Citation Nr: 18157825 Decision Date: 12/13/18 Archive Date: 12/13/18 DOCKET NO. 16-24 367 DATE: December 13, 2018 ORDER 1. Entitlement to service connection for residuals of the removal of a cyst on the cranium is granted. 2. Entitlement to service connection for telangiectasia matting on nasal bridge is denied. 3. Entitlement to service connection for right shoulder pain to include impingement is denied. 4. Entitlement to service connection for cervical radiculopathy with numbness of the left upper extremity is denied. 5. Entitlement to service connection for cervical radiculopathy with numbness of the right upper extremity is denied. 6. Entitlement to an initial compensable rating for bilateral hearing loss is denied. 7. Entitlement to an initial compensable rating for of scars, left shoulder status post surgery and suprascapular nerve releases is denied. 8. Entitlement to an initial compensable rating for scars, right knee status post surgery is denied. 9. Entitlement to an initial compensable rating for scar, sternum from cyst removal is denied. 10. Entitlement to an initial compensable rating for tinea cruris is denied. REMANDED 1. Entitlement to an initial rating in excess of 10 percent for residuals, status post left clavicular resection with degenerative arthritis of the acromioclavicular joint is remanded. 2. Entitlement to an initial rating in excess of 10 percent for left hip bursitis with limited extension is remanded. 3. Entitlement to an initial rating in excess of 10 percent for left knee sprain with degenerative arthritis of the patellofemoral joint is remanded. 4. Entitlement to an initial rating in excess of 10 percent for residuals, right knee arthroscopy is remanded. 5. Entitlement to an initial rating in excess of 10 percent for left ankle sprain is remanded. 6. Entitlement to an initial rating in excess of 10 percent for right ankle sprain is remanded. 7. Entitlement to an initial rating in excess of 10 percent for cervical strain is remanded. 8. Entitlement to an initial rating in excess of 10 percent for thoracolumbar strain is remanded. 9. Entitlement to an initial compensable rating for left hip bursitis with limited flexion is remanded. FINDINGS OF FACT 1. The Veteran has a scar due to a cranium cyst removal during service. 2. The Veteran does not have telangiectasia matting on the nasal bridge. 3. The Veteran does not have right shoulder pain, impingement, causing functional impairment of earning capacity. 4. The Veteran does not have cervical radiculopathy, numbness, left upper extremity. 5. The Veteran does not have cervical radiculopathy, numbness, right upper extremity. 6. The Veteran has Level I hearing in his right ear and Level I hearing in his left ear. 7. The Veteran has five scars of the left shoulder status post surgery and suprascapular nerve releases, but none are painful or unstable. 8. The Veteran has three scars of the right knee status post surgery, but none are painful or unstable. 9. The Veteran has one scar of the sternum from a cyst removal which is not painful or unstable. 10. The Veteran’s tinea cruris affects 4 percent of a non-exposed surface of his body; intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, has not been required for a total duration of less than six weeks during the past 12-month period. CONCLUSIONS OF LAW 1. The criteria for service connection for a scar as a residual of a cyst on the cranium due to removal are met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 2. The criteria for service connection for telangiectasia matting on the nasal bridge are not met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 3. The criteria for service connection for right shoulder pain, impingement, are not met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 4. The criteria for service connection for cervical radiculopathy, numbness, left upper extremity, are not met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 5. The criteria for service connection for cervical radiculopathy, numbness, right upper extremity, are not met. 38 U.S.C. §§ 1110, 1113, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). 6. The criteria for an initial compensable evaluation for bilateral hearing loss disability are not met. 38 U.S.C. § 1155; 38 C.F.R. § 4.85, Part 4, Diagnostic Code 6100. 7. The criteria for an initial compensable rating for scars, left shoulder status post surgery and suprascapular nerve releases are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.118, Diagnostic Codes 7804, 7805. 8. The criteria for an initial compensable rating for scars, right knee status post surgery are not met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.118, Diagnostic Codes 7804, 7805. 9. The criteria for an initial compensable rating for scar, sternum from cyst removal. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.118, Diagnostic Codes 7804, 7805. 10. The criteria for an initial compensable rating for tinea cruris have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.118, Diagnostic Code 7813-7806. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from July 1989 to July 31, 2013. Service Connection Service connection will be granted if the evidence demonstrates that a current disability resulted from an injury or disease incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. 1. Entitlement to service connection for cyst on cranium removal. During service, in May 2004, the Veteran underwent a removal of a cyst on the cranium. Post-service, the Veteran was afforded a VA examination by VA in February 2014. With regard to the inservice cyst removal, the examiner indicated that since there was no current pathology, there was no current diagnosis. However, on the scar examination, the examiner noted that there was a scar which occasionally flaked and crusted. Thus, the clinical findings were not consistent with the overall lack of a diagnosis. Therefore, service connection for a scar due to a cranium cyst removal is warranted. 2. Entitlement to service connection for telangiectasia matting on nasal bridge. Although the Veteran had telangiectasia matting on the nasal bridge during service, he has not had this condition post-service. The February 2014 examination concluded that there was no current pathology and diagnosis. The Board concludes that the Veteran does not have a current diagnosis due to residuals of the removal of a cyst on the cranium of and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303(a), (d). The existence of a current disability is the cornerstone of a claim for VA disability compensation. See Degmetich v. Brown, 104 F. 3d 1328 (1997) (holding that the VA’s and the United States Court of Appeals for Veterans Claims’ (Court) interpretation of sections 1110 and 1131 of the statute as requiring the existence of a present disability for VA compensation purposes cannot be considered arbitrary and therefore the decision based on that interpretation must be affirmed). In Brammer v. Derwinski, 3 Vet. App. 223 (1992), the Court noted that Congress specifically limited entitlement for service-connected disease or injury to cases where such incidents had resulted in a disability. See also Rabideau v. Derwinski, 2 Vet. App. 141, 143 (1992); Gilpin v. Brown, 155 F.3d 1353 (Fed. Cir. 1998) (service connection may not be granted unless a current disability exists). In this case, there is no current disability. 3. Entitlement to service connection for right shoulder pain, impingement. In Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2009), the United States Court of Appeals for the Federal Circuit (Federal Circuit) found that the term “disability” as used in 38 U.S.C. § 1110 “refers to the functional impairment of earning capacity, not the underlying cause of said disability,” and held that “pain alone can serve as a functional impairment and therefore qualify as a disability.” Thus, where pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. Therefore, it must be determined if the Veteran has pain which is due at least in part to a service-related incident and, if so, it that pain reaches the level of functional impairment of earning capacity. In this case, the Veteran reported pain of the right shoulder in service. However, his post-service February 2014 examination not only reflected no current pathology, it reflected no pain on any objective testing and no functional impairment. In the absence of proof of a present disability-i.e., a functional impairment of earning capacity-there can be no valid claim. See Saunders, see also Brammer. 4. Entitlement to service connection for cervical radiculopathy, numbness, left upper extremity. 5. Entitlement to service connection for cervical radiculopathy, numbness, right upper extremity. The Veteran had inservice cervical complaints. Post-service, he was afforded a VA examination in February 2014. The Veteran did not have right or left cervical radiculopathy or numbness. Rather, the diagnosis was cervical sprain, which has been service-connected. Therefore, in the absence of proof of the present claimed disabilities, there can be no valid claim for right or left cervical radiculopathy, numbness. Rabideau v. Derwinski, 2 Vet. App. 141, 143- 44 (1992). Therefore, service connection for left and right cervical radiculopathy, numbness, is not warranted. Ratings Disability evaluations are determined by comparing a veteran’s present symptomatology with criteria set forth in the VA’s Schedule for Rating Disabilities (Rating Schedule), which is based on average impairment in earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings apply under a particular diagnostic code, the higher evaluation is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is reviewed when making disability evaluations. See generally, 38 C.F.R. 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). In deciding the Veteran’s higher rating claims, the Board has considered the determinations in Fenderson v. West, 12 Vet. App. 119 (1999) and Hart v. Mansfield, 22 Vet. App. 505 (2007), and whether the Veteran is entitled to an increased evaluation for separate periods based on the facts found during the appeal period. In Fenderson, the Court held that evidence to be considered in the appeal of an initial assignment of a rating disability was not limited to that reflecting the then current severity of the disorder. In that decision, the Court also discussed the concept of the “staging” of ratings, finding that, in cases where an initially assigned disability evaluation has been disagreed with, it was possible for a veteran to be awarded separate percentage evaluations for separate periods based on the facts found during the appeal period. Id. at 126. Hart appears to extend Fenderson to all increased rating claims. In general, all disabilities, including those arising from a single disease entity, are rated separately, and all disability ratings are then combined in accordance with 38 C.F.R. § 4.25. However, the evaluation of the same “disability” or the same “manifestations” under various diagnoses is not allowed. See 38 C.F.R. § 4.14. A claimant may not be compensated twice for the same symptomatology as “such a result would overcompensate the claimant for the actual impairment of his earning capacity.” Brady v. Brown, 4 Vet. App. 203, 206 (1993) (interpreting 38 U.S.C. § 1155). This would result in pyramiding, contrary to the provisions of 38 C.F.R. § 4.14. However, if a veteran has separate and distinct manifestations attributable to the same injury, they should be compensated under different diagnostic codes. See Esteban v. Brown, 6 Vet. App. 259 (1994); Fanning v. Brown, 4 Vet. App. 225, 230 (1993). 6. Entitlement to an initial compensable rating for bilateral hearing loss. In evaluating service-connected hearing impairment, disability ratings are derived by a mechanical application of the rating schedule to the numeric designations assigned after audiometric evaluations are rendered. See Acevedo-Escobar v. West, 12 Vet. App. 9, 10 (1998); Lendenmann v. Principi, 3 Vet. App. 345, 349 (1992). The schedule provides a table (Table VI) to determine a Roman numeral designation (I through XI) for hearing impairment. Testing for hearing loss is conducted by a state-licensed audiologist, including a controlled speech discrimination test (Maryland CNC). The evaluation is based upon a combination of the percent of speech discrimination and the puretone threshold average which is the sum of the pure tone thresholds at 1000, 2000, 3000 and 4000 Hertz, divided by four. See 38 C.F.R. § 4.85. Table VII in the schedule is used to determine the percentage evaluation by combining the Roman numeral designations for hearing impairment of each ear, the horizontal rows representing the ear having better hearing and the vertical columns the ear having the poorer hearing. The percentage evaluation is indicated where the row and column intersect. Table VIa is used when the examiner certifies that the use of speech discrimination test is not appropriate because of language difficulties, inconsistent speech discrimination scores, etc., or when indicated under the provisions of 38 C.F.R. § 4.86. See 38 C.F.R. § 4.85(c). When the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is 55 decibels or more, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. Each ear will be evaluated separately. See 38 C.F.R. § 4.86(a). When the puretone threshold is 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz, the rating specialist will determine the Roman numeral designation for hearing impairment from either Table VI or Table VIa, whichever results in the higher numeral. That numeral will then be elevated to the next higher Roman numeral. See 38 C.F.R. § 4.86(b). In conjunction with his claim, the Veteran was afforded a VA audiological examination in February 2014. On the authorized audiological evaluation, puretone thresholds, in decibels, were as follows: HERTZ \ 1000 2000 3000 4000 average RIGHT 15 15 35 50 28.75 LEFT 10 15 35 40 25 Speech audiometry revealed speech recognition ability of 100 percent in both ears. The examiner indicated that the Veteran had sensorineural hearing loss. The effect on occupational function was that the Veteran had difficulty hearing. Under the rating criteria, the examination results constitute Level I hearing in both ears. When considered together, the result is a noncompensable or 0 percent disability evaluation. Further, the Board finds that 38 C.F.R. § 4.86(a) is not for application because the puretone threshold at each of the four specified frequencies (1000, 2000, 3000, and 4000 Hertz) is not 55 decibels or more. The Board further finds that 38 C.F.R. § 4.86(b) is not for application as the puretone threshold is not 30 decibels or less at 1000 Hertz, and 70 decibels or more at 2000 Hertz. The Board acknowledges that the Veteran reported that he had difficulty hearing, however, the audiology examination yielded results warranting a noncompensable rating. Thus, while the Board has considered the Veteran’s assertions, the Board must accord greater weight to the objective clinical findings that continue to show that the Veteran’s hearing remains in the range of a noncompensable hearing loss under the Rating Schedule. In Martinak v. Nicholson, 21 Vet. App. 447 (2007) the Court held that in addition to dictating objective test results, a VA audiologist must fully describe the functional effects caused by a hearing disability in his or her final report. Martinak, 21 Vet. App. at 455. The Court also noted, however, that even if an audiologist’s description of the functional effects of the Veteran’s hearing disability was somehow defective, the Veteran bears the burden of demonstrating any prejudice caused by a deficiency in the examination. In this case, the VA examiner noted that the functional impact of the Veteran’s hearing loss was that the Veteran has difficulty hearing. The Board in no way discounts the difficulties that the Veteran experiences as a result of his hearing loss. However, as was explained above, the assignment of disability ratings for hearing impairment is derived by a mechanical application of the rating schedule to the numeric designation assigned after audiometry results are obtained. Hence, the Board has no discretion in this matter and must predicate its determination on the basis of the results of the audiology results of record. See Lendenmann. In other words, the Board is bound by law to apply VA’s rating schedule based on the Veteran’s audiometry results. See 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Scars Scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 are rated under Diagnostic Code 7805. Any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 should be evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.118. Diagnostic Code 7800 pertains to scars of the head, face, or neck. This Code provides that a skin disorder with one characteristic of disfigurement of the head, face, or neck is rated as 10 percent disabling. Note (1) to Diagnostic 7800 provides that the eight characteristics of disfigurement, for purposes of rating under 38 C.F.R. § 4.118, are: a scar five or more inches (13 or more cm.(centimeters)) in length; a scar at least one-quarter inch (0.6 cm.) wide at widest part; a scar in which the surface contour is elevated or depressed on palpation; a scar that is adherent to underlying tissue; the skin is shown to be hypo- or hyper-pigmented in an area exceeding six square inches (39 sq. cm.); skin texture is abnormal (irregular, atrophic, shiny, scaly, etc.) in an area exceeding six square inches (39 sq. cm.); there is underlying soft tissue missing in an area exceeding six square inches (39 sq. cm.); or the skin is indurated and inflexible in an area exceeding six square inches (39 sq. cm.). A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of one feature or paired set of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with two or three characteristics of disfigurement, warrants a 30 percent disability evaluation. A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of two features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with four or five characteristics of disfigurement, warrants a 50 percent disability evaluation. A skin disorder of the head, face, or neck with visible or palpable tissue loss and either gross distortion or asymmetry of three or more features or paired sets of features (nose, chin, forehead, eyes (including eyelids), ears (auricles), cheeks, lips), or; with six or more characteristics of disfigurement, warrants an 80 percent disability evaluation. Note (2) to Diagnostic Code 7800 provides that tissue loss of the auricle is to be rated under Diagnostic Code 6207 (loss of auricle), and anatomical loss of the eye under Diagnostic Code 6061 (anatomical loss of both eyes) or Diagnostic Code 6063 (anatomical loss of one eye), as appropriate. Note (3) provides that unretouched color photographs are to be taken into consideration when rating under these criteria. Note (4) provides that disabling effects other than disfigurement that are associated with individual scar(s) of the head, face, or neck, such as pain, instability, and residuals of associated muscle or nerve injury, should be separately evaluated under the appropriate diagnostic code(s) and 38 C.F.R. § 4.25 should be applied to combine the evaluation(s) with the evaluation assigned under this diagnostic code. Note (5) provides that the characteristic(s) of disfigurement may be caused by one scar or by multiple scars and the characteristic(s) required to assign a particular evaluation need not be caused by a single scar in order to assign that evaluation. 38 C.F.R. § 4.118, Diagnostic 7800. The Veteran’s scarring is not located in the head, face, or neck areas. Under Diagnostic Code 7801 burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are deep and nonlinear in an area or areas of at least 6 square inches (39 sq. cm.) but less than 12 square inches (77 sq. cm.), warrant a 10 percent rating. Note (1) provides that a deep scar is one associated with underlying soft tissue damage. Under Diagnostic Code 7802, burn scar(s) or scar(s) due to other causes, not of the head, face, or neck, that are superficial and nonlinear in an area or areas of 144 square inches (929 sq. cm.) or greater warrant a 10 percent evaluation. Note (1) provides that a superficial scar is one not associated with underlying soft tissue damage. As indicated below, the Veteran’s scars are not deep and nonlinear. Under Diagnostic Code 7804, one or two scars that are unstable or painful warrant a 10 percent evaluation. A 20 percent rating is assigned for three or four scars that are unstable or painful. A 30 percent rating is assigned for five or more scars that are unstable or painful. Note (1) provides that an unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. Note (2) provides that if one or more scars are both unstable and painful, 10 percent is added to the evaluation based on the total number of unstable or painful scars. Note (3) provides that scars evaluated under Diagnostic Codes 7800, 7801, 7802, or 7805 may also receive an evaluation under this diagnostic code when applicable. Under Diagnostic Code 7805, scars (including linear scars) and other effects of scars evaluated under Diagnostic Codes 7800, 7801, 7802, and 7804 are rated under Diagnostic Code 7805. Any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 should be evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.118. 7. Entitlement to an initial compensable rating for of scars, left shoulder status post surgery and suprascapular nerve releases. The Veteran was examined in February 2014. At that time, five scars were identified: (1) a surgical scar located on the left upper extremity, measuring 5 centimeters by .5 centimeter and was superficial and linear. The scar was not painful or unstable; (2) a surgical scar located on the left upper extremity, measuring 1 centimeter by .1 centimeter and was superficial and linear. The scar was not painful or unstable; (3) a surgical scar, located on the left upper extremity, measuring .8 centimeter by .1 centimeter and it was superficial and linear. The scar was not painful or unstable; (5) a surgical scar located on the left upper extremity, measuring .7 centimeter by .1 centimeter and was superficial and linear. The scar was not painful or unstable; and (5) a surgical scar located on the left upper extremity, measuring .5 centimeter by .1 centimeter which was superficial and linear. The scar was not painful or unstable. The Board has considered Diagnostic Code 7804. The Veteran has five scars, all superficial and linear. Because none of the scarring is painful or unstable, there is no basis for a compensable rating under this code. Since there is no other functional impairment due to the scars, a compensable rating is also not warranted under Diagnostic Code 7805. 8. Entitlement to an initial compensable rating for scars, right knee status post surgery. The Veteran examined in February 2014. At that time, three scars were identified: (1) a surgical scar located on the right lower extremity measuring .5 centimeter by .1 centimeter and was superficial and linear. The scar was not painful or unstable (2) a surgical scar located on the right lower extremity, measuring 1 centimeter by .1 centimeter and was superficial and linear. The scar is not painful or unstable; and (3) a surgical scar, located on the right lower extremity measuring .7 centimeter by .1 centimeter which was superficial and linear. The scar was not painful or unstable. The Board has considered Diagnostic Code 7804. The Veteran has three scars, all superficial and linear. Because none of the scarring is painful or unstable, there is no basis for a compensable rating under this code. Since there is no other functional impairment due to the scars, a compensable rating is also not warranted under Diagnostic Code 7805. 9. Entitlement to an initial compensable rating for scar, sternum from cyst removal. The Veteran examined in February 2014. At that time, one scar was identified: a surgical scar, located on the anterior trunk, measuring 1 centimeter by .2 centimeter and which was superficial and linear. The scar was not painful or unstable. The Board has considered Diagnostic Code 7804. The Veteran has one scar which is superficial and linear. Because the scar is not painful or unstable, there is no basis for a compensable rating under this code. Since there is no other functional impairment due to the scar, a compensable rating is also not warranted under Diagnostic Code 7805. 10. Entitlement to an initial compensable rating for tinea cruris. The Veteran’s skin disorder is rated under Diagnostic Code 7813-7806. Diagnostic Code 7813 is rated as disfigurement of the head, face, or neck; scars; or dermatitis, depending upon the predominant disability, as indicated above. 38 C.F.R. § 4.118. The affected areas are the thighs and buttocks, not the head, face, or neck. Under Diagnostic Code 7806, a 60 percent rating is assigned when more than 40 percent of the entire body or more than 40 percent of exposed areas are affected or; constant or near- constant systemic therapy is required during a 12-month period. A 30 percent rating is assigned where 20 to 40 percent of the entire body or 20 to 40 percent of exposed areas are affected, or; systemic therapy is required for a total duration of six weeks or more, but not constantly, during a 12-month period. A 10 percent rating is assigned where at least 5 percent, but less than 20 percent, of the entire body is affected; or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, is required for a total duration of less than six weeks during the past 12-month period. A noncompensable evaluation is assigned when less than 5 percent of the entire body or less than 5 percent of exposed areas are affected, and; no more than topical therapy was required during the past 12-month period. 38 C.F.R. 4.118, Diagnostic Code 7806. In February 2014, the Veteran was examined. At that time, it was noted that the Veteran had not been treated with oral or topical medications in past year. He also had not undergone any treatment or procedures. There had not been any debilitating or non-debilitating episodes. The total area affected in the form of a hyperpigmented rash was 4 percent located on the non-exposed area of the inner thighs. A 10 percent rating is assigned where at least 5 percent, but less than 20 percent, of the entire body is affected; or at least 5 percent, but less than 20 percent, of exposed areas are affected, or; intermittent systemic therapy, such as corticosteroids or other immunosuppressive drugs, is required for a total duration of less than six weeks during the past 12-month period. The Board notes that while skin conditions may wax and wane intermittently, the post-service evidence including the February 2014 examination does not show that the required criteria were met at any time post-service. See Ardison v. Brown, 6 Vet. App. 405, 408 (1994). Accordingly, a higher compensable rating is not warranted. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for residuals, status post left clavicular resection with degenerative arthritis of the acromioclavicular joint. 2. Entitlement to an initial rating in excess of 10 percent for left hip bursitis with limited extension. 3. Entitlement to an initial rating in excess of 10 percent for left knee sprain with degenerative arthritis of the patellofemoral joint. 4. Entitlement to an initial rating in excess of 10 percent for residuals, right knee arthroscopy. 5. Entitlement to an initial rating in excess of 10 percent for left ankle sprain. 6. Entitlement to an initial rating in excess of 10 percent for right ankle sprain. 7. Entitlement to an initial rating in excess of 10 percent for cervical strain. 8. Entitlement to an initial rating in excess of 10 percent for thoracolumbar strain. 9. Entitlement to an initial compensable rating for left hip bursitis with limited flexion. For the Veteran’s service-connected orthopedic disabilities, he has claimed higher ratings. A review of the February 2014 examination reflects that recent Court directives were not complied with in that examination. The Court issued directives regarding VA examinations in Correia v. McDonald, 28 Vet. App. 158 (2016) indicating that the examiner should specifically test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing, and that the opposite joint should also be tested if undamaged. The most recent examination did not show limitation of motion, but passive motion was not assessed and nonweight-bearing was not assessed so the VA examination was inadequate per Correia. The Board further notes that in Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court explained that “the VA Clinician’s Guide instructs examiners when evaluating certain musculoskeletal conditions to obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from a veteran, including during flare-ups. The examiners should elicit relevant information as to a veteran’s flares with a description of the additional functional loss, if any, a veteran suffers during flares. The examiner should estimate a veteran’s functional loss due to flare-ups based on all the evidence of record-including the lay information or sufficiently explain why the examiner cannot do so. Additional examination is warranted in this regard. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the nature and extent of his service-connected left shoulder, left hip, bilateral ankle, bilateral knee, cervical, and thoracolumbar disabilities. The examiner should review the record prior to examination. The examination should be performed in accordance with the Disability Benefits Questionnaire (DBQ) of equivalent. The DBQ should be filled out completely as relevant. The examiner should specifically test the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. If undamaged, the opposite joint should also be tested. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flare-ups from the Veteran. The examiner should elicit relevant information as to the Veteran’s flares with a description of the additional functional loss, if any, the Veteran has during flares. The examiner should estimate the Veteran’s functional loss due to flares based on all the evidence of record-including the lay information or sufficiently explain why the examiner cannot do so. Any opinions expressed by the examiner must be accompanied by a complete rationale. 2. Review the medical opinion obtained above to ensure that the remand directives have been accomplished. If all questions posed are not answered or sufficiently answered, the case should be returned to the examiner for completion of the inquiry. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Connolly, Counsel