Citation Nr: 18147457 Decision Date: 11/06/18 Archive Date: 11/05/18 DOCKET NO. 16-56 901 DATE: November 6, 2018 REMANDED The propriety of the reduction in the disability rating for service connected residuals of knife wound of the right ankle with limitation of motion from 20 percent to 10 percent effective November 13, 2015, to include entitlement to an evaluation in excess of 10 percent is remanded. Entitlement to an initial evaluation in excess of 10 percent disabling for varicose veins, right lower extremity is remanded. Entitlement to a compensable evaluation for residuals of knife wound, scar is remanded. REASONS FOR REMAND The Veteran served on active duty with the United States Army from February 1971 to April 1974. The historical record reflects that the Veteran suffered a knife wound to the right ankle in service in 1973. In an April 2012 rating decision, the RO granted service connection for residuals of knife wound, right ankle limitation of motion and assigned a 20 percent rating under Diagnostic Code 5271 effective June 3, 2011. The RO also granted service connection for residuals of knife wound, scar and assigned a noncompensable evaluation under Diagnostic Code 7805 effective June 3, 2011. The RO denied service connection for bilateral varicose veins. The RO issued a statement of the case in March 2014 in response to the Veteran’s notice of disagreement. The Veteran did not perfect an appeal by filing VA Form 9. The Veteran’s combined disability rating was 20 percent. Thereafter, in August 2015, the Veteran filed a claim for an increased evaluation for his service connected right ankle and scar disabilities, and a claim to reopen his previously denied claim for service connection for bilateral varicose veins. The Veteran under VA examinations in November 2015. In a November 2015 rating decision, the RO did the following: granted service connection for varicose veins of the right lower extremity and assigned a 10 percent rating under Diagnostic Code 7120 effective August 31, 2015; granted service connection for deep, non-linear scar of the right ankle and assigned a noncompensable evaluation under Diagnostic Code 7801 effective August 31, 2015; continued the noncompensable evaluation for residuals of knife wound, scar; and decreased the rating for the residuals of knife wound, right ankle limitation of motion from 20 percent to 10 percent effective November 13, 2015. In regard to the reduction, the RO explained that although this evaluation was reduced, the Veteran’s overall evaluation was not changed because he was awarded a compensable evaluation for an additional disability. As the result of the rating decision, the Veteran’s combined disability rating was 30 percent effective August 31, 2015, and 20 percent effective November 13, 2015. In February 2016, the Veteran filed a notice of disagreement to the evaluation for “bilateral varicose veins,” the evaluation for residuals of knife wound, right ankle limitation of motion, and the evaluation for residuals of knife wound, scar. The RO issued a statement of the case in October 2016 that continued the assigned evaluations. The Veteran perfected an appeal by filing VA Form 9 in November 2016. Thereafter, the RO declined to reopen the claim seeking service connection for varicose veins affecting the left lower extremity in a December 2016 rating decision. Notably, during the course of the appeal, in an October 2016 rating decision, the RO granted service connection for complex regional pain syndrome (femoral nerve) of the right lower extremity and assigned a 20 percent rating under Diagnostic Code 8526 effective February 9, 2016. Thus, the Veteran is currently receiving multiple disability ratings for the right lower extremity. As such, the Board finds that the Veteran should undergo updated VA examinations for purposes of determining all signs and symptoms necessary for evaluating the Veteran’s disabilities under each of the assigned diagnostic codes and avoid violating the rule of pyramiding of benefits. See 38 C.F.R. § 4.14; Esteban v. Brown, 6 Vet. App. 259, 262 (1994). Accordingly, the above referenced matters are REMANDED for the following action: 1. Obtain updated VA treatment records and associate them with the Veteran’s claims file. 2. Schedule the Veteran for a VA examination to determine the current nature and severity of his residuals of knife wound, right ankle limitation of motion. The electronic claims file and a copy of this remand must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. (a) In reporting the results of range of motion testing, the examiner should identify any objective evidence of pain, and the degree at which pain begins. (b) Pursuant to Correia v. McDonald, the examination should record the results of range of motion testing for pain in BOTH ankles on BOTH active and passive motion AND in weight-bearing and nonweight-bearing. If the ankles cannot be tested on “weight-bearing,” then the examiner must specifically indicate that such testing cannot be done. (c) The examiner should also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups assessed in terms of the degree of additional range of motion loss. In regard to flare-ups (pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017)) if the Veteran is not currently experiencing a flare-up, based on relevant information elicited from the Veteran, review of the file, and the current examination results regarding the frequency, duration, characteristics, severity, and functional loss regarding his flares, the examiner is requested to provide an estimate of the Veteran’s functional loss due to flares expressed in terms of the degree of additional range of motion lost, or explain why the examiner cannot do so. [The Board recognizes the difficulty in making such determinations but requests that the examiner provide his or her best estimate based on the examination findings and statements of the Veteran.] 3. Schedule the Veteran for a VA examination to ascertain the current severity of the Veteran’s varicose veins of the right lower extremity. The electronic claims file and a copy of this remand must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. 4. Schedule the Veteran for a VA examination to ascertain the current severity of the Veteran’s knife wound, scar. The electronic claims file and a copy of this remand must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD N. Whitaker, Associate Counsel