Citation Nr: 18152191 Decision Date: 11/21/18 Archive Date: 11/21/18 DOCKET NO. 05-21 290 DATE: November 21, 2018 ORDER Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service connected disability is denied. Entitlement to service connection for gout, to include as secondary to service connected disability is denied. Entitlement to an initial disability rating in 20 percent, but no greater, for lumbar sprain and degenerative disc disease prior to November 9, 2011 is granted. A disability rating of 60 percent, but no greater, for lumbar sprain and degenerative disc disease on and after November 9, 2011, is granted. REMANDED Entitlement to an initial disability rating in excess of 10 percent for instability of the right knee, associated with right knee residuals of arthroscopy, status post incision and drainage of abscess with septic arthritis, small effusion, ganglion cyst, degenerative joint disease is remanded. Entitlement to an initial disability rating in excess of 10 percent for limitation of flexion of the right knee is remanded. FINDINGS OF FACT 1. The probative evidence of record demonstrates that the Veteran’s peripheral neuropathy of the bilateral lower extremities did not originate in service or for many years thereafter, is not related to any incident during active service and is not caused or aggravated by his service-connected disabilities. 2. The probative evidence of record demonstrates that the Veteran’s gout did not originate in service or for many years thereafter, is not related to any incident during active service and is not caused or aggravated by his service-connected disabilities. 3. For the period prior to November 9, 2011, the Veteran’s service-connected lumbar strain and degenerative disc disease was shown to be generally productive of limitation of forward flexion of the thoracolumbar spine to greater than 30 degrees, but no greater than 60 degrees; of combined range of motion of the thoracolumbar spine to no greater than 120 degrees; muscle spasms or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis, but was not shown to result in forward flexion of the thoracolumbar spine was limited to 30 degrees or less, favorable ankylosis of the entire thoracolumbar spine, or incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months. 4. For the period on and after November 9, 2011, the Veteran’s service-connected lumbar strain and degenerative disc disease resulted in incapacitating episodes having a total duration of at least 6 weeks during the past 12 months, but was not shown to result in unfavorable ankylosis of the entire spine. CONCLUSIONS OF LAW 1. The criteria for service connection for peripheral neuropathy of the bilateral lower extremities have not been met. 38 U.S.C. §§ 1110, 1116, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 2. The criteria for service connection for gout have not been met. 38 U.S.C. §§ 1110, 1116, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2017). 3. For the period prior to November 9, 2011, the criteria for the assignment of a rating of 20 percent disability rating, but no greater, for the Veteran’s service-connected lumbar strain and degenerative disc disease have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5234, 5243 (2017). 4. For the period on and after November 9, 2011, the criteria for the assignment of a rating of 60 percent disability rating, but no greater, for the Veteran’s service-connected lumbar strain and degenerative disc disease have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107 (West 2016); 38 C.F.R. §§ 3.102, 3.159, 3.321, 3.326, 4.1, 4.2, 4.3, 4.7, 4.10, 4.40, 4.45, 4.59, 4.71a, Diagnostic Code 5234, 5243 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303 (a). Service connection may also be granted for any disease diagnosed after discharge when all of the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Certain chronic diseases, to include neuropathy (other organic diseases of the nervous system), although not shown in service, may be presumed to have incurred in or aggravated by service if they become manifested to a compensable degree within one year of separation from active duty. 38 U.S.C. §§ 1101, 1112, 1113; 38 C.F.R. §§ 3.307, 3.309. To prevail on the issue of service connection, there must be (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 current disability. See Hickson v. West, 12 Vet. App. 247, 253 (1999). A disability can be service connected on a secondary basis if it is proximately due to or the result of a service-connected condition. 38 C.F.R. § 3.310 (a). Moreover, secondary service connection may be established, as well, by any increase in severity (i.e., aggravation) of a nonservice-connected condition that is proximately due to or the result of a service-connected condition. See 38 C.F.R. § 3.310 (b), effective October 10, 2006. See 71 Fed. Reg. 52,744 -52,747 (September 7, 2006); see also Allen v. Brown, 7 Vet. App. 439, 448 (1995). Where a service-connected disability aggravates a nonservice-connected condition, a Veteran may be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. Allen, 7 Vet. App. at 448. In short, in order to establish entitlement to service connection on this secondary basis, there must be (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) probative evidence establishing a nexus (i.e., link) between the service-connected disability and the current disability. Wallin v. West, 11 Vet. App. 509, 512 (1998). The determination of whether the requirements of service connection have been met is based on an analysis of all the evidence of record and the evaluation of its credibility and probative value. See Baldwin v. West, 13 Vet. App. 1, 8 (1999). In making these determinations, the Board must consider and assess the credibility and weight of all evidence in the claim file, including the medical and lay evidence, to determine its probative value. In doing so, the Board must provide its reasoning for rejecting any evidence favorable to the claimant. See Masors v. Derwinski, 2 Vet. App. 181 (1992); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992); Barr v. Nicholson, 21 Vet. App. 303 (2007). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each issue shall be given to the claimant. See 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. A claimant need only demonstrate an approximate balance of positive and negative evidence in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). For a claim to be denied on the merits, a preponderance of the evidence must be against the claim. See Alemany v. Brown, 9 Vet. App. 518, 519 (1996). 1. Entitlement to service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service connected conditions The Veteran is seeking service connection for peripheral neuropathy of the bilateral lower extremities. The Veteran’s service treatment records (STR) are silent for any complaints or symptoms relating to peripheral neuropathy of the bilateral lower extremities. The Board further finds that the Veteran’s bilateral peripheral neuropathy did not manifest within one year of separation from service and his symptoms of peripheral neuropathy were not continuous since service separation. The Board further finds that the Veteran’s currently-diagnosed bilateral peripheral neuropathy is not secondary to his service connected disabilities. During an August 2005 lumbar spine MRI report, the VA physician noted that the Veteran had decreased pinprick sensation in both lower extremities in a nondermatomal distribution. The examiner further noted that the Veteran was without neurological deficits or radicular signs. In February 2006, the Veteran described a sharp stabbing pain that radiated to his bilateral gluteus with tingling sensation. During a November 2011 VA spine examination, the Veteran described radiating pain below the knee, but the examiner did not find any radiculopathy or neurological abnormalities. In October 2017 the Veteran underwent a VA peripheral nerve examination. Upon a review of the Veteran’s claims file and an in-person examination, the Veteran was diagnosed with mixed predominantly demyelinating sensorimotor peripheral neuropathy at the upper and lower extremities and mild bilateral focal entrapment of the median nerve at the wrist level. Based upon the in-person examination and a review of the claims file, the examiner determined that the Veteran’s claimed bilateral peripheral neuropathy of the lower extremities were less likely than not (less than 50 percent probability) proximately due to or the result of the Veteran’s service connected conditions. He reasoned that he had reviewed the conflicting medical evidence and there is no evidence of peripheral neuropathy onset during service or of a disease during service that could be the etiology of the peripheral neuropathy at lower extremities. The examiner further determined that it was less likely than not that the Veteran’s peripheral neuropathy of the lower extremities was aggravated by a service connected disability, to include the low back disability as well as right and left knee disabilities. He reasoned that there was no evidence of aggravation found at physical examination or documental data at STR of the current peripheral neuropathy by a service-connected disability, to include the low back disability as well as right and left knee disabilities. The Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for peripheral neuropathy of the bilateral lower extremities, to include as secondary to service-connected conditions and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In reaching this conclusion the Board has considered the various statements submitted by the Veteran in support of his claim. The Veteran, while competent to report his symptoms, is not competent to render a medical opinion linking his diagnosed peripheral neuropathy to a service connected disability as this requires specialized knowledge and training. The accuracy of the Veteran’s reports of symptoms is better assessed by a medical professional, here the VA examiner. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the Board has placed greater weight on the opinions reached by the VA examiner who, as a trained health care profession, is competent to render opinions regarding medical nexus. 2. Entitlement to service connection for gout, to include as secondary to service connected conditions The Veteran is seeking service connection for peripheral neuropathy of the bilateral lower extremities. The Veteran’s STR are silent for a diagnosis of gout. His STRs do show treatment for knee swelling and pain, however, these symptoms are related to his service connected right knee conditions. A December 2007 VA treatment record is the earliest mention of gout of record. In September 2008 the Veteran sought treatment for a gouty attack in his ankle the day after left knee surgery. In October 2007 the Veteran was afforded a VA non-degenerative arthritis and dysbaric osteonecrosis examination. The Veteran’s gout diagnosis was confirmed. Following an in-person examination and a review of the Veteran’s claims file, the examiner determined that the Veteran’s gout was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event or illness. He reasoned that the record does not show evidence of gouty arthritis in service and did not have its onset until after service. The examiner also concluded that the Veteran’s gout was less likely than not (less than 50% probability) proximately due to or the result of the Veteran’s service connected condition. He reasoned that right knee degenerative joint disease does not cause gouty arthritis, because gouty arthritis is a metabolic condition related to uric acid metabolism. He was unable to determine a baseline level of severity of the Veteran’s gout based upon medical evidence available prior to aggravation or the earliest medical evidence following aggravation, because there was no pathophysiologic relation between gout and his service connected conditions. Based upon this rationale, he also determined that the Veteran’s gout was not at least as likely as not aggravated beyond its natural progression by his service connected conditions. The Board finds that the preponderance of the evidence is against the Veteran’s claim for service connection for gout, to include as secondary to service-connected conditions and the claim must be denied. Because the preponderance of the evidence is against the claim, the benefit of the doubt doctrine does not apply. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. In reaching this conclusion the Board has considered the various statements submitted by the Veteran in support of his claim. The Veteran, while competent to report his symptoms, is not competent to render a medical opinion linking his diagnosed gout to a service connected disability as this requires specialized knowledge and training. The accuracy of the Veteran’s reports of symptoms is better assessed by a medical professional, here the VA examiner. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). Accordingly, the Board has placed greater weight on the opinions reached by the VA examiner who, as a trained health care profession, is competent to render opinions regarding medical nexus. Increased Rating Disability evaluations (ratings) are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155 (West 2014); 38 C.F.R. §§ 4.1, 4.2, 4.10 (2017). In evaluating a disability, the Board considers the current examination reports in light of the whole recorded history to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). The medical as well as industrial history is to be considered, and a full description of the effects of the disability upon ordinary activity is also required. 38 C.F.R. §§ 4.1, 4.2, 4.10 (2017). 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. See 38 C.F.R. § 4.7 (2016). Reasonable doubt regarding the degree of disability will be resolved in the Veteran’s favor. 38 C.F.R. § 4.3 (2016). Separate ratings can be assigned for separate periods of time based on facts found, a practice known as “staged” ratings. Hart v. Mansfield, 21 Vet. App. 505 (2007). When all the evidence is assembled, VA is responsible for determining whether the evidence supports the claim or is in relative equipoise, with a 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) (West 2014); 38 C.F.R. § 3.102 (2017). 3. Entitlement to an initial disability rating in excess of 10 percent for lumbar sprain and degenerative disc disease prior to November 9, 2011, and a disability rating in excess of 40 percent on and after November 9, 2011 The Veteran was granted service connection for lumbar sprain and degenerative disc disease in a January 2017 rating decision. He was awarded a 10 percent disability rating, effective June 29, 2005 and a 40 percent disability rating, effective November 9, 2011. In his May 2018 VA Form 9, the Veteran requested an initial disability rating in excess of 10 percent and an earlier effective date for his 40 percent disability rating. Both of these claims are effectively a single request for entitlement to an initial disability rating in excess of 10 percent for lumbar sprain and degenerative disc disease prior to November 9, 2011, and a disability rating in excess of 40 percent on and after November 9, 2011, and the issue has accordingly recharacterized as entitlement to higher staged ratings for his service-connected low back disability. Disabilities of the spine are rated under either the General Formula for Diseases and Injuries of the Spine (General Formula) or the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes, whichever method results in the higher rating. Under the General Rating Formula, a thoracolumbar spine injury is rated as follows: a 10 percent disability rating is warranted for forward flexion of the thoracolumbar spine greater than 60 degrees but not greater than 85 degrees; or, combined range of motion of the thoracolumbar spine greater than 120 degrees but not greater than 235 degrees; or, muscle spasm, guarding, or localized tenderness not resulting in abnormal gait or abnormal spinal contour; or vertebral body fracture with loss of 50 percent or more of the height. A 20 percent disability rating is warranted for forward flexion of the thoracolumbar spine greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. A 40 percent disability rating is assigned for forward flexion of the thoracolumbar spine 30 degrees or less; or, favorable ankylosis of the entire thoracolumbar spine. A 50 percent disability rating is assigned for unfavorable ankylosis of the entire thoracolumbar spine; and a 100 percent disability rating is assigned for unfavorable ankylosis of entire spine. 38 C.F.R. § 4.71a. The rating criteria further explain, under Note (1), that any associated objective neurological abnormalities, including, but not limited to, bowel or bladder impairment, are to be evaluated separately under an appropriate diagnostic code. Under 38 C.F.R. § 4.71a, Diagnostic Code 5243 (2015), an intervertebral disc syndrome may be rated under either the General Formula or under the Formula for Rating Intervertebral Disc Syndrome Based on Incapacitating Episodes. Under the Formula for Rating Intervertebral Disc Syndrome, incapacitating episodes having a total duration of least 2 weeks but less than 4 weeks during the past 12 months warrant a rating of 20 percent. Incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months warrant a 40 percent rating. Incapacitating episodes having a total duration of at least 6 weeks during the past 12 months warrant a 60 percent rating. The record contains an August 2005 VA spine examination which diagnosed the Veteran with lumbar sprain and degenerative disc disease. The Veteran stated that the pain was localized in his lower back without radiating to the extremities. Duration of the pain was constant and severe. At the time of the examination the Veteran said the pain was 10/10. The Veteran was treating his low back symptoms with hot pads. The Veteran did not report any flare-ups because he reported his pain was constant and severe. There was no weight loss, no fever, no numbness, no bladder or bowel complaints. He also did not use any assistive devices. Functional limitations included an inability to drive due to low back and knee pain. Upon inspection, the examiner found loss of lumbar lordosis and an antalgic gait. Range of motion testing showed forward flexion of 0 to 90 degrees, extension of 0 to 30 degrees, left lateral flexion of 0 to 30 degrees, left lateral rotation of 0 to 45 degrees and right lateral rotation of 0 to 45 degrees. Pain was reported throughout the range of motion of the thoracolumbar spine. The examiner reported that the Veteran had functional loss of forward flexion from 60 to 90 degrees, extension from 0 to 30 degrees, left and right lateral rotation from 30 to 45 degrees due to pain. There was no additional limitation due to weakness, lack of endurance or fatigue. There was objective evidence of spasm and guarding at lower lumbar paravertebral muscles. However, there was no kyphosis or fixed deformity. The VA physician noted that the Veteran had decreased pinprick in both lower extremities in a nondermatomal distribution. The examiner further noted that the Veteran was without neurological deficits or radicular signs. It was also noted that the Veteran had atrophy of the bilateral quadriceps muscles, strength was 4+/5 in both lower extremities proximately and distally due to referred pain to both knees. He had +2, L4 and S1 reflexes bilaterally. The Veteran was negative for Lasegue’s sign. In a February 2006 VA treatment record the Veteran described a slight increase in pain with Valsalva. He denied change in sensation, bowel, bladder problems, erectile dysfunction or saddle anesthesia. Pain was worse in the mornings and by sitting for long periods and trying to stand up. Pain intensity was described as 8-9/10, worst 10/10, at best 6-7/10. In November 2011 the Veteran underwent a second VA back examination. He was diagnosed with intervertebral disc disease. The Veteran reported having flare-ups that caused pain too sharp to get out of bed. Initial range of motion testing showed flexion to 30 degrees with painful motion beginning at 10 degrees, extension to 0 degrees with painful motion at 0 degrees, right lateral flexion to 20 degrees with painful motion at 10 degrees, left lateral flexion to 20 degrees with painful motion at 10 degrees, right lateral flexion to 20 degrees and painful motion at 10 degrees, and left lateral rotation to 20 degrees with painful motion at 10 degrees. Range of motion measurements were the same after repetitive use testing. Functional limitations after repetitive use testing were marked by less movement than normal and pain on movement. The examiner also noted pain to palpation at the lumbar paravertebral muscles. He also had guarding and/or muscle spasm, but they did not result in abnormal gait or spinal contour. Muscle strength testing revealed active movement against some resistance for hip flexion, knee extension, ankle plantar flexion, ankle dorsiflexion and great toe extension. There was no muscle atrophy present. Reflex testing showed normal reflexes in the knee and ankle. Sensory testing revealed decreased sensation to light touch in the upper anterior thigh, thigh/knee, lower leg/ankle and foot/toes. Normal vibration distal lower extremities were found bilaterally. Straight leg raising tests were negative bilaterally and there was no radicular pain present. The examiner further found that the Veteran had intervertebral disc syndrome that resulted in an incapacitating episode lasting at least six weeks in the past 12 months. Based upon the foregoing, the Veteran is entitled to a disability rating of 20 percent, but not greater, prior to November 9, 2011, and is entitled to a 60 percent disability rating effective November 9, 2011, the date of the second VA back examination. As noted above, the Veteran may be entitled to a 20 percent disability rating prior to November 9, 2011 for his lumbar spine disability when forward flexion of the thoracolumbar spine is greater than 30 degrees but not greater than 60 degrees; or combined range of motion of the thoracolumbar spine not greater than 120 degrees; or muscle spasm or guarding severe enough to result in an abnormal gait or abnormal spinal contour such as scoliosis, reversed lordosis, or abnormal kyphosis. Although range of motion testing in August 2005 showed forward flexion of 0 to 90 degrees, examiner reported that the Veteran had functional loss of forward flexion from 60 to 90 degrees due to pain. Furthermore, functional loss of range of motion was a combined 120 degrees due to pain. The examiner also found objective evidence of guarding and an antalgic gait. However, the Veteran is not entitled to the next higher 40 percent disability rating prior to November 9, 2011, because forward flexion of the thoracolumbar spine was not limited to 30 degrees or less; nor is there any evidence that the Veteran ever experienced favorable ankylosis of the entire thoracolumbar spine. Furthermore, there is no evidence of record which shows that the Veteran experienced incapacitating episodes having a total duration of at least 4 weeks but less than 6 weeks during the past 12 months which would warrant a 40 percent disability under DC 5243 prior to November 9, 2011. The Board further finds that the Veteran is entitled to a 60 percent disability rating on and after November 9, 2011, because the November 2011 VA examiner found that the Veteran experienced an incapacitating episode having a total duration of at least 6 weeks during the past 12 months. However, the Veteran is not entitled to a 100 percent disability rating, because there is no evidence that the Veteran ever experienced unfavorable ankylosis or the functional equivalent of unfavorable ankylosis of the entire spine as required by DC 5234. REASONS FOR REMAND 1. Entitlement to an initial disability rating in excess of 10 percent for instability of the right knee, associated with right knee residuals of arthroscopy, status post incision and drainage of abscess with septic arthritis, small effusion, ganglion cyst, degenerative joint disease 2. Entitlement to an initial disability rating in excess of 10 percent for limitation of flexion of the right knee The Board recognizes that the Veteran’s right knee claims have previously been remanded; however, while the Board sincerely regrets the additional delay, the Veteran’s claim must again be remanded in order to ensure that the VA has adequately assisted the Veteran in the development of his claims. In the Board’s May 2017 decision which remanded the Veteran’s right knee claims, the Board instructed the RO to schedule the Veteran for a right knee examination. The examiner was instructed to conduct the examination “in accordance with the current disability benefits questionnaire, to include testing for pain on both active and passive motion, and in weight bearing and nonweight-bearing, consistent with 38 C.F.R. § 4.59 as interpreted in Correia v. McDonald, 28 Vet. App. 158 (2016).” See May 2017 Board Decision. Unfortunately, a review of the subsequent VA examination in October 2017 reveals that the examiner did not include testing for pain on both active and passive motion, and in nonweight-bearing, consistent with 38 C.F.R. § 4.59 as interpreted in Correia v. McDonald, 28 Vet. App. 158 (2016). On remand, the examination should include consideration of the ruling in Correia with range of motion testing for both knees in passive motion, weight-bearing, and nonweight-bearing situations. If such testing cannot be performed, the examiner must explain why such testing could not be performed. As such, the Board finds an additional remand is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998); See also Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when the VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). The matter is REMANDED for the following action: 1. Contact the Veteran, and, with his assistance, identify any outstanding records of pertinent medical treatment from VA or private health care providers. Follow the procedures for obtaining the records as set forth in 38 C.F.R. § 3.159 (c), and obtain new VA Form 21-4142 releases if necessary. If VA attempts to obtain any outstanding records that are unavailable, the Veteran and his representative should be notified in accordance with 38 C.F.R. § 3.159 (e). 2. The AOJ should secure the appropriate VA knee examination to ascertain the current severity and manifestations of the Veteran’s service-connected right knee disabilities. Access to the VBMS and Virtual VA electronic claims files must be made available to the examiner for review. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examination should include a statement as the effect of the Veteran’s service-connected disabilities on the Veteran’s occupational functioning and daily activities. The VA examiner should provide a complete rationale for any opinions provided. In particular, in order to comply with the Court’s recent precedential decision in Correia v. McDonald, No. 13-3238 (Vet. App. July 5, 2016), the VA knee examinations must include range of motion testing for both knees in the following areas: * Active motion; * Passive motion; * Weight-bearing; and * Nonweight-bearing. If the VA examiner is unable to conduct all the required testing or concludes that certain aspects of the required   testing are not necessary or are not relevant for the knees, he or she should clearly explain why that is so. DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Nelson, Associate Counsel