Citation Nr: 18150211 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-09 421 DATE: November 14, 2018 ORDER New and material evidence having been received, the application to reopen the claim of entitlement to service connection for right wrist strain is granted. Entitlement to service connection for a right wrist strain is granted. Entitlement to an initial rating of 10 percent, but no higher, for traumatic brain injury (TBI) residuals is granted, subject to controlling regulations governing the payment of monetary awards. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include anxiety disorder is remanded. Entitlement to an initial rating in excess of 10 percent for lumbar strain is remanded. Entitlement to an initial compensable rating for right knee strain is remanded. FINDINGS OF FACT 1. In a July 2011 rating decision, the RO denied service connection for right wrist disability. Although the Veteran was notified of the RO’s decision and his appellate rights in July 2011 letter, he did not appeal within the applicable time period, nor was new and material evidence received within one year of the issuance of that decision. 2. The evidence received since the final July 2011 rating decision denying service connection for right wrist disability relates to an unestablished fact necessary to substantiate the claim and, presuming its credibility, raises a reasonable possibility of substantiating the claim of entitlement to service connection for right wrist disability. 3. The evidence is at least evenly balanced as to whether the Veteran’s current right wrist strain is related to service. 4. Throughout the course of the appeal, the evidence at least evenly balanced as to whether the Veteran’s TBI residuals, other than those for which he is being compensated pursuant to a grant of service connection for migraine headaches, have been productive of a level of impairment of 1 facet of cognitive impairment. CONCLUSIONS OF LAW 1. The August 2007 rating decision denying service connection for right wrist disability is final. 38 U.S.C. § 7105(c) (2012); 38. C.F.R. §§ 3.104, 20.302, 20.1103 (2017). 2. New and material evidence has been received to warrant reopening the claim of service connection for right wrist disability. 38 U.S.C. § 5107, 5108 (2012); 38 C.F.R. § 3.156 (2017). 3. Resolving reasonable doubt in favor of the Veteran, the criteria for service connection for a right wrist strain have been met. 38 U.S.C. §§ 1110, 1154(b), 5107 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309 (2017). 4. Resolving reasonable doubt in favor of the Veteran, the criteria for an initial rating of 10 percent, but no higher, for TBI residuals other than migraine headaches, have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.124a, Diagnostic Code 8045 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 2007 to October 2007, and from November 2009 to December 2010. This matter came to the Board of Veterans’ Appeals (Board) on appeal from December 2013 and March 2015 rating decisions by the Department of Veterans Affairs (VA) Regional Office (RO). In the December 2013 decision, the RO, inter alia, granted entitlement to service connection for TBI, and assigned a noncompensable rating effective February 15, 2013. The RO also granted service connection for lumbar and right knee strain, and assigned 10 and 0 percent ratings, respectively, for these disabilities. The Veteran disagreed with the RO’s determinations, and a Statement of the Case was issued on February 12, 2016. The Veteran perfected a timely appeal in February 2016. In July 2016, the RO granted service connection for migraine headaches and assigned an initial 30 percent rating. The RO noted that the disability was previously evaluated with the TBI residuals but that it was now being treated as a separate disability with a separate rating. In the December 2013 decision, the RO also reopened the previously denied claim of entitlement to service connection for right wrist disability. The Board has characterized the issue of service connection for a right wrist disability as whether new and material evidence has been received to reopen a claim for entitlement to service connection for right wrist disability. As indicated above, although the RO reopened the Veteran’s previously denied claim for a right wrist disability, the question of whether new and material evidence has been received is one that must be addressed by the Board, notwithstanding a decision favorable to the Veteran that may have been rendered by the RO. See Barnett v. Brown, 83 F.3d 1380 (Fed. Cir. 1996); see also Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001) (the Board has a jurisdictional responsibility to consider whether it was proper for the RO to reopen a previously denied claim). As such, the Board will first consider whether new and material evidence has been received sufficient to reopen the claim of entitlement to service connection for a right wrist disability before reaching any merits determination. New and Material Evidence In general, decisions of the RO and the Board that are not appealed in the prescribed time period are final. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.1100, 20.1103. Pursuant to 38 U.S.C. § 5108, a finally disallowed claim may be reopened when new and material evidence is presented or secured with respect to that claim. New evidence means evidence not previously submitted to agency decision-makers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). To reopen a previously disallowed claim, new and material evidence must be presented or secured since the last final disallowance of the claim on any basis, including on the basis that there was no new and material evidence to reopen the claim since a prior final disallowance. See Evans v. Brown, 9 Vet. App. 273, 285 (1996). For purposes of reopening a claim, the credibility of newly submitted evidence is generally presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is low. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). Furthermore, in determining whether this low threshold is met, VA should not limit its consideration to whether the newly submitted evidence relates specifically to the reason why the claim was last denied, but instead should ask whether the evidence could reasonably substantiate the claim were the claim to be reopened, either by triggering the Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Id. at 118. As set forth above, in July 2011 rating decision, the RO denied entitlement to service connection for a right wrist disability, finding no evidence of a diagnosed right wrist disability. The Veteran was notified of his appellate rights in a July 2011 letter. He did not appeal the RO’s determination and no new and material evidence was received within a year of the issuance of the rating decision. He does not contend otherwise. Thus, the RO’s July 2011 rating decision is final and not subject to revision on the same factual basis. 38 U.S.C. § 7105(c); 38. C.F.R. §§ 3.104, 20.302, 20.1103. In this appeal, the Veteran seeks to reopen his claim of service connection for a right wrist disability. As noted above, despite the finality of a prior adverse decision, a claim will be reopened and the former disposition reviewed if new and material evidence is presented or secured with respect to the claim which has been disallowed. 38 U.S.C. § 5108 38 C.F.R. § 3.156. Thus, the Board has reviewed the entire record, with particular attention to the additional evidence received since the last final rating decision in July 2011. That evidence includes an April 2013 VA medical examination report showing a diagnosis of right wrist strain. Given the basis for the prior denial of the claim, and presuming the credibility of this evidence, the Board finds that this additional evidence relates to unestablished facts necessary to substantiate the claim of service connection for a right wrist disability, and raises a reasonable possibility of substantiating the claim; therefore, the claim is reopened. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107(b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). 1. Right Wrist Strain The Veteran seeks service connection for a right wrist disability. He contends that such disability is due to military service. For the reasons explained below, and affording the Veteran the benefit of the doubt, service connection for a right wrist disability is warranted. In this case, the evidence of record indicates that the Veteran currently has a right wrist disability. Specifically, an April 2013 VA examination report shows a diagnosis of right wrist strain. Based on this evidence, the Board finds that the first element of service connection has been met. The Veteran’s service treatment records are negative of complaints, treatment, or findings of a right wrist disability. A military separation examination is not of record. The evidence of record includes a November 2010 pre-discharge compensation claim, in which the Veteran sought entitlement to service connection for multiple disabilities, including right wrist strain. The record further indicates that the Veteran did not attend his June 2011 compensation examination in reference to the above-mentioned claim. In a January 2011 VA clinical record, the Veteran reported a vehicle roll-over where he lost consciousness in October 2010. He noted a fractured left pinky and complained of both wrists being sore focally. The Veteran’s pain level with wrist flexion was noted at three on a scale of 10. The Veteran has reported that while in Afghanistan in 2010, he was involved in a rollover, in which his vehicle rolled off the road, flipped twice and ended up in the bottom of a mountain. He stated that he was a gunner and does not remember, but thinks he hit his wrist into the hatch of the vehicle. The Veteran indicated that he was medically evacuated to Jalalabad and that he had pain of the right wrist. He further noted that the x-ray machine was down that day, and they looked and told him that nothing was wrong. See e.g. April 2013 VA examination. The Veteran’s DD-214 Form confirms the he is in receipt of the Combat Infantryman Badge for his service in Afghanistan and that his military occupational specialty was infantryman. Thus, the evidence shows that the Veteran engaged in combat with the enemy. See VA Adjudication Procedures Manual, IV.ii.1.D.1.e (updated March 31, 2017) (list of Decorations that are evidence of combat participation). The finding that the Veteran engaged in combat is significant because it allows a combat veteran to use “satisfactory lay or other evidence” to establish that he was injured or incurred a disability while on active duty, even in cases where “there is no official record” that such injury or disability occurred. Reeves v. Shinseki, 682 F.3d 988, 998 (Fed. Cir. 2012) (quoting 38 U.S.C. § 1154(b)). The Board therefore accepts the Veteran’s statements that he injured his right wrist in service. Moreover, the fact that the claimed cause of the Veteran’s right wrist disability, is therefore established by his statements, does not prevent him from also invoking the section 1154(b) rules in order to show that he incurred the disability itself while in service. Reeves, 682 F.3d at 999. The April 2013 VA examiner opined that the Veteran’s right wrist strain is less likely as not a result of injury incurred in service. The examiner’s rationale was that the Veteran on separation did not indicate any health concerns, and there was no complaint about joint pains, nor was there any treatment record for his wrist. The examiner noted that the Veteran had been working in construction where he shovels and lifts objects weighing from 10 to 60 pounds. The condition became worse for the past six months. The examiner further noted that the Veteran had been doing the construction job for six years, which meant that he had this job since 2007. In this case, the Board finds that the April 2013 VA opinion that the Veteran’s right wrist strain is not related to service is of no probative value, as it was based on an inaccurate factual premise. Reonal v. Brown, 5 Vet. App. 458, 461 (1993) (a medical opinion based on an inaccurate factual premise is not probative). Specifically, the VA medical examiner rendered the opinion that the Veteran’s current right wrist condition was not incurred in or caused by service, because on separation the Veteran did not indicate any health concerns. However, the service records contain no separation examination. Additionally, the record includes a pre-discharge compensation claim, in which the Veteran sought entitlement to service connection for multiple disabilities, including right wrist strain. Moreover, the opinion does not consider the Veteran’s competent and credible reports of the onset of his right wrist disability in service, and the continuation of those symptoms following service. In this regard, a medical opinion is inadequate if it is based solely on the absence of documentation in the record and does not take into account the Veteran’s reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). The Board finds that, given the application of 38 U.S.C. § 1154 (b) as explained in Reeves, the Veteran’s lay statements along with the other evidence above, including the Veteran’s duties in service, provides a sufficient basis to conclude that his current right wrist disability is related to the in-service injury. There is no other probative evidence of record which attributes the Veteran’s current right wrist strain to any other cause. Based on the evidence of record, and resolving reasonable doubt in his favor, the Board finds that the Veteran currently has a right wrist disability that was incurred during his active military service. Thus, service connection for right wrist strain is warranted. Higher Initial Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation 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. Any reasonable doubt regarding the degree of disability is resolved in favor of the Veteran. 38 C.F.R. § 4.3. In considering the severity of a disability, it is essential to trace the medical history of the Veteran. 38 C.F.R. §§ 4.1, 4.2, 4.41. Consideration of the whole-recorded history is necessary so that a rating may accurately reflect the elements of disability present. 38 C.F.R. § 4.2; Peyton v. Derwinski, 1 Vet. App. 282 (1991). Where, as here, a claimant appeals the initial rating assigned following an award of service connection, evidence contemporaneous with the claim for service connection and with the rating decision granting service connection would be most probative of the degree of disability existing at the time that the initial rating was assigned and should be the evidence “used to decide whether an [initial] rating on appeal was erroneous....” Fenderson v. West, 12 Vet. App. 119, 126 (1999). If later evidence obtained during the appeal period indicates that the degree of disability increased or decreased following the assignment of the initial rating, “staged” ratings may be assigned for separate periods of time based on facts found. Id. The standard of proof to be applied in decisions on claims for VA benefits is set forth in 38 U.S.C. § 5107 (b). Under that provision, VA shall consider all information and lay and medical evidence of record in a case before the Secretary with respect to benefits under laws administered by the Secretary. When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the Secretary shall give the benefit of the doubt to the claimant. 2. TBI The Veteran seeks a higher rating for his service-connected TBI. He contends that the rating currently assigned does not reflect the severity of his disability. The Veteran’s TBI residuals other than those for which he is being compensated pursuant to the grant of service connection for headaches are currently rated under Diagnostic Code 8045. Diagnostic Code 8045 recognizes three main areas of dysfunction that may result from TBIs and have profound effects on functioning: cognitive, emotional/behavioral, and physical. Each of these areas of dysfunction may require evaluation under listed facets. 38 C.F.R. § 4.124a, DC 8045. Each facet shall be assigned a level of impairment, ranging from 1 to 3. The disability rating assigned shall be based on the facet with the highest level of impairment. Id. Effective October 23, 2008, VA revised that portion of the Rating Schedule that addresses neurological conditions and affective disorders to provide detailed and updated criteria for evaluating residuals of traumatic brain injury (TBI). See 73 Fed. Reg. 54693 (September 23, 2008). As in this case, the revised criteria apply to all applications for benefits received by VA on or after October 23, 2008. The new version of Diagnostic Code 8045 continues to provide for the evaluation of residuals of TBI. 38 C.F.R. § 4.124a (effective October 23, 2008). Cognitive impairment is defined as decreased memory, concentration, attention, and executive functions of the brain. Executive functions are goal setting, speed of information processing, planning, organizing, prioritizing, self-monitoring, problem solving, judgment, decision making, spontaneity, and flexibility in changing actions when they are not productive. Not all of these brain functions may be affected in a given individual with cognitive impairment, and some functions may be affected more severely than others. In a given individual, symptoms may fluctuate in severity from day to day. Cognitive impairment is to be evaluated under the table titled Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. Id. Subjective symptoms may be the only residual of TBI or may be associated with cognitive impairment or other areas of dysfunction. Subjective symptoms that are residuals of TBI, whether or not they are part of cognitive impairment, are to be evaluated under the subjective symptoms facet in the table titled Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. However, separately evaluate any residual with a distinct diagnosis that may be evaluated under another diagnostic code, such as migraine headache or Meniere’s disease, even if that diagnosis is based on subjective symptoms, rather than under the Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified table. Id. Emotional/behavioral dysfunction is to be evaluated under § 4.130 (Schedule of ratings-mental disorders) when there is a diagnosis of a mental disorder. When there is no diagnosis of a mental disorder, evaluate emotional/behavioral symptoms under the criteria in the table titled Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified. Id. Physical (including neurological) dysfunction is to be evaluated based on the following list, under an appropriate diagnostic code: Motor and sensory dysfunction, including pain, of the extremities and face; visual impairment; hearing loss and tinnitus; loss of sense of smell and taste; seizures; gait, coordination, and balance problems; speech and other communication difficulties, including aphasia and related disorders, and dysarthria; neurogenic bladder; neurogenic bowel; cranial nerve dysfunctions; autonomic nerve dysfunctions; and endocrine dysfunctions. Id. The preceding list of types of physical dysfunction does not encompass all possible residuals of TBI. For residuals not listed here that are reported on an examination, evaluate under the most appropriate diagnostic code. Each condition should be evaluated separately as long as the same signs and symptoms are not used to support more than one evaluation, and combine under § 4.25 the evaluations for each separately rated condition. The evaluation assigned based on the Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified table will be considered the evaluation for a single condition for purposes of combining with other disability evaluations. Id. The table titled Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified contains 10 important facets of TBI related to cognitive impairment and subjective symptoms. It provides criteria for levels of impairment for each facet, as appropriate, ranging from 0 to 3, and a 5th level, the highest level of impairment, labeled total. However, not every facet has every level of severity. The Consciousness facet, for example, does not provide for an impairment level other than total, since any level of impaired consciousness would be totally disabling. A 100-percent evaluation should be assigned if total is the level of evaluation for one or more facets. If no facet is evaluated as total, assign the overall percentage evaluation based on the level of the highest facet as follows: 0 = 0 percent; 1 = 10 percent; 2 = 40 percent; and 3 = 70 percent. For example, assign a 70 percent evaluation if 3 is the highest level of evaluation for any facet. Id. The 10 important facets in the table of Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified are as follows: (1) Memory, attention, concentration, executive functions; (2) Judgment; (3) Social interaction; (4) Orientation; (5) Motor activity; (6) Visual spatial orientation; (7) Subjective symptoms; (8) Neurobehavioral effects; (9) Communication; and (10) Consciousness. Id. Note (1): There may be an overlap of manifestations of conditions evaluated under the table titled Evaluation of Cognitive Impairment and Other Residuals of TBI Not Otherwise Classified with manifestations of a comorbid mental or neurologic or other physical disorder that can be separately evaluated under another diagnostic code. In such cases, do not assign more than one evaluation based on the same manifestations. If the manifestations of two or more conditions cannot be clearly separated, assign a single evaluation under whichever set of diagnostic criteria allows the better assessment of overall impaired functioning due to both conditions. However, if the manifestations are clearly separable, assign a separate evaluation for each condition. Id. Note (2): Symptoms listed as examples at certain evaluation levels in the table are only examples and are not symptoms that must be present in order to assign a particular evaluation. Id. Note (3):” Instrumental activities of daily living refers to activities other than self-care that are needed for independent living, such as meal preparation, doing housework and other chores, shopping, traveling, doing laundry, being responsible for one’s own medications, and using a telephone. These activities are distinguished from Activities of daily living, which refers to basic self-care and includes bathing or showering, dressing, eating, getting in or out of bed or a chair, and using the toilet. Id. Note (4): The terms mild, moderate, and severe TBI, which may appear in medical records, refer to a classification of TBI made at, or close to, the time of injury rather than to the current level of functioning. This classification does not affect the rating assigned under Diagnostic Code 8045. Id. Note (5): A Veteran whose residuals of TBI are rated under a version of § 4.124a, Diagnostic Code 8045, in effect before October 23, 2008 may request review under Diagnostic Code 8045, irrespective of whether his or her disability has worsened since the last review. VA will review that Veteran’s disability rating to determine whether the Veteran may be entitled to a higher disability rating under diagnostic code 8045. A request for review pursuant to this note will be treated as a claim for an increased rating for purposes of determining the effective date of an increased rating awarded as a result of such review; however, in no case will the award be effective before October 23, 2008. For the purposes of determining the effective date of an increased rating awarded as a result of such review, VA will apply 38 C.F.R 3.114, if applicable. Id. As noted, the Veteran has separately been granted service connection for migraine headaches and assigned a 30 percent rating. The propriety of that rating has been separately appealed and a statement of the case issued in February 2018, but there does not appear to be a substantive appeal or certification with regard to this issue and the Board will therefore not address it at this time. Moreover, given that the Veteran’s symptoms of facets assigned to certain impairments have been rated separately under an alternative diagnostic code, DC 8100, for subjective dysfunction due to headaches, the Board will, to avoid pyramiding, not address these symptoms when determining the appropriate rating for the currently noncompensable TBI residuals rated under DC 8045 in this case. 38 C.F.R. § 4.14 (“[t]he evaluation of the same disability under various diagnoses,” a practice called “pyramiding,” “is to be avoided”). The evidence of record includes May 2013 and June 2016 VA examination reports which indicate that the Veteran had a complaint of mild memory loss, attention, concentration, or executive functions, but without objective evidence on testing. He exhibited normal judgment, appropriate social interaction, and normal orientation, normal motor activity, normal visual spatial orientation, and subjective symptoms that do not interfere with work, instrumental activities of daily living or work, family, or other close relationships. The examiners also noted one or more neurobehavioral effects that do not interfere with workplace interaction or social interaction. The Veteran was able to communicate by spoken and written language and to comprehend spoken and written language. His consciousness was noted as normal. The examiners concluded that the Veteran’s attention and memory difficulties are less likely than not related to his mild TBI and more likely related to his anxiety. The examiners noted that difficulties with attention that occur with mild TBI tend to improve within normal limits. The examiners further noted that his residual conditions attributable to a TBI does not impact his ability to work. For the following reasons, the evidence is at least evenly balanced as the whether the Veteran’s TBI symptoms have been productive of a level of impairment of 1 facet of cognitive impairment to warrant an initial 10 percent rating, but no higher. In this case, the May 2013 and June 2016 VA examination reports indicate that the Veteran has memory and attention difficulties. The evidence further shows that the Veteran has reported symptoms and treatment for a non-service-connected anxiety disorder. Although the VA examiners attributed the Veteran’s attention and memory symptoms to the non-service connected anxiety, they did not provide a detailed rationale. Thus, the Board finds the probative evidence of record does not differentiate between the symptomatology associated with the Veteran’s TBI and the nonservice-connected anxiety. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning). When it is not possible to separate the effects of the service-connected and non-service-connected disabilities, the benefit of the doubt doctrine described in 38 C.F.R. § 3.102 dictates that such signs and symptoms be attributed to the service-connected disability or disabilities. Mittleider v. West, 11 Vet. App. 181, 182 (1998) (citing 61 Fed. Reg. 52698 (Oct. 8, 1996)). Accordingly, the Board will attribute all of the Veteran’s attention and memory symptoms to the TBI for the purposes of assessing the severity of that disability. Based on the clinical findings summarized above, the level of severity of “1” is assigned for the Veteran’s complaints of mild memory loss, attention, concentration, or executive functions, but without objective evidence on testing. However, the criteria for a “2” under memory, attention, concentration, executive functions are not met. While the Veteran experiences mild memory and attention difficulties, the evidence does not indicate objective evidence on testing of mild impairment of memory, attention, concentration, or executive functions resulting in mild functional impairment. Moreover, a “0” is assigned for the judgment facet, social interaction facet, orientation facet, motor activity facet, visual spatial orientation facet, subjective symptoms, neurobehavioral facet, and the communication facet. Indeed, there is no evidence that any of those facets are impaired as a residual of a TBI. To that end, no such impairment was shown on examination. Likewise, the Veteran does not warrant a “total” rating for consciousness, as he is not in a persistently altered state of consciousness, such as vegetative state, minimally responsive state, or in a coma. Indeed, as explained above, assuming that the May 2013 and June 2016 VA examination testing is valid, the results from those examinations does not show deficiencies in any of the above areas. The Board has considered the Veteran’s increased rating claim and decided entitlement based on the evidence. Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, with respect to his claims. See Doucette v. Shulkin, 28 Vet. App. 366, 369-70 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). Based upon the foregoing, the Board finds that the evidence of record is at least evenly balanced as the whether the Veteran’s TBI symptoms have been productive of a level of impairment of 1 facet of cognitive impairment to warrant an initial 10 percent rating, but no higher throughout the appeal period. As the preponderance of the evidence is against any higher rating, the benefit of the doubt doctrine is not otherwise for application. 38 U.S.C. § 5107 (b); 38 C.F.R. § 4.3. REASONS FOR REMAND 1. An Acquired Psychiatric Disorder, to include Anxiety Disorder The Veteran contends that service connection is warranted for a psychiatric disorder due to his service in combat. In an August 2018 letter, the Veteran’s attorney argued that the Veteran has continually reported symptomatology for his mental health condition since his return from deployment, continues his mental health treatment, and is taking prescribed medication to help manage his condition. The Veteran’s attorney further asserted that a remand was warranted for examination of his acquired psychological condition. In July 2017, the Veteran missed the VA examination without showing good cause. The Board, however, accepts the argument of the Veteran’s representative that he had good cause for missing the exam and deserves another one. See e.g.August 2017 Power of Attorney. The Veteran’s failure to report again may result in denial of the claim, pursuant to 38 C.F.R. § 3.655. Given the foregoing, the Board finds that a remand is necessary to schedule the Veteran for another VA medical examination. 2. Lumbar Strain The Veteran seeks a higher rating for his service-connected lumbar strain. He contends that the rating currently assigned does not reflect the severity of his disability. Subsequent to the most recent VA examination, the Court, in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Thus, the Court’s holding in Correia establishes additional requirements that must be met prior to finding that a VA examination is adequate. The Veteran’s previous examinations do not appear to comply with 38 C.F.R. § 4.59 as interpreted in Correia. A more recent Court decision addressed what constitutes an adequate explanation for an examiner’s inability to estimate motion loss in terms of degrees during periods of flare-ups. Sharp v. Shulkin, 29 Vet. App. 26 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. In this case, the May 2016 VA examiner noted flare-ups of the thoracolumbar spine, but never attempted to estimate additional motion loss during flare-ups or explain why this estimate cannot be given, contrary to Sharp. Consequently, a remand is warranted for a new VA examination, to be conducted in accordance with 38 C.F.R. § 4.59 as interpreted in Correia and Sharp. 3. Right Knee Strain The Veteran seeks a compensable rating for his service-connected right knee strain. He contends that the rating currently assigned does not reflect the severity of his disability. Unfortunately, the Board finds that the April 2013 and May 2016 VA examinations are inadequate for rating purposes. As noted above, in Correia v. McDonald, the United States Court of Appeals for Veterans Claims (Court) essentially held that that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158 (2016). 38 C.F.R. § 4.59 (2017). The April 2013 and May 2016 VA examination reports do not include range of motion testing for pain on both active and passive motion or with weight-bearing and non-weight-bearing. As such, pursuant to Correia, the Veteran must be provided an adequate VA joints examination to include range of motion testing on active and passive motion and in weight bearing and non-weight bearing conditions. Thus, a remand is warranted for a new VA examination, to be conducted in accordance with 38 C.F.R. § 4.59 as interpreted in Correia. Additionally, the April 2013 VA examiner noted flare-ups of the right knee, but never attempted to estimate additional motion loss during flare-ups or explain why this estimate cannot be given, contrary to Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and etiology of any acquired psychiatric disorder. Access to records in the Veteran’s electronic VA claims files must be made available to the examiner for review in connection with the examination. After examining the Veteran and reviewing the record, the examiner should delineate all psychiatric disorders identified on examination. For each identified psychiatric disorder, the examiner should provide an opinion as to whether is it at least as likely as not (a 50 percent probability or higher) that such psychiatric disorder had its onset during service, or is otherwise causally related to active service or any incident therein. The examiner is advised that the Veteran is competent to report symptoms, treatment, and injuries, and that his reports must be taken into account in formulating the requested opinion. A complete rationale for any opinion expressed should be provided. 2. Schedule the Veteran for a VA examination to evaluate the severity of his service-connected lumbar strain disability. The record must be made available to, and be reviewed by the examiner, and the examination report should note that review. Any indicated evaluations, studies, and tests should be conducted. The joint examination should be conducted in accordance with the current disability benefits questionnaire, to include compliance with 38 C.F.R. § 4.59, as interpreted in Correia, and with Sharp. 3. Schedule the Veteran for an appropriate VA examination to determine the severity of his service-connected right knee disability. The electronic claims file must be reviewed by the examiner. All indicated studies and testing must be conducted, and all pertinent symptomatology must be reported in detail. The examination should be conducted in accordance with the current disability benefits questionnaire, to include compliance with 38 C.F.R. § 4.59, as interpreted in Correia, and with Sharp. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Walker, Associate Counsel