Citation Nr: 18150026 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 00-24 827 DATE: November 14, 2018 ORDER Entitlement to a rating higher than 10 percent for a left knee disability is denied. Entitlement to a rating higher than 10 percent for a right knee disability is denied. Entitlement to a rating higher than 10 percent for post-operative hammertoes of the left second toe is denied. Entitlement to a rating higher than 10 percent for post-operative hammertoes of the right second toe is denied. REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. Whether a rating reduction from 10 percent to 0 percent for scar, status post bone graft, right iliac crest, effective January 1, 2016 was proper is remanded. Whether a rating reduction from 60 percent to 30 percent for asthma with chronic obstructive pulmonary disease (COPD), effective January 1, 2016 was proper is remanded. FINDINGS OF FACT 1. Throughout the pendency of this claim, the Veteran’s left knee disability has been manifested by flexion limited to 100 degrees and extension, overall, to 0 degrees; it has not been manifested by flexion limited to 30 degrees or less, extension limited to 10 degrees or less, ankylosis, objective evidence of recurrent subluxation or lateral instability, dislocated or removed semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 2. Throughout the pendency of this claim, the Veteran’s right knee disability has been manifested by flexion limited to 90 degrees and extension, overall, to 0 degrees; it has not been manifested by flexion limited to 30 degrees or less, extension limited to 10 degrees or less, ankylosis, objective evidence of recurrent subluxation or lateral instability, dislocated or removed semilunar cartilage, impairment of the tibia and fibula, or genu recurvatum. 3. The Veteran’s postoperative hammertoe of the left second toe is primarily manifested by ankylosis of the interphalangeal joint, pain, weakness, fatigability, and painful and tender scar measuring no more than 4 centimeters long and 0.5 centimeters wide, without involvement of the tarsal or metatarsal joints. 4. The Veteran’s postoperative hammertoe of the right second toe is primarily manifested by ankylosis of the interphalangeal joint, pain, weakness, fatigability, and painful and tender scar measuring no more than 4 centimeters long and 0.5 centimeters wide, without involvement of the tarsal or metatarsal joints. CONCLUSIONS OF LAW 1. The criteria for a rating greater than 10 percent for a left knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5256-63. 2. The criteria for a rating greater than 10 percent for a right knee disability have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.71a, Diagnostic Codes 5003, 5256-63. 3. The criteria for a rating greater than 10 percent for left foot hammertoe, second toe, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.71a, 4.118, Diagnostic Codes 5003, 5282-7804. 4. [The criteria for a rating greater than 10 percent for right foot hammertoe, second toe, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.7, 4.71a, 4.118, Diagnostic Codes 5003, 5282-7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS This case was previously remanded for further development. In light of treatment records that have been obtained and associated with the record, the obtaining of the requested medical opinions, and the further adjudicatory actions taken by the RO, the Board finds that there has been substantial compliance with the prior remand directives. Stegall v. West, 11 Vet. App. 268 (1998); D’Aries v. Peake, 22 Vet. App. 97 (2008); Dyment v. West, 13 Vet. App. 141 (1999). Increased Rating Disability ratings are determined by the application of VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity resulting from a service-connected disability. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when assigning disability ratings. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). A claimant may experience multiple distinct degrees of disability that may result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). The following analysis is therefore undertaken with consideration of the possibility that different ratings may be warranted for different time periods. The rating of the same disability under various diagnoses is to be avoided. 38 C.F.R. § 4.14. However, that does not preclude the assignment of separate ratings for separate and distinct symptomatology where none of the symptomatology justifying a rating under one diagnostic code is duplicative of or overlapping with the symptomatology justifying a rating under another diagnostic code. Esteban v. Brown, 6 Vet. App. 259 (1994). 1. Entitlement to a rating higher than 10 percent for a left knee disability 2. Entitlement to a rating higher than 10 percent for a right knee disability Rating a service-connected disability involving a joint rated on limitation of motion requires adequate consideration of functional loss due to pain and functional loss due to weakness, fatigability, incoordination, or pain on movement of a joint. 38 C.F.R. §§ 4.45; DeLuca v. Brown, 8 Vet. App. 202 (1995). Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. It is essential that the examination on which ratings are based adequately portrays the anatomical damage, and the functional loss, with respect to these elements. In addition, the regulations state that the functional loss may be due to pain, supported by adequate pathology and evidenced by the visible behavior of the veteran undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. When rating the joints, inquiry will be directed as to whether there is less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. 38 C.F.R. § 4.45. The intent of the schedule is to recognize painful motion with joint or periarticular pathology as productive of disability. It is the intention to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Normal range of motion of the knee is to 0 degrees extension and to 140 degrees flexion. 38 C.F.R. § 4.71a, Plate II. Under Diagnostic Code 5260, limitation of flexion of the knee is rated 10 percent for flexion limited to 45 degrees. A 20 percent rating is assigned for flexion limited to 30 degrees. A 30 percent rating is assigned for flexion limited to 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5260. Under Diagnostic Code 5261, limitation of extension of the knee is rated 10 percent for extension limited to 10 degrees. A 20 percent rating is assigned for extension limited to 15 degrees. A 30 percent rating is assigned for extension limited to 20 degrees. A 40 percent rating is assigned for extension limited to 30 degrees. A 50 percent rating is assigned for extension limited to 45 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5261. Diagnostic Code 5257 provides that a 10 percent rating is warranted for slight recurrent subluxation or lateral instability of a knee. A 20 percent rating is warranted for moderate recurrent subluxation or lateral instability. A 30 percent rating is warranted for severe knee impairment with recurrent subluxation or lateral instability. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Subluxation of the patella is the incomplete or partial dislocation of the knee cap. Rykhus v. Brown, 6 Vet. App. 354 (1993). The words slight, moderate, and severe as used in the various Diagnostic Codes are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence, to the end that its decisions are equitable and just. 38 C.F.R. § 4.6. In addition, separate ratings may be assigned for compensable limitation of both flexion and extension, or for limitation of motion and instability or subluxation of the knee, or meniscal pathology. However, a separate rating can only be assigned where additional compensable symptomatology is shown that is not duplicative of that used to assign another rating. 38 C.F.R. § 4.14; VAOPGCPREC 09-04 (2004), 69 Fed. Reg. 59990 (2004);VAOPGCPREC 23-97 (1997), 62 Fed. Reg. 63604 (1997); VAOPGCPREC 9-98 (1998), 63 Fed. Reg. 56704 (1998); Lichtenfels v. Derwinski, 1 Vet. App. 484 (1991). Diagnostic Code 5003 provides that degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. 38 C.F.R. § 4.71a. When, limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is generally for application. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. A rating for arthritis cannot be combined with a rating based on limitation of motion of the same joint. 38 C.F.R. § 4.71a, Diagnostic Code 5003. The present claim for higher ratings was received by VA in February 2009. On VA examination in December 2010, The Veteran reported that his knees hurt. They swelled once or twice per week. Moderate flare-ups occurred every two to three weeks. The Veteran wore elastic braces on his knees. The examiner observed guarding of movement, tenderness, and crepitus of the bilateral knees. There was no objective instability of either knee. In a March 2011 addendum, the examiner noted that right knee flexion was to 100 degrees, and extension was to 0 degrees. Left knee flexion was to 115 degrees, and extension as to 0 degrees. There was pain but no additional limitation after repetitive use testing. On VA examination in August 2016, the Veteran reported increased pain with ascending stairs or walking on uneven ground. Flexion of the right knee was to 90 degrees, and extension was to 0 degrees. There was pain with weightbearing. Flexion of the left knee was to 100 degrees, and extension was to 0 degrees. There was pain on weightbearing. There was no additional functional loss or loss of range of motion of either knee after repetitive use. The Veteran experienced pain and lack of endurance. No muscle atrophy was present. There was no ankylosis. Joint stability testing was performed, and there was no instability of either knee. The Veteran used a cane. The Board finds that the preponderance of the evidence is against the assignment of any higher or separate disability rating under Diagnostic Code 5260 for limitation of flexion of the left or right knee at any time during the course of the appeal. Concerning the left knee, the evidence shows that flexion of the knee was limited, at worst, to 100 degrees, with consideration of pain. Concerning the right knee, the evidence shows that flexion of the knee was limited, at worst, to 90 degrees, with consideration of pain. The flexion measurements are consistent with no more than a 0 percent rating under Diagnostic Code 5260. The Board also finds that the weight of the evidence is against assigning a higher rating throughout the period of appeal under Diagnostic Code 5261 for limitation of extension for either knee. The evidence shows that extension of the left knee was to 0 degrees throughout the period of appeal. The evidence shows that extension of the right knee was to 0 degrees throughout the period of appeal. Considering the record as a whole, the extension measurements are consistent with no more than a 0 percent rating under Diagnostic Code 5261. The Veteran has repeatedly reported that he experiences pain. He has reported pain to each medical examiner, and he has additionally discussed his pain in repeated submissions to the RO. Because of the Veteran’s painful limitation of knee motion, and other symptoms, the presently assigned disability rating of 10 percent based on painful motion for each knee is warranted. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.40, 4.45, 4.59. However, the Board finds that the preponderance of the evidence is against the assignment of any higher or additional separate rating for limitation of motion of either knee. The rating assigned has considered additional functional loss due to pain and other factors. Turning to instability, the Board concludes that a compensable rating under Diagnostic Code 5257 is not warranted at any time throughout the period of appeal for either knee. Significantly, all of the VA examiners and treatment providers indicate that the Veteran’s knees were stable on objective observation. To whatever extent the Veteran may assert that his knees are unstable, the Board finds that the objective medical evidence outweighs the subjective complaints, as the medical evidence was created by trained health care providers objectively performing their professional duties following objective testing. The Board finds that those objective medical findings are more persuasive because of the training and experience of the medical professionals. In light of those medical records, the Board finds that a separate disability rating is not warranted at any time during the period of appeal for instability of either knee, pursuant to Diagnostic Code 5257. In addition, subluxation of the left and right knees is not shown. None of the treatment records, to include X-ray and MRI findings, show dislocated or removed semilunar cartilage of either knee. Thus, Diagnostic Codes 5258 and 5259 cannot serve as a basis for an increased or separate rating for either knee. Finally, in considering the applicability of other diagnostic codes, the Board finds that Diagnostic Codes 5256 (ankylosis of the knee), 5262 (impairment of the tibia and fibula), and 5263 (genu recurvatum) are not applicable, as the medical evidence does not show that the Veteran has any of those conditions. The Board notes that the Veteran’s functional loss was considered as the medical evidence shows that the Veteran has consistently complained of pain. 38 C.F.R. §§ 4.40, 4.45. However, the limitation of motion and functional loss documented in the medical records as resulting from pain, including flare-ups, is contemplated in the disability rating now currently assigned. Moreover, although the Veteran had pain on repetitive motion, that pain did not result in limitation of flexion or extension to the level that any separate or higher rating would be warranted. There is otherwise no evidence of additional significant impairment of motor skills, muscle function, or strength attributable to the Veteran’s knee disabilities, beyond what is already being compensated. Consequently, the Board finds that a higher rating based on functional loss is not warranted for either knee. VA treatment records indicate that in November 2011 and August 2012, the Veteran underwent lower extremity nerve decompression surgeries for lower limb nerve entrapment, peripheral neuropathy, and tarsal tunnel syndrome. The Veteran has claimed that his nerve decompression surgeries and residuals are manifestations of the service-connected knee disabilities. On VA peripheral nerve examination in August 2016, the examiner remarked that the Veteran experienced residual pain status-post nerve decompression surgery of the bilateral lower extremities. The examiner noted that the bilateral lower extremity nerve decompression surgeries were performed secondary to tarsal tunnel syndrome. The examiner explained that tarsal tunnel syndrome is a compression neuropathy in which the tibial nerve is compressed as it travels through the tarsal tunnel. The location of the nerve entrapment was near the ankle and would not be affected by degenerative arthritis of the knees or the residuals of the bilateral hammertoe repairs or the degenerative arthritis of the toes. Therefore, the examiner opined that the Veteran’s nerve disorder was less likely than not proximately due to or the result of the service connected disabilities. Notably, none of the medical treatment records contain any indication that the Veteran’s neurological symptoms of the bilateral lower extremities were due to or aggravated by service connected knee disabilities. To whatever extent the Veteran may assert that he experiences neurological symptoms due to the knee disabilities, the Board finds that the objective medical evidence outweighs the subjective complaints, as the medical evidence was created by trained health care providers objectively performing their professional duties following objective testing. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of any higher or separate rating for the right knee disability and the claim must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. 3. Entitlement to a rating higher than 10 percent for left foot hammertoe of the second toe 4. Entitlement to a rating higher than 10 percent for right foot hammertoe of the second toe The Veteran’s bilateral second toe hammer toe disability has been rated under Diagnostic Code 5282-7804. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires the use of an additional diagnostic code to identify the basis for the rating assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The first four numbers reflect the diagnosed disability. The second four numbers after the hyphen identify the criteria used to evaluate that disability. pertaining to hammer toes. Diagnostic Code 5282 pertains to hammer toes. Under Diagnostic Code 5282, hammer toe of a single toe is rated as rated 0 percent. Unilateral hammer toe of all toes, without claw foot, is rated 10 percent. 38 C.F.R. § 4.71a. Diagnostic Code 7804 pertains to scars, unstable or painful. Diagnostic Code 7804 provides that one or two scars that are unstable or painful are rated 10 percent disabling. Three or more scars that are unstable or painful are rated 20 percent disabling. Five or more scars that are unstable or painful are 30 percent disabling. Note (1) to Diagnostic Code 7804 provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, add 10 percent to the evaluation that is based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this Diagnostic Code, when applicable. 38 C.F.R. § 4.118. The present claim for higher ratings was received by VA in February 2009. On VA examination in December 2010, the Veteran reported pain in his feet with standing and walking. He experienced weekly flare-ups that were alleviated by medication, heat, and stretching. There was no evidence of malunion or nonunion of the tarsal or metatarsal bones of either foot. There was hammertoe of the second toe bilaterally. On VA examination in August 2016, the examiner diagnosed arthritis and postoperative hammertoe of the left and right second toes. The Veteran reported pain in both feet with prolonged standing or walking. The examiner observed that he had bilateral second toe hammertoes that had been surgically corrected. There was a single linear scar from the base of the second right toe extending to the dorsum of the foot which measured 8 centimeters. There was a single linear scar from the base of the second left toe extending to the dorsum of the foot which measured 10 centimeters. Neither scar caused a limitation of function. The examiner specified that the scars were not unstable. The Veteran has been assigned a 10 percent rating for each toe, which compensates him for the tender scars under Diagnostic Code 7804. A higher rating is not warranted for the scars, as there is a single scar on each toe, and while the scars are painful by the Veteran’s account, they are not unstable. The Board must next evaluate whether an additional rating is warranted for musculoskeletal involvement. Here, a compensable rating is not warranted under Diagnostic Code 5282 as there is involvement of single toes, rather than all toes. Further, a 10 percent rating under Diagnostic Code 5003 is not warranted as there is involvement of the phalanges only. 38 C.F.R. § 4.45. The Board notes that the Veteran’s symptoms include pain, limitation of motion, and complaints of weakness and fatigability. However, as a compensable rating is not for application for amputation of the toe when there is no metatarsal involvement, which is the situation in the case at hand, a compensable rating may not be assigned under the DeLuca principles. 38 C.F.R. § 4.68. VA treatment records indicate that in November 2011 and August 2012, the Veteran underwent lower extremity nerve decompression surgeries for lower limb nerve entrapment, peripheral neuropathy, and tarsal tunnel syndrome. The Veteran has claimed that his nerve decompression surgeries and residuals are manifestations of his service-connected hammertoe disabilities. On VA peripheral nerve examination in August 2016, the examiner remarked that the Veteran experienced residual pain status-post nerve decompression surgery of the bilateral lower extremities. The examiner noted that the bilateral lower extremity nerve decompression surgeries were performed secondary to tarsal tunnel syndrome. She explained that tarsal tunnel syndrome is a compression neuropathy in which the tibial nerve is compressed as it travels through the tarsal tunnel. The location of the nerve entrapment was near the ankle and would not be affected by residuals of the bilateral hammertoe repairs or the degenerative arthritis of the toes. Therefore, the examiner opined that the Veteran’s nerve disorder was less likely than not proximately due to or the result of the Veteran’s service connected conditions. Notably, none of the medical treatment records contain any indication that the Veteran’s neurological symptoms of the bilateral lower extremities are due to or aggravated by his service connected hammertoe disabilities. Again, to whatever extent the Veteran may assert that he experiences neurological symptoms due to his hammertoe disabilities, the Board finds that the objective medical evidence outweighs the subjective complaints, as the medical evidence was created by trained health care providers objectively performing their professional duties following objective testing. Accordingly, the Board finds that the preponderance of the evidence is against the assignment of any higher or separate rating for the bilateral hammertoe disabilities and the claims must be denied. Gilbert v. Derwinski, 1 Vet. App. 49 (1990); 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND 1. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. The Veteran’s attorney has characterized this issue as entitlement to a TDIU, to include pursuant to 38 C.F.R. § 4.16(b), from August 17, 1999. The Board recognizes that TDIU is a component of a claim for a higher rating. Rice v. Shinseki, 22 Vet. App. 447 (2009). The present appeal stems from claims for higher ratings filed in August 1999, and the claim of entitlement to TDIU must be considered from August 1999. The Veteran’s service connected combined disability ratings have been 60 percent as of August 17, 1999; 80 percent as of July 2, 2003; and 60 percent as of January 1, 2016. Total disability is considered to exist when there is an impairment in mind or body that is sufficient to render it impossible for the average person to follow a substantially gainful occupation. 38 C.F.R. § 3.340(a)(1). A total disability rating for compensation purposes may be assigned on the basis of individual unemployability, that is, when the disabled person is, in the judgment of the rating agency, unable to secure or follow a substantially gainful occupation as a result of service-connected disabilities. If there is only one service-connected disability, however, it must be rated at 60 percent or more; if there are two or more service-connected disabilities, at least one must be rated at 40 percent or more, and there must be sufficient additional disability to bring the combined rating to 70 percent or more. 38 C.F.R. § 4.16(a). Prior to July 2, 2003, and from January 1, 2016, the Veteran does not satisfy the threshold minimum rating requirements of § 4.16(a), having a combined disability rating of only 60 percent with no single disability having a rating of 40 percent or more. When a claimant does not meet those percentage requirements, TDIU may still be assigned if the claimant is unable to secure and follow a substantially gainful occupation by reason of service-connected disabilities. In such a case, the rating board is to submit the case to the Director, Compensation and Pension Service, for extraschedular consideration. 38 C.F.R. § 4.16(b). The Board itself cannot assign TDIU under 38 C.F.R. § 4.16(b) in the first instance. Bagwell v. Brown, 9 Vet. App. 337 (1996); Floyd v. Brown, 9 Vet. App. 88 (1996); Stanton v. Brown, 5 Vet. App. 563 (1993); Fanning v. Brown, 4 Vet. App. 225 (1993). Because the Board itself cannot assign an extraschedular rating in the first instance, the Board must specifically adjudicate whether to refer a case to the Director of the Compensation and Pension Service for consideration of the assignment of an extraschedular rating when the issue is either raised by the claimant or is reasonably raised by the evidence of record. Thun v. Peake, 22 Vet. App. 111 (2008); Barringer v. Peake, 22 Vet. App. 242 (2008). If, and only if, the Director determines that an extraschedular rating is not warranted, does the Board then have jurisdiction to decide the extraschedular claim on the merits. Although the Board is precluded from initially assigning an extraschedular rating, there is no restriction on the Board’s ability to review the adjudication of an extraschedular rating once the Director determines that an extraschedular rating is not warranted. Anderson v. Shinseki, 22 Vet. App. 423 (2009); Floyd v. Brown, 9 Vet. App. 88 (1996); 38 U.S.C. §§ 511 (a), 7104(a). In this case, the Board finds that the case should be referred to the Director of the Compensation and Pension Service for consideration of the assignment of an extraschedular TDIU. Evidence of record shows that the Veteran has been unemployed, and there are conflicting medical and vocational opinions of record regarding the issue of the Veteran’s employability, such as in a September 2016 VA examination report and a January 2016 private vocational assessment. 2. Whether a rating reduction from 10 percent to 0 percent for scar, status post bone graft of the right iliac crest, effective January 1, 2016, was proper is remanded. 3. Whether a rating reduction from 60 percent to 30 percent for asthma with chronic obstructive pulmonary disease (COPD), effective January 1, 2016, was proper is remanded. In August 2015, the RO provided notice to the Veteran of a proposal to reduce his pulmonary disability rating from 60 percent to 30 percent, and a scar, status post bone graft of the right iliac crest rating from 10 percent to 0 percent. In October 2015, the RO effectuated the rating reductions, effective January 1, 2016. In May 2016, the Veteran submitted a statement that constitutes a notice of disagreement concerning the rating reductions. The record does not show a notification letter than includes a notice of disagreement form. In fact, it is unclear whether a notification letter of the action was sent to the Veteran. Therefore, the written statement from the Veteran can constitute a notice of disagreement. 38 C.F.R. § 20.201(a). No statement of the case has been issued addressing the issues of the rating reductions. Manlicon v. West, 12 Vet. App. 238 (1999). Consequently, remand is required for issuance of a statement of the case concerning the issues of whether the rating reduction from 60 percent to 30 percent for a pulmonary disability, and whether the rating reduction from 10 percent to 0 percent for scar, status post bone graft of the right iliac crest, were proper. The matters are REMANDED for the following action: 1. With any necessary authorization from the Veteran, obtain all outstanding treatment records. All attempts to locate records must be documented in the claims file. 2. Determine whether a notification letter was sent for the October 2015 rating decision effectuating the reductions in rating for a pulmonary disability and a scar. If so, associate that notification letter with the claims file. 3. Then, refer the matter of entitlement to TDIU from August 1999, to specifically include pursuant to 38 C.F.R. § 4.16(b), to the Director of Compensation Services for consideration entitlement to TDIU from August 1999. 4. Then, issue a statement of the case addressing the issues of whether the rating reduction from 60 percent to 30 percent for a pulmonary disability, and whether the rating reduction from 10 percent to 0 percent for scar, status post bone graft of the right iliac crest, were proper. Notify the Veteran of his appeal rights and that a timely appeal must be submitted if he wants appellate review of those claims. If a timely appeal is received, return those claims to the Board. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Layton, Counsel