE. 38 U.S.C. §§ 5109A, 7105; see Rudd, 20 Vet. App. 296 (2006). Because the Veteran has not submitted a motion for CUE in the July 2001 or the May 2004 rating decisions that assigned the effective dates for service connection for left ankle fracture, the Board finds that the present assertions for entitlement to an effective earlier than July 2000 for the grant of service connection for left ankle fracture are attempts to establish a freestanding claim for an earlier effective date, which is not permitted under Rudd. Accordingly, this matter is dismissed. Entitlement to an effective date prior to October 15, 2013, for the grant of service connection for left knee scars. Here, VA first received a claim seeking service connection for left knee scars on October 15, 2013. That claim was granted in August 2014, and a 0 percent rating was assigned effective October 15, 2013 (the date of claim). As the claim was not received within a year of separation, under the governing law, this is the earliest available effective date, and the only way to substantiate a claim for an earlier effective date would be to disturb the finality of a prior denial of service connection for left knee scars. In this case, however, there is simply no prior claim or decision addressing his left knee scars. The October 15, 2013 correspondence was the first time VA received any correspondence referencing a claim for left knee scars. Under the circumstances, the Board finds that there is simply no basis for granting an earlier effective date for the award of service connection for a left knee scars. As such, the preponderance of the evidence is against the Veteran’s appeal in this matter, the benefit of the doubt rule does not apply, and the appeal in this matter must be denied. Entitlement to an effective date prior to September 8, 2014, for the grant of service connection for bilateral sensorineural hearing loss and tinnitus. Here, VA first received a claim seeking service connection for bilateral sensorineural hearing loss and tinnitus on September 8, 2014. That claim was granted in January 2015, and a 0 percent rating was assigned for bilateral sensorineural hearing loss and a 10 percent rating for tinnitus effective September 8, 2014 (the date of claim). As the claim was not received within a year of separation, under the governing law, this is the earliest available effective date, and the only way to substantiate a claim for an earlier effective date would be to disturb the finality of a prior denial of service connection for bilateral hearing loss and tinnitus. In this case, however, there is simply no prior claim or decision addressing his hearing loss and tinnitus. The September 8, 2014 correspondence was the first time VA received any correspondence referencing a claim for hearing loss and/or tinnitus. Under the circumstances, the Board finds that there is simply no basis for granting an earlier effective date for the award of service connection for bilateral hearing loss and tinnitus. As such, the preponderance of the evidence is against the Veteran’s appeal in these matters, the benefit of the doubt rule does not apply, and the appeal in these matters must be denied. Entitlement to an effective date prior to September 8, 2014 for the grant of service connection for major depressive disorder, anxiety disorder not otherwise specified and alcohol abuse in remission. Here, VA first received a claim seeking service connection for depression/anxiety on September 8, 2014. That claim was granted in February 2015, and a 70 percent rating was assigned for major depressive disorder, anxiety disorder NOS and alcohol abuse in remission effective September 8, 2014 (the date of claim). As the claim was not received within a year of separation, under the governing law, this is the earliest available effective date, and the only way to substantiate a claim for an earlier effective date would be to disturb the finality of a prior denial of service connection for depression/anxiety. In this case, however, there is simply no prior claim or decision addressing his depression/anxiety. The September 8, 2014 correspondence was the first time VA received any correspondence referencing a claim for depression/anxiety. Under the circumstances, the Board finds that there is simply no basis for granting an earlier effective date for the award of service connection for major depressive disorder, anxiety disorder NOS, and alcohol abuse in remission. As such, the preponderance of the evidence is against the Veteran’s appeal in this matter, the benefit of the doubt rule does not apply, and the appeal in this matter must be denied. REASONS FOR REMAND Although the Board regrets the delay, the Board finds that additional development is needed before the Veteran’s remaining claims on appeal can be decided. Entitlement to service connection for degenerative arthritis of the thoracic spine, degenerative arthritis of the right knee, degenerative arthritis of the right ankle, a right ankle condition, and a condition to account for shortening of the left lower extremity, to include as secondary to service-connected left knee degenerative arthritis. The Veteran claims that his degenerative arthritis of the thoracic spine, right knee and right ankle, as well as right ankle condition and condition to account for shortening of the left lower extremity are secondary to his already service-connected degenerative arthritis of the left knee are due to his active duty service or in the alternative due to his service-connected left knee degenerative arthritis. Secondary service connection may be established for a disability that is proximately due to, the result of, or aggravated by a service-connected disease or injury. 38 C.F.R. § 3.310 (a); see also Allen v. Brown, 7 Vet. App. 439 (1995) (en banc). To substantiate a secondary service connection claim, the Veteran must show: (1) a present disability (for which service connection is sought); (2) a service-connected disability; and (3) competent evidence that the service connected disability caused or aggravated the disability for which service connection is sought. The Board notes that in July and August 2014, the Veteran underwent VA examinations to determine the etiology of his claimed conditions to include whether they were the result of his service-connected left knee disability. However, none of the pertinent VA examination reports of record adequately addressed his secondary theory of entitlement, because the examiners only indicated that his disabilities were not proximately due to or the result of his left knee disability. The examiners did not discuss whether such conditions were aggravated by his service-connected disability. Consequently, new examinations are needed to clarify the likely cause of these disabilities. Entitlement to a rating in excess of 10 percent disabling for service-connected left knee instability, a rating in excess of 10 percent disabling for service-connected left knee degenerative arthritis status post medial and lateral meniscectomy, a compensable rating for service-connected bilateral sensorineural hearing loss, a compensable rating for service-connected left knee scars, and a rating in excess of 70 percent disabling for service-connected major depressive disorder, anxiety disorder not otherwise specified and alcohol abuse in remission are remanded. Relevant to the Veteran’s claims for increased ratings for his service-connected disabilities, the Court has held that, where the record does not adequately reveal the current state of claimant’s disabilities, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the last examination. Allday v. Brown, 7 Vet. App. 517, 526 (1995). The record reflects that the Veteran was most recently afforded a VA Mental Health examination in February 2015, a VA Hearing Loss and Tinnitus examination in January 2015, and Knee, Lower Leg and Ankle examinations in July and August 2014. The Board finds that contemporaneous examinations are necessary as the Veteran has alleged significantly worsening symptoms since his last VA examinations. Specifically, the Veteran has alleged that his conditions are far worse than are represented by his current ratings. Therefore, the Board finds that a remand is required in order to determine the Veteran’s current level of impairment with regard to his service-connected disabilities. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). In regard to the Veteran’s claims for increased ratings for his left knee disabilities, remand is also required so that range of motion testing can be conducted pursuant to a recent decision issued by the United States Court of Appeals for Veterans Claims (Court) in Correia v. McDonald, 28 Vet. App. 158 (2016). The new examinations should include specific findings regarding the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. Regarding the Court’s further ruling that the Veteran’s “normal” joint should be tested for comparison to the service-connected joint, the Board notes that the Veteran is currently seeking service connection for right knee disabilities. As such, there is no “normal” paired joint that can be measured as a point of comparison. Entitlement to a TDIU due to service connected disabilities. The Board finds that the claim for entitlement to a TDIU is inextricably intertwined with the claims for increased ratings remanded herein. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Due to the amount of time which will pass on remand, updated treatment records should be obtained and associated with the claims file. The matters are REMANDED for the following action: 1. Obtain updated treatment records. 2. Schedule the Veteran for an orthopedic examination by an appropriate examiner to determine the nature and cause of any back, right knee, and right ankle disabilities and the current severity of his service-connected left knee disability and associated scars. Based on a review of the record, examination of the Veteran (including eliciting a complete medical history and subjective report), and any tests or studies deemed necessary, the examiner must respond to the following: (a) Please diagnose all back, right ankle, and right knee disabilities found, to include any degenerative arthritis. (b) For each disability diagnosed, please opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such disability is related to the Veteran’s military service. For any arthritis diagnosed, please indicate if such manifested to a compensable degree within one year of the Veteran’s discharge from service. (c) For each disability diagnosed, please also opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is CAUSED OR AGGRAVATED (WORSENED BEYOND ITS NATURAL PROGRESSION) BY the Veteran’s service-connected left knee disability. The examiner must also describe all symptoms, pathology, and resultant impairment associated with the Veteran’s service-connected left knee disability, to include his associated scars, in sufficient detail to allow for application of the pertinent rating criteria. Range of motion studies must be completed, and must include active and passive motion and weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite, undamaged joint. The examiner should also note any further functional limitations due to pain, weakness, fatigue, incoordination, or any other such factors. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). 3. Schedule the Veteran for an examination with an appropriate examiner to determine the nature and cause of any condition to account for shortening of the left lower extremity. Based on a review of the record, examination of the Veteran (including eliciting a complete medical history and subjective report), and any tests or studies deemed necessary, the examiner must respond to the following: (a) Please diagnose all conditions which would account for shortening of the left lower extremity. (b) For each disability diagnosed, please opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such disability is related to the Veteran’s military service. For any arthritis diagnosed, please indicate if such manifest to a compensable degree within one year of the Veteran’s discharge from service. (c) For each disability diagnosed, please also opine as to whether it is AT LEAST AS LIKELY AS NOT (A 50 PERCENT PROBABILITY OR GREATER) that such is CAUSED OR AGGRAVATED (WORSENED BEYOND ITS NATURAL PROGRESSION) BY the Veteran’s service-connected left knee disability. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). 4. Schedule the Veteran for an examination with an appropriate examiner to determine the current severity of his major depressive disorder, anxiety disorder NOS and alcohol dependence in remission. Based on an examination, review of the record, and any tests or studies deemed necessary, the examiner should describe all pertinent pathology, symptoms (frequency and severity), and associated impairment of function in sufficient detail to allow for application of the relevant rating criteria. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). 5. Finally, schedule the Veteran for an examination with an appropriate examiner to determine the current severity of his bilateral sensorineural hearing loss. Based on an examination, review of the record, and any tests or studies deemed necessary, the examiner should describe all pertinent pathology, symptoms (frequency and severity), and associated impairment of function in sufficient detail to allow for application of the relevant rating criteria. A detailed explanation (rationale) is requested for all opinions provided. (By law, the Board is not permitted to rely on any conclusion that is not supported by a thorough explanation. Providing an opinion or conclusion without a thorough explanation will delay processing of the claim and may also result in a clarification being requested). L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Unger, Associate Counsel