Citation Nr: 18146077 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 13-01 308 DATE: October 30, 2018 REMANDED Entitlement to an initial evaluation in excess of 20 percent for left knee patellofemoral syndrome, to include consideration of an extraschedular evaluation, is remanded. Entitlement to an initial evaluation in excess of 20 percent for lumbosacral spine degenerative disc and joint disease (low back disability), to include consideration of an extraschedular evaluation, is remanded. Entitlement to an initial compensable evaluation prior to March 18, 2013, and to an evaluation in excess of 10 percent thereafter, for gastroesophageal reflux disease (GERD) and irritable bowel syndrome (IBS) is remanded. Entitlement to initial compensable evaluation prior to March 18, 2013, and to an evaluation in excess of 10 percent thereafter, for left carpal tunnel syndrome is remanded. Entitlement to an initial compensable evaluation prior to March 18, 2013, and to an evaluation in excess of 10 percent thereafter, for right carpal tunnel syndrome is remanded. Entitlement to an initial compensable evaluation prior to March 18, 2013, and to an evaluation in excess of 10 percent thereafter, for left tarsal tunnel syndrome is remanded. Entitlement to an initial compensable evaluation for right tarsal tunnel syndrome is remanded. REASONS FOR REMAND The Veteran had active service from February 1980 to October 1982, from January 1990 to May 1990, from November 1994 to May 1995, October 1996 to March 1997, November 1997 to May 1998, May 1998 to September 1998, October 1998 to February 2000, from April 2000 to September 2000, from October 2000 to April 2001, from April 2001 to September 2001, from October 2001 to May 2002; from October 2002 to October 2003, from November 2003 to December 2004, from April 2005 to September 2008, October 2008 to April 2009, April 2009 to January 2010, from March 2011 to June 2012. This matter comes before the Board of Veterans’ Appeals (Board) from a rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. This case was previously before the Board in February 2017. It was decided in part and remanded in part. The Veteran’s attorney asserts that the Veteran did not receive notice of VA examinations scheduled by the VA. See August 2018 letter. A review of the claims file shows that the AOJ has a different address on file than the VA Medical Center, and it appears that the VA Medical Center sent notice for the examinations to a different address than the address that the AOJ has on file. The Veteran’s current address appears to be the address that the AOJ has on file. New VA examinations should be scheduled for the Veteran and notice for the examinations sent to the Veteran’s address on file with the AOJ. The Veteran’s attorney also noted that the Veteran did not receive a letter asking her to identify recent sources of medical treatment. The AOJ should resend the March 14, 2017 letter to the Veteran to her current address on file. The matters are REMANDED for the following action: 1. Resend the March 14, 2017 letter to the Veteran’s current address listed on file with the AOJ. 2. Send notice for examinations to the address on file with AOJ or a confirmed address for the Veteran. 3. Schedule the Veteran for an examination of the current severity of her left knee disability. 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 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). The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 4. Schedule the Veteran for an examination of the current severity of her low back disability. 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 low back disability alone and discuss the effect of the Veteran’s low back 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). The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 5. Schedule the Veteran for an examination of the current severity of her left and right carpal tunnel syndrome. 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 carpal tunnel syndrome alone and discuss the effect of the Veteran’s carpal tunnel syndrome 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). 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected GERD and IBS. The examiner should provide a full description of the 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 GERD and IBS alone and discuss the effect of the Veteran’s GERD and IBS 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). The examiner must specifically state whether the Veteran has any additional manifestations and findings (including specifically chronic fatigue, anemia, and a B12 deficiency) associated with her service-connected digestive conditions. See August 2016 Appellant Brief (reflecting the Veteran’s assertion that her chronic fatigue syndrome, anemia, and B12 deficiency are symptoms of her GERD and IBS). 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected left and right tarsal tunnel syndrome. The examiner should provide a full description of the 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 left and right tarsal tunnel syndrome alone and discuss the effect of the Veteran’s left and right tarsal tunnel syndrome 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). 8. After completing any other development that may be indicated, specifically consider whether referral of extraschedular consideration is warranted for the Veteran’s left knee or low back disability. See August 2016 Appellant Brief (explicitly asserting that extraschedular consideration is warranted for the Veteran’s left knee and low back conditions). If so, make the appropriate referral. 9. Readjudicate the Veteran’s claim, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, she and her attorney should be furnished a supplemental statement of the case and afforded an appropriate period of time within which to respond thereto. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Tahirih S. Samadani, Counsel