Citation Nr: 18151163 Decision Date: 11/20/18 Archive Date: 11/16/18 DOCKET NO. 16-49 749 DATE: November 20, 2018 REMANDED Entitlement to service connection for a right foot disability, to include as secondary to service-connected right knee and right ankle disabilities and associated service-connected scars, is remanded. Entitlement to an initial compensable for right knee limitation of extension with degenerative joint disease and chondromalacia patella is remanded. Entitlement to an initial rating higher than 10 percent for right knee limitation of flexion with pain and arthritis is remanded. Entitlement to an initial compensable rating for status-post residual scar of the right knee is remanded. Entitlement to an initial rating higher than 10 percent for lumbar spine disability with intervertebral disc syndrome (IVDS) is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1985 to December 1988; November 2002 to November 2003; November 2004 to November 2006; and, December 2010 to December 2011. The Board finds that a remand is necessary to provide the Veteran with a VA examination for his right foot claim and updated VA examinations for his increased rating claims on appeal. Right Knee (flexion, extension, and scar) and Lumbar Spine Disabilities The Veteran underwent a VA compensation examination in September 2016 to assess the severity of the Veteran’s right knee and lumbar spine disabilities. In his October 2016 substantive appeal, the Veteran indicated that these disabilities have worsened since his last VA examination. The Board thus finds that a new examination is necessary to determine the current severity of the Veteran’s right knee and back disabilities, given his reports of worsening. See Snuffer v. Gober, 10 Vet. App. 400 (1997). Right Foot The RO denied the Veteran’s right foot claim based on a finding of no current diagnosis. Specifically, it was noted that although he had had a right foot drop (peroneal nerve palsy) secondary to right knee injury, it had resolved following corrective surgery. The Veteran appears to assert that his claimed right foot disability is a neurologic and/or dermatologic issue. The Veteran is already service connected for one right knee surgical scar and two scars on the right lower extremity associated with the service-connected right ankle condition. However, the record shows a diagnosis of a depressed keloid on the right foot and it is unclear whether this scar has already been considered. Given the medical and lay evidence of record, a VA examination is necessary to determine whether the Veteran has a right foot disability aside from those already service connected. He has yet to be afforded a VA examination specifically for his right foot claim. Lastly, the Board notes that VA treatment records associated with the claims file subsequent after the September 2016 statement of the case have not yet been considered by the RO in a supplemental statement of the case. The matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file. 2. Then, provide the Veteran with a VA examination to determine the nature and etiology of any currently diagnosed right foot disability (dermatological, neurological, and orthopedic). The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. After a review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Identify all currently diagnosed right foot disabilities, to include a depressed keloid on the right foot. In doing so, elicit from the Veteran all of his right foot symptoms. (b) Then, clearly indicate what, if any, right foot disability has been present since the date of claim, aside from the already service-connected right knee and right ankle disabilities, and their resultant scars. Even if previously diagnosed right foot disabilities are NOT currently shown on examination, the examiner MUST still address the prior diagnoses and explain why they have resolved or no longer result in pathology. (c) For each right foot disability diagnosed since the date of claim that is not already service-connected, provide an opinion as to: i. Whether it at least as likely as not had its onset during active duty service or is otherwise related to it. ii. Whether it was caused or aggravated by his service-connected right knee and/or right ankle disabilities and their resultant service connected scars. The examiner should provide a complete rationale for all opinions on both causation and aggravation. 3. Provide the Veteran with a VA examination to determine the current severity of his right knee disability and associated surgical scar. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. (a) All indicated studies and tests, including range of motion, should be performed. (b) Elicit from the Veteran all signs and symptoms of his right knee disability, including information from the Veteran (and the treatment records) as to the frequency, duration, characteristics, severity, or functional loss with any repetitive use or during any flare-ups. (c) For the right knee scar: (i) Provide measurements including scar length and width at its widest part; (ii) Indicate whether any associated scar causes loss of function; (iii) Indicate whether any associated scar is superficial, deep, nonlinear, unstable, or painful; (iv) Elicit from the Veteran all symptoms he attributes to his right knee scar. The examiner should provide a complete rationale for all opinions. 4. Then, provide the Veteran with a VA examination to determine the current level of severity of his lumbar spine disability. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. (a) All indicated studies and tests, including range of motion, should be performed, and (b) Elicit from the Veteran all signs and symptoms of his lumbar spine disability, including information from the Veteran (and the treatment records) as to the frequency, duration, characteristics, severity, or functional loss with any repetitive use or during any flare-ups. The examiner should provide a complete rationale for all opinions. (Continued on the next page)   5. Then, readjudicate the claims on appeal. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Yaffe, Achiya