Citation Nr: 18151927 Decision Date: 11/20/18 Archive Date: 11/20/18 DOCKET NO. 15-15 539 DATE: November 20, 2018 REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic disorder (PTSD) is remanded. Entitlement to an increased rating in excess of 20 percent for stress reaction of the right lower extremity with knee impairment is remanded. Entitlement to an increased rating in excess of 20 percent for stress reaction of the left lower extremity with knee impairment is remanded. REASONS FOR REMAND The Veteran served on active duty from October 2001 to May 2002. This matter comes before the Board of Veterans’ Appeals (Board) from a June 2013 rating decision. In February 2018, the Veteran and her mother testified before the undersigned in a Board hearing. In an August 2018 rating decision, the Regional Office (RO) granted an increase in the evaluations assigned the Veteran’s lower extremity disabilities and recharacterized the disabilities as two separate issues (stress reaction of the left lower extremity with knee impairment and stress reaction of the right lower extremity with knee impairment); separate 20 percent ratings were assigned for each lower extremity disability, effective May 31, 2011. Though the Veteran was granted an increased disability rating for these two disabilities, the issue is still before the Board. See AB v. Brown, 6 Vet. App. 35, 38 (1993) (where a claimant has filed a notice of disagreement as to a regional office (RO) decision assigning a particular rating, a subsequent RO decision assigning a higher rating, but less than the maximum available benefit, does not abrogate the pending appeal). 1. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD is remanded. The Veteran contends that her psychiatric disorder is related to a military sexual trauma (MST). The Veteran was afforded a VA PTSD examination in July 2018. The examiner diagnosed PTSD, opioid use disorder and borderline personality disorder. The examiner opined that the Veteran’s PTSD was less likely as not related to the Veteran’s military service, and attributed the Veteran’s PTSD to severe childhood trauma as there was no marker evidence to support a diagnosis of PTSD that is related to the claimed service-related MST. The examiner found further that there was no psychiatric disorder manifest in service; that there was no information to support that the other psychiatric diagnoses (opioid use disorder and personality disorder) are causally or etiologically related to service. Finally, the examiner stated that there is no information or evidence of superimposed psychiatric disorder in service that resulted in a current diagnosis that is at least as likely as not related to service. Subsequently, in September 2018, the Veteran stated that she had more information related to her service connection claim. Specifically, she stated that she had police reports, photos, and childhood documentation that would correct the record and change the “lies”. The Veteran stated she needed more time to obtain evidence. The Board finds that the Veteran should be provided the opportunity to provide evidence concerning her MST. Therefore, upon remand, the Veteran must be given an opportunity to submit further evidence. If further evidence is submitted concerning her MST, then VA must provide an addendum medical opinion to determine whether the new evidence indicates an in-service MST that is related to the Veteran’s diagnosed PTSD. 2. Stress reactions to the left and right tibias and the left and right knees The Veteran contends that her disability rating for her bilateral tibia and knee stress reactions should be higher. The Veteran underwent a VA knee and lower leg conditions examination in July 2018. The United States Court of Appeals for Veterans Claims (Court) has held that “to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of” 38 C.F.R. § 4.59. See Correia v. McDonald, 28 Vet. App. 158 (2016). The referenced portion of 38 C.F.R. § 4.59 states that “[t]he joints involved should be tested 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 July 2018 VA knee and lower leg examination did not comply with Correia as it the examiner did not test for pain on both active and passive motion. Further, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups, and failed to “estimate the functional loss that would occur during flares.” Id. A remand is required so that the Veteran may be afforded a new VA examination that contains adequate information pursuant to Correia and Sharp. The matters are REMANDED for the following action: 1. Provide the Veteran an opportunity to submit further evidence to support her claim including that evidence referenced in her September 2018 statement concerning her claimed MST. 2. If the Veteran provides additional relevant evidence concerning her claimed MST, then obtain an addendum medical opinion from an appropriate clinician. The examiner must opine as to the following: (a.) Whether the record, to include any new evidence submitted by the Veteran, demonstrates markers/behavior changes that support the Veteran’s contention of MST as a stressor for PTSD. Examples of behavior changes that may constitute credible evidence of the stressor include, but are not limited to: a request for a transfer to another military duty assignment; deterioration in work performance; substance abuse; episodes of depression, panic attacks, or anxiety without an identifiable cause; or unexplained economic or social behavior changes. (b.) If there are credible makers/behavior changes that supports the Veteran’s contention of MST, then whether it is at least as likely as ot that the Veteran’s PTSD was caused or aggravated by any in-service MST 3. Schedule the Veteran for an examination of the current severity of her bilateral stress reactions in the lower extremities with bilateral knee impairment. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the bilateral lower extremity disabilities alone and discuss the effect of these disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Robert Batten, Associate Counsel