Citation Nr: 18154311 Decision Date: 11/29/18 Archive Date: 11/29/18 DOCKET NO. 16-09 190 DATE: November 29, 2018 REMANDED Entitlement to a rating in excess of 10 percent for a left knee disability is remanded. Entitlement to a rating in excess of 10 percent for a right knee disability is remanded. Entitlement to service connection for a low back disability, to include as secondary to service-connected bilateral knee disabilities is remanded. Entitlement to service connection for a left hip disability, to include as secondary to service-connected bilateral knee disabilities is remanded. Entitlement to service connection for a right hip disability, to include as secondary to service-connected bilateral knee disabilities is remanded. Entitlement to service connection for a left ankle disability, to include as secondary to service-connected bilateral knee disabilities is remanded. Entitlement to service connection for a right ankle disability, to include as secondary to service-connected bilateral knee disabilities is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, had service from October 2001 to February 2002. In May 2018, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge (VLJ); a transcript of the hearing is associated with the claims file. Entitlements to a rating in excess of 10 percent for left and right knee disabilities, as well as entitlements to service connection for low back, left hip, left ankle, right hip, and right ankle disabilities, all to include as secondary to service-connected bilateral knee disabilities are remanded. The Veteran testified before the undersigned in May 2018 and explained that his bilateral knee disabilities have worsened since the last VA examination in February 2018. Specifically, he described frequent episodes of instability and his knees giving out that are not documented in prior VA examinations. However, the Board is without the expertise necessary to determine the extent of worsened symptoms exhibited by the Veteran’s disability. “VA regulations specifically require the performance of a new medical examination ... [when] ‘evidence indicated there has been a material change in a disability or that the current rating may be incorrect.’” Caffrey v. Brown, 6 Vet. App. 377, 381 (quoting 38 C.F.R. § 3.327(a)) (1994). As there is evidence indicating that the Veteran’s conditions have worsened since his last VA examination of record, the Board finds that the Veteran’s claims should be remanded to provide him with an updated examination to accurately assess the current condition of these disabilities. In claims for a rating increase, it is first and foremost a priority to ensure that the most current assessment of the service-connected disability picture is of record. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991). The Veteran also testified that his service connection claims on appeal are exclusively secondary to the service-connected bilateral knee disabilities and did not begin in service. The July 2012 VA examination and November 2012 addendum opinion noted that the Veteran’s low back, bilateral hip, and bilateral ankle disabilities showed pain on range of motion, but did not reveal any abnormal diagnostic findings or diagnosis. The examiner did not discuss whether the pain shown on range of motion testing for any claimed disability reached the level of functional impairment of earning capacity. Saunders v. Wilkie, 886 F.3d 1356 (2018). Without further clarification, the Board is without medical expertise to determine the nature and etiology of the claimed disabilities. Colvin v. Derwinski, 1 Vet. App. 171 (1991). In light of the above, the Board finds that new VA examination opinions must be obtained for these disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral knee disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the left and right knee disabilities alone and discuss the individual effect of the Veteran’s left and right knee disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left and right hip disability. The examiner must opine on the following: (a.) whether it is at least as likely as not proximately due to a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of left and right hip disabilities. (b.) whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of left and right hip disabilities. (c.) if there is no diagnosed disability, is it at least as likely as not that any pain reaches the level of a functional impairment of earning capacity? Describe any impairment caused. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left and right ankle disability. The examiner must opine on the following: (a.) whether it is at least as likely as not proximately due to a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of left and right ankle disabilities. (b.) whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of left and right ankle disabilities. (c.) if there is no diagnosed disability, is it at least as likely as not that any pain reaches the level of a functional impairment of earning capacity? Describe any impairment caused 4. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any low back disability. The examiner must opine on the following: (a.) whether it is at least as likely as not proximately due to a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of a low back disability. (b.) whether it is at least as likely as not aggravated beyond its natural progression by a service-connected disability. The examiner should discuss the relationship, if any, between the Veteran’s claimed gait alteration due to the service-connected left and right knee disabilities and the development of a low back disability. (c.) if there is no diagnosed disability, is it at least as likely as not that any pain reaches the level of a functional impairment of earning capacity? Describe any impairment caused. H. SEESEL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Connally, Counsel