Citation Nr: 18148547 Decision Date: 11/08/18 Archive Date: 11/07/18 DOCKET NO. 16-06 529 DATE: November 8, 2018 REMANDED ISSUES Entitlement to an initial compensable rating for left knee disability is remanded. Entitlement to an initial compensable rating for right knee disability is remanded. Entitlement to service connection for Gastric Reflux Disease (GERD), to include as secondary to service-connected neck and back disabilities is remanded. Entitlement to service connection for right hand disability is remanded. Entitlement to service connection for left hand disability is remanded. REMANDED ISSUES While the record contains VA examination from April 2013, regarding the Veteran’s bilateral knee disabilities, the examination does not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). Specifically, the examinations do not contain passive range of motion measurements. Therefore, a remand to obtain an adequate examination is necessary. The Veteran contends that he has GERD as a result of the medication he takes for his service-connected neck and back disability. VA treatment records from December 2013 indicate that the Veteran has GERD. Review of the record reflects that he was not provided a VA examination regarding this claim. Similarly, the Veteran was not provided a VA examination regarding his claim for disabilities of the right and left hand. Therefore, a remand is necessary to obtain examination before the Board can adjudicate these claims. The matters are REMANDED for the following action: 1. Update VA medical records. 2. After completion of directive #1, schedule the Veteran for examinations of the current severity of bilateral knee disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also 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 the disabilities in question alone and discuss the effect of the Veteran’s disabilities 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). 3. After completion of directive #1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any GERD. The claims file should be made available to the examiner, who should indicate in his/her report that the file was reviewed as part of the examination. The examiner should take a complete history from the Veteran. All indicated tests and studies should be completed. The examiner must describe all pertinent symptomatology. Following the completion of the examination, the examiner should provide an opinion answering the following questions: Is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s GERD is caused by his service-connected back disability, to include medication prescribed; and Is it at least as likely as not (50 percent or greater probability) that the Veteran’s GERD has been aggravated by his service-connected back disability, to include medication prescribed. In the alternative, is it at least as likely as not (a 50 percent or greater probability) that the Veteran’s GERD is caused by his service-connected neck disability, to include medication prescribed; and Is it at least as likely as not (50 percent or greater probability) that the Veteran’s GERD has been aggravated by his service-connected neck disability, to include medication prescribed. The term “aggravated” in the above context means a permanent worsening of his symptoms, and not temporary or intermittent flare-ups, which resolve and return to the baseline level disability. A complete rationale should be provided for all opinions. If an opinion cannot be provided without resorting to speculation, the examiners must explain why this is the case. 4. After completion of directive #1, schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any bilateral hand disability. The claims file should be made available to the examiner, who should indicate in his/her report that the file was reviewed as part of the examination. The examiner should take a complete history from the Veteran. All indicated tests and studies should be completed. The examiner must describe all pertinent symptomatology. Following the completion of the examination, the examiner should provide an opinion answering the following question: Identify all diagnosed bilateral hand conditions. As to any/each diagnosed bilateral hand condition, is it at least as likely as not (a 50% or higher degree of probability) that the disability is related to service? (Continued on the next page)   The rationale for this opinion must include some discussion of the February 2010 Medical History Report showing that the Veteran reported bilateral hands falling asleep. JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S.SOLOMON