Citation Nr: 18152861 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 14-40 257A DATE: November 27, 2018 ORDER The application to reopen the claim of entitlement to service connection for a left ankle disability is granted. The application to reopen the claim of entitlement to service connection for a right ankle disability is granted. The application to reopen the claim of entitlement to service connection for radiculopathy of the bilateral lower extremities is granted. The application to reopen the claim of entitlement to service connection for an adjustment disorder with depressed mood is granted. Entitlement to service connection for an artery disability is denied. Restoration of a 40 percent disability rating for meniscectomy, right knee with post traumatic changes is granted. Restoration of a 20 percent disability rating for limitation of flexion of the right knee is granted. REMANDED Entitlement to service connection for a left ankle disability is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to service connection for erectile dysfunction is remanded. Entitlement to service connection for radiculopathy of the bilateral lower extremities is remanded. Entitlement to service connection for an acquired psychiatric disorder, to include PTSD is remanded. Entitlement to a disability rating in excess of 20 percent for a lumbar spine strain is remanded. Entitlement to a compensable disability for impairment of the thigh, right hip is remanded. Entitlement to a disability rating in excess of 10 percent for a left knee medial meniscus tear is remanded. Entitlement to a disability rating in excess of 20 percent for limited flexion of the right knee is remanded. Entitlement to a disability rating in excess of 40 percent for a meniscectomy, right knee with posttraumatic degenerative changes is remanded. Entitlement to a total disability rating based upon individual unemployability is remanded. FINDINGS OF FACT 1. The Veteran’s application to reopen a claim for service connection for a left ankle disability was denied by a May 2010 rating decision. The Veteran did not perfect an appeal of this decision, and it became final. 2. The Veteran’s application to reopen a claim for service connection for a right ankle disability was denied by a May 2010 rating decision. The Veteran did not perfect an appeal of this decision, and it became final. 3. Since the May 2010 rating decision, the Veteran has submitted new evidence that relates to previously unestablished elements of claims for service connection for left and right ankle disabilities and raises a reasonable possibility of substantiating these claims. 4. Service connection for radiculopathy of the bilateral lower extremities was denied by a December 2012 rating decision. The Veteran did not perfect an appeal of this decision, and it became final. 5. Since the December 2012 rating decision, the Veteran has submitted new evidence that relates to a previously unestablished element of the claim for service connection for radiculopathy of the bilateral lower extremities and raises a reasonable possibility of substantiating the claim. 6. Service connection for an adjustment disorder with depressed mood was denied by an April 2009 rating decision. The Veteran did not perfect an appeal of this decision, and it became final. 7. Since the April 2009 rating decision, the Veteran has submitted new evidence that relates to a previously unestablished element of the claim for service connection for an adjustment disorder with depressed mood and raises a reasonable possibility of substantiating the claim. 8. The Veteran’s arteriosclerosis was not incurred during, and is not otherwise related to, the Veteran’s period of active service. 9. Symptoms of the Veteran’s arteriosclerosis have not been continuous since separation from service, and the disability did not manifest to a compensable degree in the year following separation from service. 10. In December 2012, the RO reduced the Veteran’s evaluation for service-connected meniscectomy, right knee with post traumatic changes from 40 percent to 10 percent, effective March 1, 2013. 11. In December 2012, the RO reduced the Veteran’s evaluation for service-connected limitation of flexion of the right knee from 20 percent to 0 percent, effective March 1, 2013. 12. Improvement of the Veteran’s meniscectomy, right knee and limitation of flexion right knee have not been shown. CONCLUSIONS OF LAW 1. The May 2010 rating decision that denied the Veteran’s application to reopen his claim for service connection for a left ankle disability is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 2. The evidence received since the May 2010 rating decision is new and material, and the claim for service connection for a left ankle disability is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 3. The May 2010 rating decision that denied the Veteran’s application to reopen his claim for service connection for a right ankle disability is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 4. The evidence received since the May 2010 rating decision is new and material, and the claim for service connection for a right ankle disability is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 5. The December 2012 rating decision that denied the Veteran’s claim for service connection for radiculopathy of the bilateral lower extremities is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 6. The evidence received since the December 2012 rating decision is new and material, and the claim for service connection for radiculopathy of the bilateral lower extremities is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 7. The April 2009 rating decision that denied the Veteran’s claim for service connection for an adjustment disorder with depressed mood is final. 38 U.S.C. § 7105 (2012); 38 C.F.R. § 20.1103 (2017). 8. The evidence received since the April 2009 rating decision is new and material, and the claim for service connection for an adjustment disorder with depressed mood is reopened. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (a) (2017). 9. The criteria for service connection for an artery disability, diagnosed as arteriosclerosis, have not been met. 38 U.S.C. §§ 1101, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.307, 3.309 (2017). 10. Restoration of a 40 percent disability rating for meniscectomy, right knee with post traumatic changes, effective March 1, 2013 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.344, 4.3, 4.7, 4.71a, Diagnostic Code 5621 (2017). 11. Restoration of a 20 percent disability rating for limitation of flexion of the right knee, effective March 1, 2013 is warranted. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 3.344, 4.3, 4.7, 4.71a, Diagnostic Code 5260 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 1978 to January 1979 and from July 1980 to September 1982. New and Material Evidence, Generally While the Veteran’s appeals for entitlement to service connection for radiculopathy of the bilateral lower extremities and service connection for an adjustment disorder with depressed mood have come to the Board after the AOJ reopened these claims, the Board must still consider whether new and material evidence was received sufficient to reopen the claim in order to establish the Board’s jurisdiction to reach the underlying claims and adjudicate them on a de novo basis. See Jackson v. Principi, 265 F.3d 1366, 1369 (Fed. Cir. 2001). Generally, a claim that has been denied by an unappealed RO decision or an unappealed Board decision may not thereafter be reopened. 38 U.S.C. §§ 7104(b), 7105(c). An exception to this rule exists for cases in which new and material evidence is presented or secured with respect to a claim that has been disallowed, in which case the claim must be reopened and the former disposition reviewed. 38 U.S.C. § 5108. “New” evidence means evidence not previously submitted to agency decision makers, and “material” evidence means 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 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). This is a “low threshold” in which the phrase “raises a reasonable possibility” should be interpreted as “enabling rather than precluding reopening.” Shade v. Shinseki, 24 Vet. App. 110, 121 (2010). The credibility of the newly-submitted evidence is presumed. See Justus v. Principi, 3 Vet. App. 510 (1992). New and Material Evidence for Right and Left Ankle Disabilities The Veteran was initially denied entitlement to service connection for right and left ankle disabilities in an August 2007 rating decision as the evidence did not support that the Veteran had a current diagnosis of a right or left ankle disability. The August 2007 rating decision was not appealed and became final. 38 C.F.R. § 20.1103. In September 2012, a rating decision found that new and material evidence had not been provided to reopen the Veteran’s claims for service connection for right and left ankle disabilities. The September 2012 rating decision was not appealed and also became final. 38 C.F.R. § 20.1103. Since that rating decision, additional evidence has been associated with the claims file. In July 2012, the Veteran underwent a VA examination regarding his left and right ankles. The Veteran reported that he has frequent twisting of both ankles due to his service-connected right knee disability. The examiner noted that the Veteran walked with an antalgic gait. This evidence is new, as it was not part of the record at the time of the prior denial of these claims. It is also material, as it relates to the previously unestablished element of whether the Veteran’s current left and right bilateral ankle strains are due to his service-connected disability. This evidence is neither cumulative nor redundant, and raises a reasonable possibility of substantiating the Veteran’s claims. As such, new and material evidence has been received, and reopening the Veteran’s claims for service connection for left and right ankle disabilities is warranted. New and Material Evidence for Radiculopathy of the Bilateral Lower Extremities A December 2012 rating decision denied the Veteran’s claim for service connection for radiculopathy of the bilateral lower extremities on the basis that the Veteran’s medical records did not indicate that the Veteran had a current diagnosis of the condition. The December 2012 rating decision was not appealed and became final. 38 C.F.R. § 20.1103. Since that rating decision, additional evidence has been associated with the claims file. The Veteran underwent a June 2016 VA examination that diagnosed the Veteran with bilateral radiculopathy due to a lumbar spine disability. This evidence is new, as it was not part of the record at the time of the prior denial of the claim. It is also material, as it relates to the previously unestablished element of whether the Veteran has a current diagnosis of bilateral lower extremity radiculopathy. When viewed with the previous evidence of record, this evidence indicating that the Veteran has a diagnosis of lower extremity radiculopathy is neither cumulative nor redundant, and raises a reasonable possibility of substantiating the Veteran’s claim. As such, new and material evidence has been received, and reopening the claim is warranted. New and Material Evidence for an Adjustment Disorder The Veteran’s claim for service connection for an adjustment disorder with depressed mood was denied in an April 2009 rating decision as the evidence did not support an etiological relationship between his current disability and his period of active service or was secondary to his service-connected right knee condition. The April 2009 rating decision was not appealed and became final. 38 C.F.R. § 20.1103. Since that rating decision, additional evidence has been associated with the claims file. In a July 2012 examination, the Veteran reported that he was depressed because “he could not walk like he used to.” The Board notes that the Veteran is service-connected for left and right knee disabilities and was noted to have an antalgic gait and walk with a cane in a separate July 2012 VA examination. This evidence is new, as it was not part of the record at the time of the prior denial of the claim. It is also material, as it relates to the previously unestablished element of whether the Veteran’s current depressive disorder was incurred in, or is otherwise due to, his period of service. When viewed with the previous evidence of record, this evidence indicating that the Veteran’s depressive disorder is etiologically related to his service-connected conditions is neither cumulative nor redundant, and raises a reasonable possibility of substantiating the Veteran’s claim. As such, new and material evidence has been received, and reopening the claim is warranted. Service Connection for an Artery Disability Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1131 (2012); 38 C.F.R. §§ 3.303, 3.304 (2017). In order to establish service connection for the claimed disorder, 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, or in certain circumstances, lay evidence of a nexus between the claimed in-service disease or injury and the current disability. See 38 C.F.R. §§ 3.303, 3.304 (2017); see also Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Hickson v. West, 12 Vet. App. 247, 253 (1999); Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009). In addition, certain chronic disabilities are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. While arteriosclerosis is considered to be a “chronic disease,” the evidence does not indicate that such a disability was incurred in service or within one year of separation from service; therefore, the provisions of 38 C.F.R. § 3.303(b) are not applicable. See Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Service connection may also be awarded for any disability which is proximately due to or the result of, or is otherwise aggravated by, a service-connected disease or injury. 38 C.F.R. § 3.310. “When aggravation of a veteran’s non-service-connected condition is proximately due to or the result of a service-connected condition, such veteran shall be compensated for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation.” Allen v. Brown, 7 Vet. App. 439 (1995). The Board must determine the value of all evidence submitted, including lay and medical evidence. Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). The evaluation of evidence generally involves a three-step inquiry. First, the Board must determine whether the evidence comes from a “competent” source. The Board must then determine if the evidence is credible, or worthy of belief. Barr v. Nicholson, 21 Vet. App. 303, 308 (2007). The third step of this inquiry requires the Board to weigh the probative value of the evidence in light of the entire record. A layperson is competent to report on the onset and continuity of current symptomatology based on personal knowledge. See Layno v. Brown, 6 Vet. App. 465, 470 (1994). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if the layperson: (1) is competent to identify the medical condition, (2) is reporting a contemporaneous medical diagnosis, or (3) is describing symptoms that support a later diagnosis by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372, at 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. See Caluza v. Brown, 7 Vet. App. 498 (1995). In determining whether service connection is warranted for a disability, 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 the claim, in which case the claim is denied. 38 U.S.C. § 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination, the benefit of the doubt is afforded the claimant. In March 2013, the Veteran filed a claim for service connection for “hardening of the arteries.” The Veteran reported that he had been told by his physician that he had “hardening of the arteries” and that he would submit medical records supporting this claim. Shortly thereafter, the Veteran submitted records that included a March 2013 treatment record completed by B.S., D.O. indicating that the Veteran has calcifications of the posterior leg indicative of arteriosclerosis or “hardening of the arteries.” While the evidence indicates that the Veteran has a diagnosis of arteriosclerosis, none of the competent evidence of record provides any support for a relationship between the Veteran’s arteriosclerosis and his period of active service, or any of his service-connected disabilities. The Veteran’s service treatment records do not report any complaints related to his arteries and do not report a diagnosis of arteriosclerosis. His September 1982 separation examination also indicated a normal heart and vascular system. No other evidence of a relationship between the Veteran’s condition and his period of service is of record, including his VA and private medical records. Veteran has not even provided lay evidence of a relationship between his arteriosclerosis and either his period of service, or one of his service-connected disabilities. In the Veteran’s February 2014 Notice of Disagreement, the Veteran’s representative indicated that support for this claim would be provided “upon receipt of a medical opinion.” The Veteran has not provided any subsequent argument or evidence to support a claim of service connection on a direct or secondary basis. The Veteran’s May 2016 VA Form 9 listed the issue as one on appeal, but also did not provide additional support for the Veteran’s claim for service connection. As none of the competent evidence of record, even potentially, indicates that the Veteran’s arteriosclerosis or any artery disability either began during, or is otherwise due to, his period of service (or any service-connected disability), the Veteran’s claim for service connection for an artery disability condition must be denied. As the preponderance of the evidence is against the Veteran’s claim, the benefit-of- the-doubt doctrine is not applicable. 38 U.S.C. § 5107 (b) (2012); see also Gilbert, 1 Vet. App. at 55 (1990). Reductions, Generally Disability evaluations 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 his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In Brown v. Brown, 5 Vet. App. 413 (1993), the United States Court of Appeals for Veterans Claims (Court) interpreted the provisions of 38 C.F.R. § 4.13 to require that in any rating reduction case, it must be ascertained, based upon a review of the entire recorded history of the condition, whether the evidence reflects an actual change in the disability and whether the examination reports reflecting such change are based upon thorough examinations. Moreover, 38 C.F.R. §§ 4.2 and 4.10 provide that in any rating reduction case, not only must it be determined that an improvement in a disability has actually occurred, but also that that improvement in a disability has actually reflects an improvement in the veteran’s ability to function under the ordinary conditions of life and work. Brown, 5 Vet. App. at 421. In determining whether a reduction was proper, the Board must focus upon evidence available to the RO at the time the reduction was effectuated, although post-reduction medical evidence may be considered in the context of evaluating whether the condition had actually improved. See Dofflemyer v. Derwinski, 2 Vet. App. 277, 281-82. However, post-reduction evidence may not be used to justify an improper reduction. In cases where a rating has been in effect for less than 5 years the disability in question has not become stabilized and is likely to improve, reexaminations disclosing improvement, physical or mental, in these disabilities will warrant a rating reduction. 38 C.F.R. § 3.344 (c). In rendering a decision on appeal, the Board must also 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). Whether the reductions of the disability ratings for service-connected for meniscectomy, right knee with post traumatic changes and limitation of flexion of the right knee were proper In May 2010, the Veteran was assigned a 40 percent rating for his meniscectomy of the right knee with posttraumatic changes, effective March 25, 2010. The Veteran was also granted a separate 20 percent evaluation for limitation of flexion of the right knee, effective March 25, 2010. The Veteran was provided a VA examination of his right knee disability in July 2012. In response to the findings of this examination, a September 2012 rating decision proposed that the Veteran’s right knee ratings be reduced from 40 percent and 20 percent to 10 percent and 10 percent, respectively. In a December 2012 rating decision, the Veteran’s ratings were reduced with the limitation of flexion resulting in a 0 percent rating, rather than 10 percent. The Veteran’s meniscectomy of the right knee with posttraumatic changes is rated under a hyphenated diagnostic code DC 5259-5261. Hyphenated diagnostic codes are used when a rating under one diagnostic code requires use of an additional diagnostic code to identify the basis for the assigned rating; the additional code is shown after the hyphen. Here, the hyphenated diagnostic code indicates that the Veteran’s meniscectomy of the right knee (DC 5259) is rated under the criteria for limitation of leg extension (DC 5261). The Veteran’s limitation of flexion of the right knee is rated under DC 5260. DC 5260 provides for the assignment of a noncompensable rating when flexion is limited to 60 degrees; a 10 percent rating is warranted when flexion of the leg is limited to 45 degrees; a rating of 20 percent is appropriate when leg flexion is limited to 30 degrees; and a rating of 30 percent is warranted when flexion is limited to 15 degrees. 38 C.F.R. § 4.71a, DC 5260 (2017). Under DC 5261, limitation of extension of the leg to 5 degrees warrants a noncompensable rating; 10 degrees is rated as 10 percent disabling; extension limited to 15 degrees is rated as 20 percent disabling; extension limited to 20 degrees is rated as 30 percent disabling; extension limited to 30 degrees is rated as 40 percent disabling; and extension limited to 45 degrees is rated as 50 percent disabling. 38 C.F.R. § 4.71a, DC 5261 (2017). DC 5259 assigns a 10 percent rating when the joint remains “symptomatic” following removal of the meniscus. 38 C.F.R. § 4.71a, DC 5259 (2017). Normal range of motion of the knee is from 0 degrees of extension to 140 degrees of flexion. 38 C.F.R. § 4.71, Plate II. Upon review of the record, the Board finds that the evidence available at the time of the December 2012 rating decision did not reflect an actual change has occurred in the Veteran’s disability, particularly it did not reflect an improvement in the veteran’s ability to function under the ordinary conditions of life and work. The Board, therefore, finds that the reductions of both ratings were improper. First, the Board notes that the evidence in the claims file at that time indicates that the Veteran’s condition was unlikely to improve. In a June 2010 orthopedic consultation, the chief resident of orthopedics at the Philadelphia VAMC stated that the Veteran’s knee condition “has never gotten better and has gradually been worsening” since his in-service injury. Further, the July 2012 evaluation on which the reductions are based stated that the Veteran did not have any addition limitations due to flare-ups or after repetitive use testing; however, the Veteran reported flare-ups of his right knee disability during his January 2016 VA examination and reported “worsening of the condition on provocation” that results in additional impairment to his ability to walk distances or stand for periods greater than 10-15 minutes. After resolving any reasonable doubt in favor of the Veteran, the Board finds that the evidence of record does not demonstrate that the Veteran’s right knee disabilities had improved in such a manner that the Veteran’s ability to function under the ordinary conditions of life and work had been enhanced. Thus, the reductions of the Veteran’s right knee disabilities were not proper, and restoration of the prior disability ratings is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102; 38 C.F.R. § 3.344 (c); Gilbert, supra. Duties to Notify and Assist The Veterans Claims Assistance Act of 2000 (VCAA) and implementing regulations imposes obligations on VA to provide claimants with notice and assistance. The evidence indicates that adequate notice was provided to the Veteran and that VA complied with the requirements of 38 U.S.C. § 5103 (a) and 38 C.F.R. § 3.159(b). 38 U.S.C. §§ 5102, 5103, 5103A, 5107, 5126 (2012); 38 C.F.R §§ 3.102, 3.156(a), 3.159, 3.326(a) (2017). The Board also concludes that VA’s duty to assist has been satisfied with regard to the issues decided on appeal. The Veteran’s service treatment records and VA medical records are associated with the claims file. The Veteran’s Social Security Administration records and private medical records identified by the Veteran have also been associated with the file. The Veteran has not identified any outstanding records that are relevant to the claims being decided on appeal. The Board notes that the Veteran was not provided a medical examination regarding his claim for service connection for a bilateral artery disability; however, as the competent evidence of record does not even potentially indicate that this condition is related to the Veteran’s service on a direct, presumptive, or secondary basis, the Board finds that no such examination is required. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The Board finds that the duty to assist has, therefore, been satisfied and there is no reasonable possibility that further assistance would be capable of substantiating the claims decided on appeal. 38 U.S.C. § 5103A (a)(2) (2012). REASONS FOR REMAND Entitlement to service connection for a left ankle disability, a right ankle disability, radiculopathy of the bilateral lower extremities, and an acquired psychiatric disorder, to include PTSD, are remanded. The Board finds that new medical opinions should be obtained regarding the Veteran’s claims for service connection for left and right ankle disabilities, and lower extremity radiculopathy as the previous opinions are inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). In July 2012, the examiner opined that the Veteran’s ankle disabilities were not due to his service-connected right knee disability because “there is no evidence that service-connected right knee condition status post right knee meniscectomy with posttraumatic degenerative changes caused bilateral ankle strain” and cited normal ankle x-rays in June 2010. The Board finds that this rationale is conclusory and provides little evidence for the opinion that the Veteran’s current service-connected condition did not cause his diagnosed ankle disability. With regard to bilateral lower extremity radiculopathy, the examiner provided an opinion that the Veteran’s current diagnosed radiculopathy was due to his degenerative arthritis of his low back, rather than his service-connected lumbar strain without providing a rationale beyond the fact that the Veteran was diagnosed with a different back disability. The examiner opined that the other back disability was not due to his service-connected lumbar strain because it is likely multifactorial in nature, including other trauma, but did not provide an explanation why this would not be due to the Veteran’s service-connected conditions that were determined to cause his service-connected lumbar strain or directly due to trauma incurred during the Veteran’s active service. The Board notes that this opinion also does not acknowledge the Veteran’s reports of radiculopathy and sciatic pain prior to his diagnosis of degenerative arthritis of his low back. The Board finds that a new medical opinion should be obtained regarding the etiology of his diagnosed bilateral lower extremity radiculopathy. The Board also finds that a new medical opinion should be obtained regarding whether the Veteran has an acquired psychiatric disorder, to include PTSD, due to his period of service. The Veteran has argued that his in-service right knee injury was a traumatic event that is causing him to suffer from PTSD. The Board notes that the Veteran has a current diagnosis of an adjustment disorder and depressive disorder, which the Veteran has also argued is due to his service-connected disabilities. The Board finds that a medical opinion should be obtained regarding the etiology of any current acquired psychiatric disorder, to include PTSD. Entitlement to service connection for erectile dysfunction is remanded. The Board finds that the Veteran’s claim for erectile dysfunction is intertwined with his claim for service-connection for an acquired psychiatric disorder. The Veteran’s medical records from the Philadelphia VAMC in April 2013 indicate that his ED may be related to stress. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two or more issues are inextricably intertwined if one claim could have significant impact on the other). Entitlement to a disability rating in excess of 20 percent for a lumbar spine strain, a compensable disability for impairment of the right thigh, a disability rating in excess of 10 percent for a left knee medial meniscus tear, a disability rating in excess of 20 percent for limited flexion of the right knee, a disability rating in excess of 40 percent for a meniscectomy, right knee are remanded. In January 2016, the Veteran was provided VA examinations regarding the severity of his orthopedic disabilities, including his back, right hip, and knees. The examiner noted that the Veteran reported flare-ups of these conditions, but stated that additional limitations due to flare-ups could not be provided without resorting to mere speculation as the examiner was “not present with the Veteran during a flare-up.” In Sharp v. Shulkin, 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. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The Board finds that the examiner did not adequately explain why it was necessary to resort to mere speculation regarding the Veteran’s functional limitations during flare-ups. Accordingly, the Board finds that a new, VA examination should be provided that discusses any additional functional limitations during periods of flare-ups of the Veteran’s conditions, if possible. Entitlement to a total disability rating based upon individual unemployability is remanded. Finally, the Board finds that the Veteran’s claim for TDIU is inextricably intertwined with the Veteran’s claims for a higher rating. Accordingly, this issue must also be remanded. The matters are REMANDED for the following action: 1. Undertake appropriate efforts to obtain a medical opinion regarding the etiology of the Veteran’s left ankle disability, right ankle disability, and his bilateral lower radiculopathy. Any additional examination or testing of the Veteran may be conducted, if deemed necessary. The examiner is asked to provide an opinion to the following: a) whether it is it at least as likely as not (a 50 percent probability or greater) that any current ankle disability was caused by any period of active service? b) whether it is it at least as likely as not (a 50 percent probability or greater) that any current ankle disability was caused by any service-connected disability? c) whether it is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s bilateral lower extremity radiculopathy was caused by any incident of the Veteran’s period of active service? d) whether it is it at least as likely as not (a 50 percent probability or greater) that the Veteran’s bilateral lower extremity radiculopathy was caused by any service-connected disability, including his service-connected back disability? If providing a negative opinion, the examiner is asked to discuss the Veteran’s report of sciatic nerve pain in February 2010 and the July 25, 2011 psychological examination that noted that the Veteran complained of “lumbar problems with sciatica that was diagnosed in 1981.” The claims file should be reviewed in conjunction with this request and the report thereof should reflect that such a review occurred. A thorough rationale, to include reference to relevant evidence of record as appropriate, should be provided for all opinions expressed. If the examiner is unable to provide a requested opinion, a supporting rationale must be given concerning why the opinion cannot be provided. 2. Undertake appropriate efforts to obtain a medical opinion regarding the etiology of any current acquired psychiatric disability, to include PTSD. The entire claim file must be reviewed by the examiner. If the examiner determines that a physical examination is necessary, then one should be provided. The examiner should indicate whether the Veteran has had a diagnosis of a current acquired psychiatric disability, to include PTSD; and, if so, whether it is at least as likely as not (i.e., at least a 50 percent probability) is related to any period of active service, or had onset during service. If not, the examiner should opine as to whether any current acquired psychiatric disability, to include PTSD, is it at least as likely as not (a 50 percent probability or greater) caused by any service-connected disability. Any examiner is advised that the Veteran is competent to report in-service events, his symptoms and history. Such reports must be specifically acknowledged and considered in formulating any opinions. A thorough rationale, to include reference to relevant evidence of record as appropriate, should be provided for all opinions expressed. If the examiner is unable to provide a requested opinion, a supporting rationale must be given concerning why the opinion cannot be provided. 3. Undertake appropriate efforts to schedule the Veteran for a current VA examination to determine the severity, manifestations, and effects of his service-connected back, right hip, and left and right knee disabilities. The examiner must review the claims file in conjunction with the examination. All pertinent symptomatology and findings should be reported in detail. The examiner must specifically provide an opinion regarding whether the Veteran’s disabilities would result in additional functional limitations during periods of flare-ups or after repetitive use over time. If the examination is not conducted during a period of a flare-up or after repetitive use over time, the examiner must provide an estimated opinion of additional functional limitations based upon the evidence of record, including the Veteran’s lay statements and medical evidence of record. If the examiner is unable to provide such an opinion, the 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. 4. After the above-development has been completed, readjudicate the Veteran’s claims on appeal. If the claims remain denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC) and an adequate opportunity to respond, after which the matter should be returned to the Board for further adjudication, if otherwise in order. K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P.M. Johnson, Counsel