Citation Nr: 18152956 Decision Date: 11/27/18 Archive Date: 11/26/18 DOCKET NO. 15-16 413 DATE: November 27, 2018 ORDER An initial rating in excess of 20 percent for right shoulder degenerative changes with tendinosis is denied. An initial rating in excess of 20 percent for left shoulder degenerative changes with tendinosis is denied. A 10 percent rating, but no greater, prior to December 12, 2014 for bilateral pes planus with plantar fasciitis is granted. A 30 percent rating, but no greater, for the period from December 12, 2014 to March 19, 2017 for bilateral pes planus with plantar fasciitis is granted. A rating in excess of 30 percent for the period beginning March 20, 2017 for bilateral pes planus with plantar fasciitis is denied. A compensable rating for blepharitis is denied. A compensable rating for allergic rhinitis is denied. A compensable rating for gastroesophageal reflux disease (GERD) and hepatitis B prior to November 20, 2014 and in excess of 10 percent thereafter is denied. A compensable rating for onychomycosis with onychodystrophy is denied. A compensable rating for alopecia areata is denied. A compensable rating for acne vulgaris is denied. A rating in excess of 10 percent for left wrist tendonitis is denied. A rating in excess of 10 percent for right wrist tendonitis is denied. REMANDED Entitlement to an initial rating in excess of 10 percent for left hip degenerative changes is remanded. Entitlement to an initial rating in excess of 10 percent for right hip degenerative changes is remanded. Entitlement to an initial rating in excess of 10 percent for right knee arthritis is remanded. FINDINGS OF FACT 1. The Veteran’s right shoulder degenerative changes with tendinosis causes loss of flexion and abduction to no less than 85 degrees. 2. The Veteran’s left shoulder degenerative changes with tendinosis causes loss of flexion to no less than 75 degrees and loss of abduction to no less than 70 degrees. 3. Prior to December 12, 2014, the Veteran’s bilateral pes planus with plantar fasciitis manifest with pain on use, midfoot malalignment, moderate pronation, valgus not correctible by manipulation, and weight bearing line medial to the great toe. Symptoms were not relieved by built-up shoe or arch support. 4. As of December 12, 2014, the Veteran’s bilateral pes planus with plantar fasciitis manifest with pain accentuated on use and manipulation, characteristic callouses, marked deformity, and weight-bearing line fall over or medial to the great toe, but without marked inward displacement and severe spasm of the Achillis tendon on manipulation. 5. The Veteran’s blepharitis does not cause any visual impairment, to include impairment of visual acuity, visual field, and muscle function, and there is no evidence of incapacitating episodes as a result of the condition. 6. The Veteran’s allergic rhinitis does not manifest with polyps, greater than 50 percent obstruction of nasal passage on both sides, or complete obstruction on one side. 7. Prior to November 20, 2014, the Veteran’s GERD manifest only with heartburn, and her hepatitis B was asymptomatic. 8. As of November 20, 2014, the Veteran’s GERD manifest with persistently recurrent epigastric distress, dysphagia, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux, nausea, and vomiting not productive of considerable impairment of health. 9. The Veteran’s onychomycosis with onychodystrophy has not been treated with systemic therapy, does not affect any exposed areas of her body, affects less than 20 percent of her entire body, and has not resulted in scarring or any characteristic of disfigurement. 10. The Veteran’s alopecia areata involves hair loss on her scalp, involving an exposed surface area of three percent and total body area of one percent. 11. The Veteran’s acne vulgaris is superficial and has not resulted in scarring or any characteristic of disfigurement. 12. The Veteran’s right and left wrist tendonitis does not manifest with ankylosis, and symptoms including loss of grip strength are no more than mild. CONCLUSIONS OF LAW 1. The criteria for an evaluation in excess of 20 percent for right shoulder degenerative changes with tendinosis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, Diagnostic Code 5201 (2017). 2. The criteria for an evaluation in excess of 20 percent for left shoulder degenerative changes with tendinosis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, Diagnostic Code 5201 (2017). 3. The criteria for an evaluation of 10 percent, but no greater, prior to December 12, 2014 for bilateral pes planus with plantar fasciitis have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, Diagnostic Code 5276 (2017). 4. The criteria for an evaluation of 30 percent, but no greater, from December 12, 2014 to March 19, 2017 for bilateral pes planus with plantar fasciitis have been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.71a, Diagnostic Code 5276 (2017). 5. The criteria for an evaluation in excess of 30 percent, beginning March 20, 2017, for bilateral pes planus with plantar fasciitis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.71a, Diagnostic Code 5276 (2017). 6. The criteria for a compensable rating for blepharitis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.75a, 4.76, 4.77, 4.78, Diagnostic Code 6018 (2017). 7. The criteria for a compensable rating for allergic rhinitis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.97, Diagnostic Code 6522 (2017). 8. The criteria for a compensable rating for gastroesophageal reflux disease (GERD) and hepatitis B prior to November 20, 2014 and in excess of 10 percent thereafter have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.114, Diagnostic Codes 7345 and 7346 (2017). 9. The criteria for a compensable rating for onychomycosis with onychodystrophy have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.118, Diagnostic Codes 7800-7806, 7813 (2017). 10. The criteria for a compensable rating for alopecia areata have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.118, Diagnostic Code 7831 (2017). 11. The criteria for a compensable rating for acne vulgaris have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.118, Diagnostic Code 7828 (2017). 12. The criteria for a rating in excess of 10 percent for left wrist tendonitis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, 4.124a, Diagnostic Codes 5215 and 8515 (2017). 13. The criteria for a rating in excess of 10 percent for right wrist tendonitis have not been met. 38 U.S.C. § 1155, 5107 (2012); 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, 4.124a, Diagnostic Codes 5215 and 8515 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS Increased Rating Claims Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155 (2012); 38 C.F.R. § 4.1 (2017). Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7 (2017). Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3 (2017). However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14 (2017). If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). See AB v. Brown, 6 Vet. App. 35 (1993) (a claim for an original or an increased rating remains in controversy when less than the maximum available benefit is awarded). When an evaluation of a disability is based on limitation of motion, the Board must also consider in conjunction with the otherwise applicable diagnostic code 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 of disuse. The provisions of 38 C.F.R. § 4.40 state that disability of the musculoskeletal system is primarily the inability due to damage or inflammation in parts of the system to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. A finding of functional loss due to pain must be supported by adequate pathology and evidenced by the visible behavior of the claimant 38 C.F.R. § 4.40, Johnston v. Brown, 10 Vet. App. 80, 85 (1997). 1. Right Shoulder The Veteran’s current 20 percent rating percent for her right shoulder degenerative changes with tendinosis is under Diagnostic Code 5201. With respect to the major side, Diagnostic Code 5201 provides for a 20 percent rating when arm motion is limited to shoulder level. A 30 percent rating is warranted when arm motion is limited to midway between side and shoulder level. A 40 percent rating is warranted when arm motion is limited to 25 degrees from the side. 38 C.F.R. § 4.71a (2017). The evidence here reflects that the Veteran’s right side is her major side. On VA examination in 2010, the Veteran reported having shoulder pain. Range of motion testing of her right shoulder showed the Veteran to have 135 degrees flexion, 120 degrees abduction, and 90 degrees external and internal rotation, with no objective evidence of pain. There was no additional limitation of motion or impairment of function after repetitive use testing. On a VA physical therapy initial evaluation in September 2012 the Veteran’s right shoulder flexion was measured to 150 degrees and abduction to 160 degrees. A December 2013 VA treatment record reflects that the Veteran reported right shoulder pain with overhead activities and an overall feeling of weakness. She had full range of motion with pain on flexion and abduction. On VA examination in October 2014 the Veteran reported shoulder pain at night due to sleeping on her side and intermittent pain on movement such as lifting overhead and carrying a purse on her shoulder. She reported her extension is limited when the pain is bad. On range of motion testing she had flexion to 160 degrees, abduction to 150 degrees, and external and internal rotation to 90 degrees. She was noted to have pain causing functional loss. Pain with weight bearing was not noted. Muscle strength was normal. She had no weakness, fatigue, or incoordination. On VA examination in March 2017 the Veteran reported worsening, sharp shoulder pain aggravated by overhead reaching, driving, lying on her side, and heavy lifting. On range of motion testing she had flexion and abduction to 85 degrees, external rotation to 40 degrees, and internal rotation to 45 degrees with pain on all movements causing functional loss. There was no evidence of pain with weight bearing and no additional loss after repetitive use testing. Muscle strength was normal. A November 2017 VA treatment record notes the Veteran’s report of continuing shoulder pain. Active range of motion was noted to be 160 degrees and passive range of motion 170 degrees. For a rating in excess of 20 percent under Diagnostic Code 5201, arm motion must be limited to at least midway between side and shoulder level. The Board notes that shoulder level is approximately 90 degrees. Here, neither the Veteran’s flexion or abduction have ever been measured to less than 85 degrees. The Board specifically acknowledges the Veteran’s reports of pain, but finds that the functional loss due to her pain is contemplated by the 20 percent rating already assigned and an increased rating based solely on pain is not warranted. See 38 C.F.R. § 4.40; Mitchell v. Shinseki, 25 Vet. App. 32 (2011); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991). VA examiners also specifically tested range of motion after repetitive use and found no additional functional loss. Thus, even with consideration of the DeLuca factors, the Board finds that a rating in excess of 20 percent is not warranted. The Board has considered the applicability of principles set forth in Correia v. McDonald, 28 Vet. App. 158 (2016), but finds a new examination is not warranted on that basis. The Board notes that the Correia case involved a claim for an increased rating for knee disorders, as opposed to the current case which involves a shoulder disability. In Correia, the Court provided a precedential interpretation of the final sentence of 38 C.F.R. § 4.59, which reads: “The joints involved should be tested for pain on both active and passive motion, in weight-bearing and non-weight bearing and, if possible, with the range of the opposite undamaged joint.” Specifically, the Court held “that the final sentence of § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities.” The Court also stated 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 § 4.59.” The Court provided two qualifications to this requirement. First, it “trust[ed] that its decision today will be taken as requiring the range of motion testing listed in the final sentence of § 4.59 in every case in which those tests can be conducted.” The Court specifically found that it was not competent to determine “whether upper extremities are or can be weight-bearing,” though it did find that knees were “undoubtedly weight-bearing.” In a later footnote, the Court “le[ft] it to medical professionals to determine whether the listed range of motion testing can be performed on the joints at issue in a particular case.” Second, the Court indicated that range of motion testing of the opposite joint does not apply “for joints that do not have an opposite or whose opposite is also damaged.” The Court in Correia held, in essence, that to be adequate, an examination of a joint must include range of motion testing of the joint in the following areas: active motion, passive motion, weight-bearing, and non-weight bearing. The Board initially notes, however, that the Correia case is less applicable in the case of a shoulder than in the knee. Although the VA examination in this case did not specify whether range of motion testing was done with active motion or passive motion, the Board finds that this is inconsequential under the facts of this case. The Board takes notice that on VA examinations, the testing of the range of shoulder motions is generally done by assessing active motion rather than passive. The “active” motion is tested by having a veteran attempt to move his or her arm to measure his flexion, abduction, and external rotation. Although it may possible to test passive motion without weight bearing by having the examiner move the arm, such testing would not reveal useful information. In this regard, active range of motion testing produces test results that are more restricted than the results produced by passive range of motion testing in which the medical provider forces the joint through its motions. In fact, here a VA treatment record from November 2017 includes both active and passive range of motion testing that reflects greater passive range of motion than active range of motion. As discussed above, for the Veteran to be awarded a higher disability rating for her right shoulder disability, arm motion must be limited to at least midway between side and shoulder level. Here, range of motion testing has consistently shown arm motion greater than shoulder level, with only the March 2017 VA examination indicating a limitation of flexion and abduction to 85 degrees. A November 2017 VA treatment record indicating both active and passive range of motion testing indicates active range of motion well above shoulder level and passive range of motion even higher. Therefore, remand for any additional range of motion testing would result in delay without additional benefit flowing to the Veteran, and is thus inappropriate. Soyini v. Principi, 1 Vet. App. 540, 546 (1991). In summary, the Board finds that the criteria for a rating higher than 20 percent for a right shoulder disability have not been met or approximated at any point during the appeal period. The claim must therefore be denied. 2. Left Shoulder The Veteran’s current 20 percent rating percent for her left shoulder degenerative changes with tendinosis is under Diagnostic Code 5201. With respect to the minor side, Diagnostic Code 5201 provides for a 20 percent rating when arm motion is limited to shoulder level or midway between side and shoulder level. A 30 percent rating is warranted when arm motion is limited to 25 degrees from the side. 38 C.F.R. § 4.71a (2017). On VA examination in 2010, the Veteran reported having shoulder pain. Range of motion testing showed the Veteran to have 155 degrees flexion, 145 degrees abduction, and 90 degrees external and internal rotation with no objective evidence of pain in the left shoulder. There was no additional limitation of motion or impairment of function on repetitive use testing. On a VA physical therapy initial evaluation in September 2012 the Veteran’s flexion and abduction were measured to 160 degrees. On VA examination in October 2014 the Veteran reported shoulder pain at night due to sleeping on her side and intermittent pain on movement such as lifting overhead and carrying a purse on her shoulder. She reported her extension is limited when the pain is bad. On range of motion testing she had flexion and abduction to 170 degrees and external and internal rotation to 90 degrees. She was noted to have pain causing functional loss. Pain with weight bearing was not noted. Muscle strength was normal. She had no weakness, fatigue, or incoordination. In a July 2015 letter the Veteran’s physical therapist stated that she had been receiving treatment since November 2012 and at the Veteran’s initial evaluation she had pain lifting her left shoulder above 90 degrees, shoulder height, although she was able to do it when absolutely necessary. On VA examination in March 2017 the Veteran reported worsening, sharp shoulder pain aggravated by overhead reaching, driving, lying on her side, and heavy lifting. On range of motion testing she had flexion to 75 degrees, abduction to 70 degrees, external and internal rotation to 40 degrees, with pain on all movements causing functional loss. There was no evidence of pain with weight bearing and no additional loss after repetitive use testing. Muscle strength was normal. A November 2017 VA treatment record notes the Veteran’s report of continuing shoulder pain. Active range of motion was noted to be 130 degrees and passive range of motion 170 degrees. For a rating in excess of 20 percent under Diagnostic Code 5201 arm motion must be limited to at least 25 degrees from the side. Here, the Veteran’s flexion has never been measured to less than 75 degrees and her abduction has never been measured to less than 70 degrees. The Board specifically acknowledges the Veteran’s reports of pain, but finds that the functional loss due to her pain is contemplated by the 20 percent rating already assigned and an increased rating based solely on pain is not warranted. See 38 C.F.R. § 4.40; Mitchell, 25 Vet. App. 32; Schafrath, 1 Vet. App. at 592. VA examiners also specifically tested range of motion after repetitive use and found no additional functional loss. Thus, even with consideration of the DeLuca factors, the Board finds that a rating in excess of 20 percent is not warranted. 3. Bilateral Pes Planus with Plantar Fasciitis The Veteran currently has a noncompensable rating for bilateral pes planus with plantar fasciitis prior to March 20, 2017 and a 30 percent rating thereafter under Diagnostic Code 5276. Diagnostic Code 5276, for rating flatfoot, provides that a 0 percent rating is assignable when symptoms are mild and relieved by built-up shoe or arch support. A 10 percent rating is assignable for moderate impairment with weight-bearing line over or medial to great toe, inward bowing of the tendo Achillis, pain on manipulation and use of the feet. A 30 percent rating is assignable for severe bilateral impairment manifested by objective evidence of marked deformity (pronation, abduction, etc.), pain on manipulation and use accentuated, indication of swelling on use, and characteristic callosities. A 50 percent rating is assignable for pronounced bilateral impairment manifest with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo Achillis on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, Diagnostic Code 5276 (2017). On VA examination in October 2010 the Veteran was noted to have pain, swelling, stiffness, weakness, and lack of endurance while standing due to her bilateral foot condition. She reported being able to stand up for an hour and walk one to three miles. She reported flare-ups at least weekly lasting one to two days that caused difficulty walking. On examination, there was midfoot malalignment, moderate pronation, no arch present, valgus not correctible by manipulation, and weight-bearing line medial to the great toe. Achilles alignment was normal. She noted only a fair response to treatment for her foot pain, including rest, elevation, heat and cold, pain medication, custom-made inserts, and physical therapy. A December 2010 VA treatment x-ray was read to note some soft tissue swelling in the area of foot tenderness. A January 2013 VA treatment record indicates that the Veteran uses orthotics for flat feet. In September 2013 she requested new orthotics, reporting her current ones hurt her feet. The Board find that giving the Veteran the benefit of the doubt, her bilateral pes planus with plantar fasciitis most closely approximated the criteria for a 10 percent rating prior to December 12, 2014 as her symptoms were not relieved by orthotics and her overall impairment was more moderate than mild. Therefore, the Board finds a 10 percent rating is warranted prior to December 12, 2014. The Board finds that a higher rating, which is assignable for severe bilateral impairment, is not warranted. The Veteran was not noted to have accentuated pain on manipulation of her feet at her October 2010 VA examination, and she reported being able to stand for an hour and walk one to three miles. For the rating period beginning December 12, 2014 to March 19, 2017, the Board finds that the evidence reflects the Veteran’s condition had worsened such that a higher, 30 percent rating, is warranted as of that date. On VA examination on December 12, 2014 the Veteran reported she has arch pain and swelling in her feet with extended walking. She reported being able to stand for 30 minutes or walk two blocks before the onset of foot pain. The examiner noted the Veteran has pain accentuated on use, pain on manipulation of the feet, characteristic callouses, and has used orthotics that did not relieve her symptoms. She was noted to have decreased longitudinal arch height on weight bearing, marked deformity (not pronation), with the weight-bearing line fall over or medial to the great toe. She did not have extreme tenderness of the plantar surfaces of her feet, inward bowing of the Achilles tendon, or marked inward displacement and severe spasm of the Achilles tendon on manipulation. She was noted not to have pain, weakness, fatigability, or incoordination significantly limiting functional ability during a flare-up or after repetitive use. A May 2015 VA treatment record notes continued complaints of foot pain due to her orthotics. She was noted to have pronation. On VA examination in March 2017 the Veteran reported wearing arch supports with minimal relief. She reported her foot pain is aggravated by standing and walking for long periods of time and her feet are tender. The examiner noted that the Veteran has pain accentuated on use and manipulation of the feet. She was noted not to have swelling on use, characteristic calluses, extreme tenderness of plantar surfaces, objective evidence of marked deformity, marked pronation, inward bowing of the Achilles tendon, or marked inward displacement and severe spasm of the Achilles tendon, and the weight-bearing line was noted not to fall over or medial to the great toe. She did have decreased longitudinal arch height on weight-bearing. She was noted to have pain on examination but no functional loss of the lower extremity due to the condition. Functional loss was further not noted during flare-ups or after repetitive use over time. For these reasons, the Board finds that a 30 percent rating is warranted for the rating period beginning December 12, 2014 to March 19, 2017. The Board further finds that a higher, 50 percent rating, is not warranted for the appeal period beginning December 12, 2014. On examination in 2014 and 2017 the Veteran was noted not to have extreme tenderness of plantar surfaces of the feet or marked inward displacement and severe spasm of the tendo achillis on manipulation. Based on the forgoing, the Board finds that a rating in excess of 30 percent is not warranted under Diagnostic Code 5276. The Board has also considered the criteria for evaluations pursuant to Codes 5277 (weak foot), 5278 (claw foot), 5279 (anterior metatarsalgia), 5280 (hallux valgus), 5281 (hallux rigidus), 5282 (hammer toe), 583 (malunion or nonunion of tarsal or metatarsal bones), and 5284 (other injures of the foot). With respect to Code 5284, a 10 percent evaluation is assigned for other injuries of the foot when such injuries are moderate in nature. 38 C.F.R. § 4.71a (2017). A 20 percent evaluation is warranted when those injuries are moderately severe, a 30 percent evaluation is assigned to severe injuries, and 40 percent is assigned with actual loss of use of the foot. Id. The Board notes that the Veteran is service connected for plantar fasciitis as well as pes planus. However, the Board finds that the Veteran’s foot condition is properly rated under Diagnostic Code 5276 as the Veteran’s symptoms and affected functions are all contemplated by Diagnostic Code 5276. 4. Blepharitis The Veteran’s blepharitis is rated as noncompensable under Diagnostic Code 6099-6018. When an unlisted condition is encountered, it is permissible to rate that condition under a closely related disability as to which not only the functions affected, but the anatomical localization and symptomatology, are closely analogous. See 38 C.F.R. § 4.20 (2017). When an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the diagnostic code number will be “built-up” by using the first two digits of that part of the rating schedule which most closely identifies the part, or system, of the body involved and adding “99” for the unlisted condition. See 38 C.F.R. § 4.27 (2017). Diagnostic Code 6018 applies to chronic conjunctivitis. During the pendency of the appeal, VA issued a final rule revising the portion of the VA Schedule for Rating Disabilities that addresses the organs of special sense and schedule of ratings-eye. 89 Fed. Reg. 15316 (Apr. 10, 2018). The final rule went into effect May 13, 2018. Where there is a change in the rating criteria during the appeal period, the Board will consider the claim in light of both the former and revised schedular rating criteria, although an increased evaluation based on the revised criteria cannot predate the effective date of the amendments. Both the former and revised criteria distinguish active and inactive disease processes. Under the former criteria, an active disease process (with objective findings, such as red, thick conjunctivitae, mucous secretion, etc.) is assigned a 10 percent rating. Under the revised criteria, an active disease process is rated pursuant to the General Rating Formula for Diseases of the Eye, with a minimum rating of 10 percent. For an inactive disease process, both the former and revised criteria instruct to evaluate based on residuals, such as visual impairment and disfigurement (Diagnostic Code 7800). With regard to visual impairment, the May 2018 amendments made no substantive changes to how visual acuity is rated. With regard to visual field and muscle function examinations, the use of a Goldmann chart is no longer required. There are otherwise no substantive changes to how those types of visual impairment are rated. The General Rating Formal for Diseases of the Eye instructs to evaluate on the basis of either visual impairment due to a particular condition or on incapacitating episodes, whichever results in a higher evaluation. For a compensable rating based on documented incapacitating episodes, there must be incapacitating episodes requiring at least one treatment visit for an eye condition during the past 12 months. Note (1) indicates that, for the purposes of evaluations under 38 C.F.R. § 4.79, an incapacitating episode is an eye condition severe enough to require a clinic visit to a provider specifically for treatment purposes. Note (2) indicates that examples of treatment may include but are not limited to: systemic immunosuppressants or biologic agents; intravitreal or periocular injections; laser treatments; or other surgical interventions. Note (3) indicates that, for the purposes of evaluating visual impairment due to a particular condition, refer to 38 C.F.R. § 4.75-4.78 and to § 4.79, Diagnostic Codes 6061-6091. The evaluation of visual impairment is based on impairment of visual acuity (excluding developmental errors of refraction), visual field, and muscle function. 38 C.F.R. § 4.75(a) (2017). Evaluation of visual acuity is based on corrected distance vision with central fixation. 38 C.F.R. § 4.76(b)(1) (2017). The measurements for each eye are applied to the table for Impairment of Central Visual Acuity. Generally, the table is divided into steps corresponding to different levels of visual acuity for one eye, and each step is further divided into subsections of visual acuity for the other eye, with corresponding ratings. The rater will first locate the step that matches the visual acuity of the poorer eye. Within that step, the rater will then locate the subsection that matches the visual acuity of the better eye, which will produce the corresponding rating. Where a reported visual acuity is between two sequentially listed visual acuities, the visual acuity which permits the higher evaluation will be used. 38 C.F.R. § 4.76(c) (2017). Evaluation of visual field is based on the remaining field of vision in each eye. The table of Ratings for Impairment of Visual Fields provides ratings for visual field loss. The first half of the table provides ratings based on loss of an entire half of field of vision in an eye. The second half of the table provides ratings based on the average concentric contraction of the visual field of each eye. 38 C.F.R. § 4.77(b) (2017). Evaluations of visual impairment of muscle function is based on the degree of diplopia. 38 C.F.R. § 4.78(a) (2017). On VA examination in October 2010 the Veteran was noted to have blepharitis under control, with no effect on vision. He was noted to have a full visual field, 20/20 vision, and no diplopia. A routine eye examination in June 2011 did not include a diagnosis of blepharitis. On VA examination in December 2014 the Veteran’s vision was 20/40 or better and he had a full visual field and no diplopia. Her blepharitis was noted to be under control, with no effect on vision. A September 2017 VA treatment record indicates 20/20 vision with full visual field. On VA examination in March 2017 the examiner stated that the Veteran did not remember blepharitis, but reported having itchy and gritty eyes. The Veteran’s corrected distance vision was 20/40 or better and he had a full visual field and no diplopia. As the record does not indicate that the Veteran’s blepharitis causes any visual impairment, to include impairment of visual acuity, visual field, and muscle function, and there is no evidence of incapacitating episodes as a result of blepharitis, the Board finds that a compensable rating is not warranted for the condition. 5. Allergic Rhinitis The Veteran’s contends she is entitled to a higher rating for allergic rhinitis. The Veteran’s noncompensable rating for allergic rhinitis was assigned under Diagnostic Code 6522. Under Diagnostic Code 6522, allergic or vasomotor rhinitis without polyps, but with greater than 50 percent obstruction of nasal passage on both sides or complete obstruction on one side, warrants a 10 percent rating. With polyps a 30 percent rating is warranted. 38 C.F.R. § 4.97 (2017). On VA compensation and pension examination in October 2010 the Veteran reported nasal discharge, sneezing, post-nasal drip, and itchy nose one to two times per month lasting from one to two days. On examination no nasal obstruction or nasal polyps were noted with a normal septum and normal turbinates. A January 2014 VA treatment record reflects that the Veteran reported year-round rhinitis with a continual feeling of obstruction. However, on examination, there was no nasal discharge seen, no nasal vestibule abnormalities, her nasal septum was normal, nasal mucousa normal, nasal turbinate normal, and she had no sinus tenderness. On VA compensation and pension examination in December 2014 and March 2017 the Veteran was noted not to have greater than 50 percent obstruction of the nasal passage either sides. No polyps were seen on examination. As there is no evidence of either nasal obstruction of greater than 50 percent or nasal polyps, a compensable rating for allergic rhinitis is not warranted. As a preponderance of the evidence is against a compensable rating, the benefit of the doubt doctrine does not apply, and the claim must be denied. 6. GERD and Hepatitis B The Veteran has a noncompensable rating for GERD and hepatitis B prior to November 20, 2014 and a 10 percent rating thereafter under Diagnostic Code 7345-7346. Diagnostic Code 7345, which lists the criteria for rating chronic liver disease without cirrhosis, including hepatitis B, provides that a noncompensable rating is warranted when the condition is nonsymptomatic. Higher ratings are provided based on symptomatology including fatigue, malaise, and anorexia or incapacitating episodes of at least one week during the past 12-month period. Diagnostic Code 7346, for rating hiatal hernia, provides for a 60 percent rating where there are symptoms of pain, vomiting, material weight loss and hematemesis or melena with moderate anemia; or other symptom combinations productive of severe impairment of health. A 30 percent rating is warranted where there is persistently recurrent epigastric distress with dysphagia, pyrosis, and regurgitation, accompanied by substernal or arm or shoulder pain, productive of considerable impairment of health. A 10 percent rating is warranted where there are two or more of the symptoms for the 30 percent evaluation of less severity. 38 C.F.R. § 4.114 (2017). The terms “severe impairment of health” and “considerable impairment of health” are not defined in the rating schedule; rather than applying a mechanical formula, VA must evaluate all the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 (2017). Ratings under diagnostic codes 7301 to 7329, inclusive, 7331, 7342, and 7345 to 7348 inclusive will not be combined with each other. A single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation. 38 C.F.R. § 4.114 (2017). For purposes of evaluating conditions in 38 C.F.R. § 4.114, the term “substantial weight loss” means a loss of greater than 20 percent of the individual’s baseline weight, sustained for three months or longer; and the term “minor weight loss” means a weight loss of 10 to 20 percent of the individual’s baseline weight, sustained for three months or longer. 38 C.F.R. § 4.112. “Baseline weight” means the average weight for the two-year-period preceding onset of the disease. At her October 2010 VA compensation and pension examination, the Veteran reported that she was diagnosed with hepatitis B in 1996 and her symptoms resolved within a month and she is not currently receiving and treatment for the condition. With respect to GERD, the Veteran reported having heartburn and burning in the throat that she treats with Nexium. A November 2012 VA treatment note indicates that the Veteran is on medication to treat heartburn and regurgitation. VA treatment records from January, February, April, September, and October 2013 also include a review of symptoms in which the Veteran denied heartburn, regurgitation, nausea, vomiting, abdominal pain, diarrhea, or constipation. A January 2014 VA treatment record states that the Veteran reported she has heartburn treated with Nexium sometimes. She denied dysphagia, nausea, vomiting, abdominal pain, diarrhea, and constipation. On VA examination in November 2014 the examiner indicated that the Veteran experiences persistently recurrent epigastric distress, dysphagia, reflux, regurgitation, substernal pain, sleep disturbance caused by esophageal reflux, nausea, and vomiting. A June 2016 VA treatment record notes that the Veteran reported having heartburn if she forgets to take Omeprazole. She denied nausea or vomiting. A November 2016 VA treatment record notes the Veteran’s reflux to be well-controlled. The Veteran underwent another VA compensation and pension examination in March 2017 at which she reported having pyrosis and reflux occurring daily with intermittent food trapping in the throat. The examiner indicated the Veteran’s GERD symptoms include dysphagia, pyrosis, reflux, and regurgitation. The examiner indicated that the Veteran’s GERD does not result in considerable impairment of health. With respect to hepatitis B, on VA compensation examination in March 2017 the Veteran attributed decreased appetite and a 10-pound weight loss to her hepatitis B. The examiner indicated that the Veteran’s only symptom is daily fatigue and her condition has not resulted in any incapacitating episodes. The Board finds that the Veteran’s predominate disability between GERD and hepatitis B is GERD. The record contains no complaints of any symptoms related to hepatitis B until the Veteran’s March 2017 examination at which the examiner indicated the only symptom to be daily fatigue. The Board notes that the Veteran also reported a loss of appetite at that time, but the VA examiner did not attribute the symptom to hepatitis B. No incapacitating episodes have been attributed to the Veteran’s hepatitis B. However, the record reflects that the Veteran has reported GERD symptoms throughout the period on appeal. The Board has considered all of the Veteran’s GERD symptoms, as she herself has reported them, and finds that the Veteran’s condition does not warrant a compensable rating prior to November 20, 2014 or in excess of 10 percent thereafter. Prior to November 20, 2014, the Veteran reported having heartburn, but the evidence does not reflect any complaints of dysphagia or substernal or arm or shoulder pain. There are further no complaints of regurgitation, although a November 2012 note indicates that the Veteran is on medication to treat heartburn and regurgitation. Throughout 2013 the Veteran’s medical records indicate a denial of all GERD symptoms. Based on the forgoing, the Board finds that a compensable rating is not warranted prior to November 20, 2014 under Diagnostic Code 7346. The Veteran’s November 20, 2014 VA examination is the first evidence of a worsening of the Veteran’s GERD such that a compensable rating is warranted. However, the evidence as of November 20, 2014 does not support a rating in excess of 10 percent. For a higher, 30 percent rating, GERD symptoms must be productive of considerable impairment of health. No such considerable impairment of health is suggested by the record. In November 2016 her condition was noted ot be well-controlled. The March 2017 VA examiner specifically noted the condition did not result in considerable impairment of health. Based on the forgoing, the Board finds that a rating in excess of 10 percent is not warranted Diagnostic Code 7346. The Board has considered the overall severity of the Veteran’s disability, including both her GERD and hepatitis B symptoms, throughout the period on appeal, but finds that elevation to a compensable rating prior to November 20, 2014 or a rating in excess of 10 percent as of November 20, 2014 is not warranted. 7. Onychomycosis with Onychodystrophy The Veteran’s onychomycosis with onychodystrophy is rated as noncompensable under Diagnostic Code 7899-7806. Onychomycosis is not specifically listed in the rating scale; however, Diagnostic Code 7813 (dermatophytosis, to include tinea of the nails) and Diagnostic Code 7820 (infections of the skin not listed elsewhere, to include fungal infections) both provide that such disability is to be rated as a disfigurement of the head, face, or neck, (Diagnostic Code 7800), scars (Diagnostic Codes 7802, 7803, 7804, and 7805), or dermatitis (Diagnostic Code 7806) depending on the predominant disability. 38 C.F.R. § 4.118 (2017). Under Diagnostic Code 7806 (dermatitis or eczema), a 10 percent evaluation is assigned where there is involvement of at least 5 percent, but less than 20 percent, of the entire body, or at least 5 percent, but less than 20 percent, of exposed areas affected, or; intermittent systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of less than six weeks during the past 12-month period. A 30 percent evaluation requires involvement of 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas affected, or; systemic therapy such as corticosteroids or other immunosuppressive drugs required for a total duration of six weeks or more, but not constantly, during the past 12-month period. A 60 percent rating is assigned with involvement of more than 40 percent of the entire body or more than 40 percent of exposed areas affected, or; constant or near constant systemic therapy such as corticosteroids or other immunosuppressive drugs required during the past 12-month period. A disability under Diagnostic Code 7806 may also be rated as disfigurement of the head, face, or neck (Diagnostic Code 7800), or scars (Diagnostic Codes 7802, 7803, 7804, and 7805) depending on the predominant disability. 38 C.F.R. § 4.118 (2017). On VA examination in October 2010 the Veteran reported having discolored toenails with white debris under the nails that she treats with antifungal medication. The examiner noted the presence of onychomycosis of the great toenail, second toenail, and fifth toenails in both feet. August 2012 and March 2013 VA treatment records note the Veteran’s toes and nails to appear normal. The Veteran underwent another VA examination in March 2017. No objective evidence of onychomycosis was found on examination. Thus, the evidence reflects that the Veteran’s onychomycosis, when present, does not affect any exposed areas of her body and affects well less than 20 percent of her entire body. Further, the condition has not been treated with systemic therapy. Further, the evidence does not reflect that the Veteran’s onychomycosis has resulted in scarring or any characteristic of disfigurement listed under Diagnostic Code 7800. Based on the forgoing, the Board finds that a compensable rating is not warranted for the Veteran’s onychomycosis with onychodystrophy. 8. Alopecia Areata The Veteran contends she is entitled a higher rating for alopecia areata. Her current noncompensable rating is under Diagnostic Code 7831. Under Diagnostic Code 7831 when hair loss is limited to the scalp and face, a noncompensable rating is warranted. A 10 percent rating is warranted for loss of all body hair. 38 C.F.R. § 4.118 (2017). Here, the evidence does not reflect, and the Veteran has not claimed, that she has a loss of all body hair. On VA examination in October 2010 the Veteran claimed scalp hair loss. The examiner indicated that the Veteran had had minimal amount of hair loss in the temple area. The examiner indicated that the Veteran had traction alopecia over an exposed surface area of three percent and over total body area of one percent. A December 2014 VA treatment record notes non-scarring alopecia on the frontal hairline. The Veteran underwent another VA examination in March 2017. No objective evidence of alopecia areata was found on examination. Based on the forgoing, the Board finds that a preponderance of the evidence is against a compensable rating for alopecia areata. 9. Acne Vulgaris The Veteran contends she is entitled a higher rating for acne vulgaris. Her current noncompensable rating is under Diagnostic Code 7828. Under Diagnostic Code 7828 superficial acne (comedones, papules, pustules) of any extent warrants a noncompensable rating. Deep acne (deep inflamed nodules and pus-filled cysts) affecting less than 40 percent of the face and neck, or deep acne other than on the face and neck should be rated at 10 percent. A 30 percent rating is warranted for deep acne affecting 40 percent or more of the face and neck. Acne may also be rated as disfigurement of the head, face, or neck (DC 7800) or scars (DCs 7801, 7802, 7804, or 7805), depending upon the predominant disability. 38 C.F.R. § 4.118 (2017). On VA compensation and pension skin examination in October 2010, the examiner stated that the Veteran had minimal amount of facial acne, covered 10 percent of the exposed surface of her body and two percent of her body surface. A March 2012 VA treatment record notes chronic, recurrent facial acne treated with a topical gel involving scattered, diffuse small comedomes over the face. In December 2014 the Veteran’s doctor completed a skin diseases disability benefits questionnaire. The doctor indicated that the Veteran’s acne, which is both superficial acne and deep acne, is controlled with topical steroids. The doctor did not indicate that the acne affects an area other than the face and neck. A VA treatment record also from December 2014 notes “few closed comedones” on the face. A September 2016 VA treatment note indicates that the Veteran had scattered comedonal papules along her hairline on her forehead and temples. The Veteran underwent another VA examination in March 2017. The examiner noted that the Veteran is on only topical medication for her acne. No objective evidence of acne vulgaris was found on examination. A May 2017 VA treatment note states that the Veteran denied papules, pustules, or nodules. She was noted to have several closed and a few open comedones on her face. The Board finds that a preponderance of the evidence supports that the Veteran has only superficial acne. Although the Veteran’s doctor checked deep acne as well as superficial acne on a disability benefits questionnaire completed in December 2014, there are no medical treatment records supporting the existence of deep acne, including a December 2014 VA treatment record noting the presence of only a few closed comedones. On multiple physical examinations only superficial acne has been noted. The Board finds that the Veteran’s acne predominately manifests as superficial. Therefore, a compensable rating is not warranted under Diagnostic Code 7828. The evidence further does not reflect that the Veteran’s acne has resulted in scarring or any characteristic of disfigurement listed under Diagnostic Code 7800. As such, the Board finds that a preponderance of the evidence is against a compensable rating. 10. Left and Right Wrist The Veteran’s service-connected bilateral tendonitis of the wrists has been evaluated pursuant to the criteria set forth in 38 C.F.R. § 4.71a, Diagnostic Code 5215, relating to limitation of motion of the wrist. Pursuant to Diagnostic Code 5215, a 10 percent disability rating is warranted where palmar flexion is limited in line with the forearm, or where dorsiflexion is less than 15 degrees. 38 C.F.R. § 4.71a, Diagnostic Code 5215. This is the maximum schedular rating based on limitation of motion of the wrist under this diagnostic code. A higher schedular rating is only warranted when there is evidence of ankylosis. 38 C.F.R. § 4.71a, Diagnostic Code 5214 (2017). Here, there is no evidence to support that the Veteran has ankylosis of either wrist. On VA examination in November 2014 the Veteran reported she has lost range of motion in her wrist, but testing showed normal range of motion bilaterally. VA examination in November 2017 noted some loss of range of motion, but no ankylosis. The Veteran herself has further not reported ankylosis of her wrists nor do any other medical treatment records indicate ankylosis. Therefore, a rating in excess of 10 percent for loss of range of motion under the schedular criteria is not permitted. The Board notes that the Veteran’s wrist condition was originally service connected as carpal tunnel syndrome under Diagnostic Code 8599-8515. The record reflects that the Veteran was diagnosed with carpal tunnel syndrome in service prior to an electromyography (EMG) being conducted. Nerve conduction testing was performed at the Veteran’s October 2010 compensation and pension VA examination. That testing showed no evidence of carpal tunnel syndrome. Another EMG was conducted at the VA in 2015, and records indicate that testing also did not support a diagnosis of carpal tunnel syndrome. The Veteran was diagnosed with DeQuervian’s tenosynovitis. The November 2017 VA examiner explained that the Veteran has tendonitis of the wrists, which is a correction of the in-service diagnosis of carpal tunnel syndrome, which was given based only on clinical impression without the benefit of testing to confirm or refute the diagnosis. Although a preponderance of the evidence is against finding that the Veteran has carpal tunnel syndrome, the Board has considered whether her condition may be rated by analogy based on a similarity of symptoms and location. Diagnostic Code 8515 applies to paralysis of the median nerve, and provides for a 10 percent rating for mild symptoms involving the median nerve of either the major or minor side. With moderate symptoms involving the median nerve, a 30 percent rating is assignable for the major side, and a 20 percent rating is assignable for the minor side. With severe symptoms involving the median nerve, a 50 percent rating is assignable for the major side, and a 40 percent rating is assignable for the minor side. With complete paralysis of the median nerve, a 70 percent rating is assignable for the major side, and a 60 percent rating is assignable for the minor side. 38 C.F.R. § 4.124a (2017). Symptoms of complete paralysis of the median nerve are noted to include the hand inclined to the ulnar side, the index and middle fingers more extended than normally, considerable atrophy of the muscles of the thenar eminence, the thumb in the place of the hand (ape hand); pronation incomplete and defective, absence of flexion of index finger and feeble flexion of middle finger, cannot make a fist, index and middle fingers remain extended; cannot flex distal phalanx of thumb, defective opposition and abduction of the thumb, at right angles to palm; flexion of wrist weakened; and pain with trophic disturbances. Id. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120 (2017). Disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term incomplete paralysis indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124. Words such as “mild,” “moderate,” “severe” and “pronounced” are not defined in the VA Schedule for Rating Disabilities. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are “equitable and just.” 38 C.F.R. § 4.6 (2017). On VA examination in October 2010 the Veteran reported weakness, tremors, stiffness, numbness, paresthesias, and pain in her wrists. She reported trouble grabbing things, using tools, opening jars, lifting and carrying, and decreased manual dexterity. Reflex, sensory, and motor examinations were normal. At a January 2013 VA medical appointment she reported a recent decrease in grip strength and numbness in her left forearm and hand. On examination she was found to have 5/5 grip strength on her right and 4/5 grip strength on the left. Deep tendon reflexes were normal and sensation was intact bilaterally. A November 2013 VA treatment record the Veteran reported increased weakness in her right hand the last month with opening jars or using a keyboard and numbness at night. Sensory examination showed her right hand intact to light touch, vibration, temperature, and proprioception. Reflexes and muscle strength were both normal. Muscle normal. January 2014 VA treatment record lists the Veteran report of hand tinging and pain in the dorsal aspect of thumb, with some numbness and grip weakness. On sensory examination she was intact to light touch and pin throughout the upper extremities and deep tendon reflexes were normal. On VA examination in November 2014 the Veteran reported a loss of range of motion in her wrist, pain radiating through her palm, a loss of grip strength, and numbness. Range of motion testing was normal in her right and left wrists. There was no additional loss of function or range of motion on repetitive use testing. Pain, weakness, and fatigability or incoordination were not noted to significantly limit functional ability with repeated use over time or during flare-ups. A June 2015 VA occupational therapy evaluation noted the Veteran to have below average grip strength on her right and average grip strength on her left. Sensory testing was normal. She had normal hand, finger, and wrist motion with no tenderness on palpation or pain on motion. She was noted to have wrist and finger weakness. A July 2015 VA therapy record notes the Veteran to have a slight decrease in grip and maintained pinch grip strength in both hands. Sensory testing was normal. No wrist or finger weakness was observed. She had normal hand, finger, and wrist motion with no tenderness on palpation or pain on motion. On VA examination in November 2016 the Veteran was noted to have normal strength with wrist flexion and extension and normal sensory examination in her hands and fingers. On VA examination in November 2017 the Veteran reported cramping and increased pain with repetitive use. Muscle strength testing was normal. The examiner opined the Veteran would need to avoid prolonged repetitive action with her wrists, such as typing. The Board notes that the Veteran has voiced a number of subjective complaints with regard to her wrists and hands, including pain, numbness, and loss of grip strength. However, there is little objective evidence of hand and wrist symptoms. Sensory testing has repeatedly been normal. She has further generally been found to have normal muscle strength, with the only records suggesting an objective reduction in grip strength a January 2013 VA treatment record indicating a 4/5 grip strength on the left and a July 2015 occupational therapy record noting a slight decrease in grip strength bilaterally. The Board finds that with consideration of the nature and severity of all of the Veteran’s symptoms and their limited functional impact, her tendonitis most closely approximates mild symptomatology. Thus, even under Diagnostic Code 8515, a rating in excess of 10 percent is not warranted. Based on the forgoing, the Board finds that a rating in excess of 10 percent for either right or left wrist tendonitis is not warranted. REASONS FOR REMAND 1. Right and Left Hips The Veteran has undergone multiple VA examinations of her hips, including in October 2010, November 2014, and most recently in March 2017. Although the 2017 VA examiner stated that joint testing per Correia v. McDonald, 28 Vet. App. 158 (2016) was performed as medically appropriate, the examination report does not list range of motion testing with degrees of motion for active motion, passive motion, weightbearing, and nonweight-bearing or explain why it would not have been medically appropriate to perform such testing. Only one set of range of motion measurements are provided for each hip, pain is noted on motion, and no evidence of pain is noted on weight bearing. In Correia, the Court of Appeals for Veterans Claims held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Correia, 28 Vet. App. 158. Thus, the Court’s holding in Correia establishes additional requirements that must be met prior to finding that a VA examination is adequate. On remand, the Veteran should be afforded a new VA examination that includes all required testing. 2. Right Knee The Veteran has undergone multiple VA examinations of her right knee, including in October 2010, July 2015, and most recently in March 2017. Although the 2017 VA examiner stated that joint testing per Correia was performed as medically appropriate, the examination report does not list range of motion testing with degrees of motion for active motion, passive motion, weightbearing, and nonweight-bearing or explain why it would not have been medically appropriate to perform such testing. Only one set of range of motion measurements are provided for the right knee, pain is noted on motion, and no evidence of pain is noted on weight bearing. On remand, the Veteran should be afforded a new VA examination that includes all required testing. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination of the current severity of her bilateral hip disability. The examiner must test (and record) 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. 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). The evaluation must include whether the Veteran can cross her legs or “toe-out more than 15 degrees,” as this is a part of the rating criteria under Diagnostic Code 5253. The examiner should note the degree at which painful motion is observed, if painful motion is observed. 2. Schedule the Veteran for an examination of the current severity of her right knee disability. The examiner must test (and record) 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. 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). The examiner should note the degree at which painful motion is observed, if painful motion is observed. (Continued on Next Page) 3. Then, readjudicate the claims on appeal. ROMINA CASADEI Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Christensen