Citation Nr: 18151073 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 18-02 683 DATE: November 16, 2018 ORDER The application to reopen the claim of entitlement to service connection for a lumbar spine disorder is granted. Service connection for degenerative changes of the lumbar spine as secondary to the service-connected left knee disabilities is granted. The application to reopen the claim of entitlement to service connection for neuropathy of the right lower extremity is granted. The application to reopen the claim of entitlement to service connection for a right ankle disorder is granted. The application to reopen the claim of entitlement to service connection for a cervical spine disorder is denied. A rating in excess of 20 percent for residuals of a left knee injury with instability is denied. A rating in excess of 10 percent for left knee degenerative arthritis with limitation of motion is denied. REMANDED Entitlement to service connection for neuropathy of the right lower extremity is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a right foot disorder is remanded. Entitlement to a separate rating for residuals of a left knee meniscus disability is remanded. Entitlement to a total disability rating for compensation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. In an unappealed August 2010 rating decision, the RO denied the claim for service connection for a cervical spine disorder, denied the claim for service connection for peripheral neuropathy, denied the claim for a right ankle disorder, and denied reopening the claim for service connection for a lumbar spine disability. 2. Evidence received since the August 2010 rating decision is not new and material and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for the cervical spine disorder. 3. Evidence received since the August 2010 rating decision is new and material and raises a reasonable possibility of substantiating the claim of entitlement to service connection for neuropathy of the right lower extremity. 4. Evidence received since the August 2010 rating decision is new and material and raises a reasonable possibility of substantiating the claim of entitlement to service connection for the lumbar spine disorder. 5. Evidence received since the August 2010 rating decision is new and material and raises a reasonable possibility of substantiating the claim of entitlement to service connection for a right ankle disorder. 6. The Veteran’s degenerative changes of the lumbar spine are, at least in part, secondary to his service-connected left knee disabilities. 7. Throughout the rating period on appeal, the Veteran’s left knee disability has been manifested by limitation of motion in flexion limited to, at worst, 90 degrees and extension was lacking 10 degrees; the evidence did not show “severe” instability of the left knee or recurrent subluxations. CONCLUSIONS OF LAW 1. The August 2010 rating decision that denied service connection for a cervical spine disorder, denied service connection for neuropathy of the right lower extremity, denied service connection for a right ankle disorder, and denied the claim to reopen service connection for a lumbar spine disorder, is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 2. New and material evidence has not been received since the last denial of service connection for a cervical spine disorder and the application to reopen the claim is denied. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (a) (2017). 3. New and material evidence has been received since the last denial of service connection for neuropathy of the right lower extremity and the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (a) (2017). 4. New and material evidence has been received since the last denial of service connection for a lumbar spine disorder and the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (a) (2017). 5. New and material evidence has been received since the last denial of service connection for a right ankle disorder and the claim is reopened. 38 U.S.C. §§ 5108, 7105 (2012); 38 C.F.R. § 3.156 (a) (2017). 6. The criteria for service connection for degenerative changes of the lumbar spine as secondary to the service-connected left knee disabilities are met. 38 U.S.C. §§1101, 1110, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.310 (2017). 7. The criteria for an increased rating in excess of 20 percent for residuals of a left knee injury with instability are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Code 5257 (2017). 8. The criteria for an increased rating in excess of 10 percent for left knee degenerative arthritis with limitation of motion are not met. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, 5260 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1949 to July 1953. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions issued in September 2013 and April 2014 by the Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran withdrew his request for a Board hearing. The Board notes that in Rice v. Shinseki, 22 Vet. App. 447 (2009), the United States Court of Appeals for Veterans Claims (Court) stated that a claim for a TDIU due to service-connected disability is part and parcel of an increased rating claim when such claim is raised by the record. The Veteran has raised the issue of unemployability. In light of the Court’s holding in Rice, the Board has considered the TDIU claim as part of his pending increased rating claims and has accordingly listed the raised TDIU claim as an issue. New and Materia -Laws and Analysis The Veteran was initially denied service connection for a lumbar spine disorder in a March 2001 rating decision because there was no indication that the Veteran’s disorder was related to service or that the Veteran’s spine disorder was related to a service-connected disability. Moreover, in an August 2010 rating decision, the RO denied service connection for a cervical spine disorder, denied service connection for a right ankle disorder, denied service connection for neuropathy, and denied reopening the claim for service connection for a lumbar spine disorder. The Veteran was notified of the rating decision, but did not appeal the decision. As such, the August 2010 rating decision became final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. A claim will be reopened in the event that new and material evidence is presented. 38 U.S.C. § 5108. Because the August 2010 rating decision was the last final disallowance, the Board must review all of the evidence submitted since that rating decision to determine whether the Veteran’s claims for service connection should be reopened and re-adjudicated on a de novo basis. Evans v. Brown, 9 Vet. App. 273 (1996). If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Board shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. With regard to petitions to reopen previously and finally disallowed claims, the Board must conduct a two-part analysis. First, the Board must determine whether the evidence presented or secured since the prior final disallowance of the claim is “new and material.” Second, if the Board determines that the evidence is “new and material,” it must reopen the claim and evaluate the merits of the claim in view of all the evidence, both new and old. Manio v. Derwinski, 1 Vet. App. 140, 145 (1991). Section 3.156(a) provides as follows: A claimant may reopen a finally adjudicated claim by submitting new and material evidence. New evidence means existing 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). 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 VA Secretary’s duty to assist or through consideration of an alternative theory of entitlement. Id at 118. In determining whether evidence is new and material, the “credibility of the evidence is to be presumed.” Justus v. Principi, 3 Vet. App. 510, 513 (1992). Regarding the cervical spine disorder, the August 2010 rating decision denied the claim because the Veteran did not have a current diagnosis pertaining to the cervical spine. The evidence received since the August 2010 rating decision, to include the Veteran’s lay statements, does not show a diagnosis pertaining to the cervical spine. In an October 2016 private medical evaluation from Dr. Bruno, there was no indication of a cervical spine disorder. In a September 2013 VA neck examination report, the Veteran denied any neck problems and stated that he had a ruptured disk in his low back, but not in the neck. For these reasons, the Board finds that the evidence received since the August 2010 rating decision is not new and material and does not raise a reasonable possibility of substantiating the claim of entitlement to service connection for the cervical spine disorder. The application to reopen the claim for service connection for a cervical spine disorder is denied. Regarding neuropathy of the right lower extremity, the Veteran’s claim for service connection for a lumbar spine disorder is being granted herein. As such, the Board finds that this constitutes new and material evidence as the Veteran’s neuropathy of the right lower extremity may be associated with his now service-connected lumbar spine disability. VA treatment records in February 2010 show a diagnosis of polyneuropathy, and it was noted that similar findings could be seen in patients with lumbar polyradiculopathy. As such, the application to reopen this claim is granted. Regarding the right ankle disorder, the Veteran’s claim was initially denied because there was no evidence showing that the Veteran’s ankle disorder was related to service or to the service-connected left knee disorder. The new evidence received since the August 2010 rating decision now includes a February 2016 statement from Dr. White. During the evaluation, the Veteran reported that he sustained a serious injury in service to both the left knee and right foot. The right foot condition was noted to have worsened over the years. Dr. White opined that the Veteran’s condition was directly related to the in-service injury. This medical evaluation is new, as such evidence was not of record prior to the issuance of the August 2010 rating decision. Moreover, the evidence is material, as it relates to the unestablished element of a relationship between the Veteran’s right foot disorder and service. Regarding the lumbar spine disorder, the evidence received subsequent to the August 2010 rating decision includes, in pertinent part, an October 2016 private medical evaluation from Dr. Bruno. The report indicated that, because of the Veteran’s left knee arthritis (and resulting left leg length discrepancy), the Veteran had related changes in the lumbosacral spine that were secondary to the service-connected left knee impairment. The Board finds that this evidence is new and material within the meaning of applicable law and regulations. In this regard, the October 2016 medical evaluation is new, as such evidence was not of record prior to the issuance of the August 2010 rating decision. Moreover, the evidence is material, as it relates to the unestablished element of a relationship between the Veteran’s spine disorder and his service-connected left knee disability. As such, the lumbar spine claim is reopened. Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Only chronic diseases listed under 38 C.F.R. § 3.309 (a) (2017) are entitled to the presumptive service connection provisions of 38 C.F.R. § 3.303 (b). Walker v. Shinseki, 708 F.3d 1331 Fed. Cir. 2013). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310 (a). See 38 C.F.R. § 3.310 (a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). The controlling regulation has been interpreted to permit a grant of service connection not only for disability caused by a service-connected disability, but for the degree of disability resulting from aggravation of a non-service-connected disability by a service-connected disability. See Allen v. Brown, 7 Vet. App. 439, 448 (1995). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57(1990). Competency of evidence differs from weight and credibility. Competency is a legal concept determining whether testimony may be heard and considered by the trier of fact, while credibility is a factual determination going to the probative value of the evidence to be made after the evidence has been admitted. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with the veteran prevailing in either event, or whether a preponderance of the evidence is against a claim, in which case, the claim is denied. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. Lumbar Spine The Veteran maintains that he has a lumbar spine disorder that is either caused or aggravated by his service-connected left knee disabilities. Upon review of all the evidence of record, both lay and medical, the Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s lumbar spine disorder is secondary to his service-connected left knee disability. Initially, the Board finds that the Veteran has been diagnosed with severe degenerative disease of the lumbar spine. See September 1999 MRI report. He was also diagnosed with herniated disks and mild compression of L3-4 nerve roots. See September 2009 VA spine examination report. As noted above, the evidence includes an October 2016 private medical evaluation from Dr. Bruno. The evaluation indicated that the Veteran was interviewed and physically examined. Further, Dr. Bruno reviewed and discussed the relevant medical evidence of record. It was indicated that the Veteran used two crutches and a walker or wheelchair. The Veteran’s left leg was noted to be one inch shorter than the right leg. It was then opined that, because of the Veteran’s left knee arthritis and resulting shortening of the left leg, the Veteran had related changes in the lumbosacral spine that were more than likely “secondary” to his service-connected left knee disabilities. The Board finds the opinion from Dr. Bruno to be highly probative as to whether the Veteran’s lumbar spine disorder is secondary to his left knee disabilities. Dr. Bruno reviewed the relevant evidence in the claims file, interviewed the Veteran, performed a physical examination of the Veteran’s knee and spine, discussed relevant medical literature in detail, and provided an opinion supported by a well-reasoned rationale. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (holding that it is the reasoning for the conclusion that contributes probative value to a medical opinion). The Board has reviewed the remaining evidence of record and finds that there are no other medical opinions that are contradictory to Dr. Bruno’s findings. As such, the Board finds that the Veteran’s lumbar spine disorder is secondary to his service-connected left knee disabilities. Laws and Analysis for Left Knee Disability Ratings Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4 (2017). Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the Veteran working or seeking work. 38 C.F.R. § 4.2 (2017). Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. In cases in which a reasonable doubt arises as to the appropriate degree of disability to be assigned, such doubt shall be resolved in favor of the veteran. 38 C.F.R. § 4.3 (2017). Where, as here, entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern, including the appropriateness of staged ratings whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994); Hart v. Mansfield, 21 Vet. App. 505 (2007). The relevant temporal focus for adjudicating an increased rating claim is on the evidence concerning the state of the disability from the time period one year before the claim was filed until VA makes a final decision on the claim. See Francisco, 7 Vet. App. at 58; Hart, 21 Vet. App. at 505. Except as otherwise provided in the rating schedule, all disabilities, including those arising from a single disease entity, are to be rated separately, and then all ratings are to be combined pursuant to 38 C.F.R. § 4.25 (2017). Esteban v. Brown, 6 Vet. App. 259, 261 (1994). However, the Court has interpreted 38 U.S.C. § 1155 as implicitly containing the concept that the rating schedule may not be employed as a vehicle for compensating a claimant twice (or more) for the same symptomatology; such a result would overcompensate the claimant for the actual impairment of the earning capacity and would constitute pyramiding of disabilities, which is cautioned against in 38 C.F.R. § 4.14 (2017). In Esteban, the Court held that the critical element was that the symptomatology for any of the conditions was duplicative of or overlapping with the symptomatology of the other conditions. The relevant rating criteria include Diagnostic Code 5010, which instructs the rater to rate traumatic arthritis as degenerative arthritis under Diagnostic Code 5003. Under Diagnostic Code 5003, arthritis established by X-ray findings is rated on the basis of limitation of motion under the appropriate Diagnostic Codes for the specific joint or joints involved. When, however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined and not added, under Diagnostic Code 5003. For purpose of rating disability from arthritis, the elbow is considered a major joint. 38 C.F.R. § 4.45 (f). The diagnostic codes that focus on limitation of motion of the knee are Diagnostic Codes 5260 (limitation of flexion) and 5261 (limitation of extension). For rating purposes, normal range of motion in a knee joint is from 0 to 140 degrees. 38 C.F.R. § 4.71, Plate II. The Rating Schedule provides for ratings of 0, 10, 20, or 30 percent where there is limitation of flexion of the leg to 60, 45, 30, or 15 degrees, respectively, and for ratings of 0, 10, 20, 30, 40, or 50 percent for limitation of extension of the leg to 5, 10, 15, 20, 30, or 45 degrees, respectively. 38 C.F.R. § 4.71a, Diagnostic Codes 5260, 5261. VA’s General Counsel has held that separate ratings are available for limitation of flexion and limitation of extension under Diagnostic Codes 5260 and 5261. VAOPGCPREC 9-2004 (2004). Diagnostic Code 5257 provides ratings of 10, 20, and 30 percent for recurrent subluxation or lateral instability of the knee which is slight, moderate, or severe, respectively. 38 C.F.R. § 4.71a, Diagnostic Code 5257. Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. Diagnostic Code 5259 provides for a 10 percent rating for symptomatic removal of the semilunar cartilage. VA’s General Counsel has held that a claimant who has arthritis and instability of the knee may be rated separately under DCs 5003 and 5257. VAOPGCPREC 23-97; 62 Fed. Reg. 63,604 (1997). The General Counsel subsequently clarified that for a knee disability rated under DC 5257 to warrant a separate rating for arthritis based on X-ray findings and limitation of motion, limitation of motion under DC 5260 or DC 5261 need not be compensable but must at least meet the criteria for a zero-percent rating. A separate rating for arthritis can also be based on X-ray findings and painful motion under 38 C.F.R. § 4.59. VAOPGCPREC 9-98 (1998); 63 Fed. Reg. 56,704 (1998). VA’s General Counsel has subsequently held that separate ratings can also be provided for limitation of knee extension and flexion. VAOPGCPREC 9-2004; 69 Fed. Reg. 59,990 (2004). When an evaluation of a disability is based upon limitation of motion, the Board must also consider, in conjunction with the otherwise applicable diagnostic codes, any additional functional loss the veteran may have sustained by virtue of other factors as described in 38 C.F.R. §§ 4.40 and 4.45. DeLuca v. Brown, 8 Vet. App. 202, 206 (1995). Such factors include more or less movement than normal, weakened movement, excess fatigability, incoordination, pain on movement, swelling, and deformity or atrophy from disuse. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the Veteran. 38 C.F.R. § 4.40; Johnston v. Brown, 10 Vet. App. 80, 85 (1997). Moreover, in Correia v. McDonald, 28 Vet. App 158 (2016), the Court determined that VA examination reports in cases of joint disabilities must comply with the language of 38 C.F.R. § 4.59 by evaluating range of motion “for pain on both active and passive motion, in weight bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint.” The Veteran filed his claim for an increased rating pertaining to the left knee in May 2012. The relevant evidence since that date includes a September 2013 VA knee examination. During the evaluation, the Veteran reported worsening pain in the left knee since the last VA examination conducted in 2009. He denied pain at rest, but pain was triggered with weight bearing, standing, and walking. He reported feelings of the knee “giving out.” Flare-ups were noted to occur with prolonged walking. Upon range of motion testing, flexion of the left knee was limited to 110 with pain starting at 110 degrees. There was no objective evidence of painful motion in extension. Repetitive use testing of the left knee did not additionally limit motion. All joint stability testing, to include medial-lateral instability testing, was normal. The examiner indicated that there was no history of recurrent patellar subluxation or dislocation. The Veteran was not shown to have a meniscal condition or a surgical procedure to the left knee. The evidence also includes a February 2016 statement from Dr. White. It was noted that radiographs taken in February 2016 showed severe joint degeneration and a complete absence of the medial cartilage. The Veteran further submitted an October 2016 private medical evaluation by Dr. Bruno. Upon examination, it was noted range of motion of the left knee resulted in limitation to 10 degree (extension) and 90 degrees (flexion), with all motion accompanied by crepitus. The knee joint was enlarged with bony arthritic changes and moderately-tender, but without instability. The Veteran was afforded a VA knee examination in May 2017. During the evaluation, the Veteran reported that, depending on his activity, his left knee pain could increase to a 10 out of 10, with 10 being the most severe pain. His knee pain was aggravated by walking and worse at night. The Veteran was noted to have been fitted with a rigid brace for his left knee. Upon range of motion testing, flexion of the left knee was limited to 90 with pain. Extension was to 0 degrees with pain. The pain was noted to cause functional loss both in flexion and extension. There was also pain on weight-bearing. Repetitive use testing of the left knee did not additionally limit motion. All joint stability testing, to include lateral instability testing, was normal. The Veteran did not have a meniscal condition or a surgical procedure to the left knee. He also did not have ankylosis in the left knee. Upon review of all the evidence of record, the Board finds that a rating in excess of 20 percent under Diagnostic Code 5257 (instability of the knee) is not warranted. The evidence throughout the rating period on appeal does not show any indication that the Veteran has instability of the left knee or recurrent subluxations or dislocations to a severe degree. As such, a higher rating in excess of 20 percent is not warranted under this code. The Veteran is also in receipt of a 10 percent rating for the rating period for arthritis with limitation of flexion under Diagnostic Code 5003-5260. Upon consideration of the evidence, the Board finds that the disability picture for the Veteran’s left knee arthritis does not warrant a disability rating in excess of 10 percent for the period on appeal. A review of range of motion testing performed during the relevant rating period on appeal shows that flexion of the left knee was, at worst, limited to 90 degrees. As such, a rating in excess of 10 percent for limitation of flexion of the left knee is not warranted. Further, VA General Counsel has interpreted that separate ratings may be assigned under Diagnostic Codes 5260 and 5261 for disability of the same joint where there is both compensable limitation of flexion and extension. VAOPGCPREC 9-2004. Here, the evidence includes the October 2016 private medical evaluation by Dr. Bruno, which showed left knee range of motion limited to 10 degrees in extension and limited to 90 degrees in flexion. However, to warrant separate ratings for limitation of flexion and extension, both must be limited to a compensable degree. In other words, the evidence must show compensable limitation of motion of extension (10 degrees) and limitation of motion of flexion (45 degrees). See id. As the evidence of record does not show that limitation of flexion is limited to a compensable degree, a separate compensable rating for limitation of extension (Diagnostic Code 5261) is not warranted in this case. The Board also considered whether higher ratings are warranted based on additional functional loss due to pain, weakness, excess fatigability, or incoordination, to include with repeated use during flare-ups. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, at 204-7. The Board finds that the Veteran’s pain, limitation of motion, and claimed “giving out” are adequately contemplated by the currently assigned ratings under Diagnostic Codes 5257 and 5003. In considering the applicability of other diagnostic codes, the Board finds that Diagnostic Codes 5256 (ankylosis of the knee), 5259 (symptomatic removal of semilunar cartilage), 5262 (tibia and fibula impairment), and 5263 (genu recurvatum) are not applicable in this instance, as the medical evidence does not show that the Veteran has any of those conditions. 38 C.F.R. § 4.71a, Diagnostic Codes 5256, 5259, 5263 (2017). For these reasons, the Board finds that, for the rating period on appeal, a rating in excess of 20 percent for left knee instability is denied. A rating in excess of 10 percent for left knee arthritis with limitation of flexion is denied. The Board is remanded the issue of whether a separate rating for a meniscus condition under Diagnostic Code 5258 is warranted. REASONS FOR REMAND Neurological Disorder The Veteran seeks service connection for peripheral neuropathy of the right lower extremity. As discussed above, the Veteran has now been awarded service connection for a lumbar spine disorder. VA treatment records in February 2010 show a diagnosis of polyneuropathy. The record also indicated that similar findings could be seen in patients with lumbar polyradiculopathy. The Board finds that the Veteran should be afforded a VA examination to assist in determining whether he has a neurological disorder that is related to his now service-connected lumbar spine disability and, if so, to assist in determining the severity of any such neurological disability. Right Ankle and Right Foot The Veteran maintains that his right ankle and foot disorders are related to service or, alternatively, to a service-connected disability. The Veteran has been diagnosed with degenerative joint disease of the right ankle, claw foot deformity of the right foot, and hammertoes of the right foot. The evidence includes a February 2016 statement from Dr. White. During the evaluation, the Veteran reported that he sustained a serious injury in service to both the left knee and right foot. The right foot condition was noted to have worsened over the years. Dr. White opined that the Veteran’s condition was directly related to the in-service injury. The Board finds this opinion lacks probative value as service treatment records do not show a confirmed right foot injury. Moreover, Dr. White did not provide a rationale in support of the opinion. The Board notes that the Veteran is service connected for left knee disabilities and for a lumbar spine disability. Moreover, he has been found to have a 1-inch left leg length discrepancy. A medical opinion has not been obtained regarding the etiology of the Veteran’s right ankle disorder, to include whether it is caused or aggravated by a service-connected disability. The Veteran’s right foot disorders have been related to the Veteran’s right foot arthritis. See July 2013 VA foot examination report. As such, the right foot disability is intertwined with the claim for service connection for a right ankle disorder. For these reasons, a remand is warranted. Left Knee Meniscus Condition The Veteran has already been assigned ratings of 20 percent (instability) and 10 percent (arthritis with limitation of motion) for his service-connected left knee disability. In this decision, the Board has denied higher ratings for these disabilities. Nonetheless, the Board finds that a remand is necessary regarding the issue of entitlement to a separate rating for a left knee meniscal condition. In this regard, Diagnostic Code 5258 provides a 20 percent rating may be assigned for dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. The evidence includes a February 2016 statement from Dr. White. It was noted that radiographs taken in February 2016 showed severe joint degeneration and a complete absence of the medial cartilage. However, the remaining evidence of record, to include VA examination reports, does not show that the Veteran has a meniscus condition. Thus, on remand, clarification is needed as to whether the Veteran has dislocated semilunar cartilage with frequent episodes of “locking,” pain, and effusion into the joint. TDIU The claims being remanded could potentially have an impact regarding the TDIU issue; therefore, the issue of a TDIU is inextricably intertwined with the issues being remanded and adjudication of TDIU must be deferred pending the proposed development. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA neurological examination to determine if he has radiculopathy of any extremity related to the now service-connected lumbar spine disability and, if so, to determine the current level of severity of the disability. The claims file should be made available to and reviewed by the examiner. 3. Schedule the Veteran for a VA ankle examination. The electronic claims file must be made available to the individual designated to provide the opinion. The examiner is then asked to address the following: (a.) List all current diagnoses pertaining to the Veteran’s right ankle. (b.) For each diagnosis state whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right ankle disorder was incurred in service or is otherwise related to service. (c.) If unrelated to service, state whether the Veteran’s right ankle disorder it is at least as likely as not (50 percent or greater probability) either caused or aggravated by a service-connected disability, including the left knee or lumbar spine disabilities. (d.) A rationale for all requested opinions shall be provided. 4. Schedule the Veteran for an examination of his left knee. The claims file must be made available to and thoroughly reviewed by the examiner in connection with the examination, and the examiner must indicate that the claims file has been reviewed in association with the examination. The examiner should address the following: (a.) Indicate whether there is a dislocated semilunar cartilage in the left knee, and, if so, describe all related symptoms, to include frequent episodes of “locking,” pain, and effusion into the joint. (b.) In making this determination, the examiner is asked to discuss the February 2016 statement from Dr. White where it was noted that radiographs taken in February 2016 showed a complete absence of the medial cartilage. (c.) A rationale for all requested opinions shall be provided. 5. Thereafter, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel