Citation Nr: 18158128 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 14-35 348A DATE: December 14, 2018 ORDER New and material evidence has been received to reopen a claim for entitlement to service connection for a short left leg. To that extent only, the appeal is granted. Entitlement to service connection for a short left leg is granted. Entitlement to service connection for sciatica is denied. Entitlement to an effective date earlier than May 2, 2011 for the award of the grant of service connection for retropatellar left knee syndrome is denied. Entitlement to an effective date earlier than March 27, 2013 for the award of the grant of service connection for scars on the lateral side of both feet is granted. REMANDED Whether new and material evidence has been received to reopen a claim for entitlement to service connection for scoliosis of the lumbar spine is remanded. Entitlement to an evaluation in excess of 20 percent for thoracic strain with scoliosis is remanded. Entitlement to an evaluation in excess of 10 percent for post-operative right knee meniscectomy is remanded. Entitlement to an initial evaluation in excess of 10 percent for retropatellar left knee syndrome is remanded. Entitlement to an evaluation in excess of 20 percent for status post closed wedge osteotomy, left fifth metatarsal, with screw fixation is remanded. Entitlement to an evaluation in excess of 20 percent for status post closed wedge osteotomy, right fifth metatarsal, with screw fixation is remanded. Entitlement to an initial compensable evaluation for scars on the lateral side of both feet is remanded. Entitlement to an evaluation in excess of 50 percent for bilateral flat feet is remanded. Entitlement to a compensable evaluation for status post septorhinoplasty for deviated nasal septum is remanded. Entitlement to an evaluation in excess of 20 percent for hypertension is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. In an April 1999 rating decision, the RO denied the Veteran’s petition to reopen a claim for service connection for a shortened left leg; the Veteran did not submit a Notice of Disagreement (NOD), no new and material evidences was received within one year of the decision, and the decision became final. 2. The evidence received since the April 1999 rating decision is not cumulative or redundant of the evidence of record, does relate to an unestablished fact, and does raise a reasonable possibility of substantiating the Veteran’s claim of entitlement to service connection for a short left leg. 3. Resolving all reasonable doubt in favor of the Veteran, the evidence is at least in equipoise that his currently diagnosed left leg length discrepancy began during active duty service. 4. The competent and credible evidence demonstrates that the Veteran does not have a current diagnosis for sciatica. 5. In March 1995, the Veteran filed a claim for service connection for left knee pain, which was denied in a December 1995 rating decision; the Veteran did not appeal that decision, and it became final. 6. On May 2, 2011, the RO received the Veteran’s petition to reopen a claim for service connection for a left knee disability; there was no communication prior to May 2, 2011 that could be construed as an informal or formal claim for entitlement to service connection for a left knee disability. 7. Resolving all reasonable doubt in favor of the Veteran, the implicit claim for scars on the lateral side of both feet was received on September 9, 2011. CONCLUSIONS OF LAW 1. The April 1999 rating decision that denied the petition to reopen the claim for entitlement to service connection for shortened left leg is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 20.302, 20.1103. 2. New and material evidence has been received to reopen the claim of entitlement to service connection for a short left leg. 38 U.S.C. § 5108; 38 C.F.R. § 3.156. 3. The criteria for entitlement to service connection for a short left leg have been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 4. The criteria for entitlement to service connection for sciatica have not been met. 38 U.S.C. §§ 1110, 1131, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. 5. The criteria for entitlement to an effective date earlier than May 2, 2011 for the award of the grant of service connection for retropatellar left knee syndrome have not been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 3.400. 6. The criteria for entitlement to an effective date as of September 9, 2011 for the award of the grant of service connection for scars on the lateral side of both feet have been met. 38 U.S.C. §§ 5103, 5103A, 5107, 5110; 38 C.F.R. §§ 3.102, 3.159, 3.400. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the U.S. Army from February 1986 to May 1986 and in the U.S. Navy from March 1988 to January 1995. These matters come before the Board of Veterans’ Appeals (Board) on appeal from rating decisions in August 2011, February 2012, August 2014, and October 2016 by the Department of Veterans Affairs (VA) Regional Office (RO). In the August 2011 rating decision, the RO denied a higher than 20 percent evaluation for hypertension; denied service connection for sciatica; and denied reopening the claims for scoliosis of the thoracic spine, scoliosis of the lumbar spine, and a left knee disability. The Veteran appealed that decision. In the February 2012 rating decision, the RO denied a higher than 20 percent evaluation for thoracic strain; denied a higher than 50 percent evaluation for bilateral flat feet; denied a higher than 20 percent evaluation for status post closed wedge osteotomy, left fifth metatarsal, with screw fixation; denied a higher than 20 percent evaluation for status post closed wedge osteotomy, right fifth metatarsal, with screw fixation; denied a higher than 20 percent evaluation for hypertension; denied a higher than 10 percent evaluation for post-operative right knee meniscectomy; denied a compensable evaluation for status post septorhinoplasty for deviated nasal septum; and denied a TDIU. The Veteran appealed that decision. In the August 2014 rating decision, the RO denied reopening the claim for service connection for a short left leg; granted service connection for retropatellar left knee syndrome and assigned a 10 percent evaluation, effective May 2, 2011; granted service connection for scoliosis of the thoracic spine; recharacterized the service-connected disability as thoracic strain with scoliosis; and denied a higher than 20 percent evaluation for thoracic strain with scoliosis. The Veteran appealed for service connection for a short left leg, a higher initial evaluation and earlier effective date for retropatellar left knee syndrome; and a higher evaluation for thoracic strain with scoliosis. In the October 2016 rating decision, the RO granted service connection for scars on the lateral side of both feet and assigned a noncompensable evaluation, effective March 27, 2013. The Veteran appealed for a higher initial evaluation and an earlier effective date. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a May 2018 videoconference hearing. The Board notes that the VLJ took testimony on the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for scoliosis of the lumbar spine. However, a careful review of the record shows that in the August 2014 rating decision, the RO granted service connection for scoliosis of the thoracic spine. The RO indicated that it considered this to be a full grant of the benefits sought on appeal. At the time of the August 2014 rating decision, no statement of the case (SOC) had been issued addressing the Veteran’s service connection claim for scoliosis of the lumbar spine. Therefore, the Board finds that although testimony was taken on the Veteran’s service connection claim for scoliosis of the lumbar spine, that issue has not yet been perfected. Given that further action by the RO is required before the Board can address this issue, a remand is required as discussed below. In May 2018, the Veteran submitted additional evidence in support of his appeal along with a signed waiver of RO consideration of evidence. The Board accepts this evidence for inclusion in the record. See 38 C.F.R. § 20.1304. Duties to Notify and Assist Pursuant to the Veterans Claims Assistance Act (VCAA), VA has duties to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C. §§ 5102, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.156(a), 3.159. Neither the Veteran nor his representative has raised any issues with the duty to notify or duty to assist. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board . . . to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). New and Material Evidence 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for a short left leg Rating actions are final and binding based on evidence on file at the time the claimant is notified of the decision and may not be revised on the same factual basis except by a duly constituted appellate authority. 38 C.F.R. § 3.104(a). The claimant has one year from notification of an RO decision to initiate an appeal by filing a notice of disagreement (NOD) with the decision, and the decision becomes final if an appeal is not perfected within the allowed time period. 38 U.S.C. § 7105(b) and (c); 38 C.F.R. §§ 3.160(d), 20.200, 20.201, 20.202, 20.302(a). If new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. New evidence means existing evidence not previously submitted to agency decisionmakers. Material evidence means existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). The United States Court of Appeals for Veterans Claims (Court) has held that the determination of whether newly submitted evidence raises a reasonable possibility of substantiating the claim should be considered a component of the question of what is new and material evidence, rather than a separate determination to be made after the Board has found that evidence is new and material. See Shade v. Shinseki, 24 Vet. App. 110 (2010). The Court further held that new evidence would raise a reasonable possibility of substantiating the claim if, when considered with the old evidence, it would at least trigger the Secretary’s duty to assist by providing a medical opinion. Id. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence is to be presumed. Justus v. Principi, 3 Vet. App. 510, 513 (1992). In a December 1995 rating decision, the RO denied the Veteran’s original claim for service connection for functional short leg, because service medical records did not show findings regarding the claimed disability and a discrepancy in leg length is not considered to be related to service unless it is shown that some injury or disease caused the shortening of the leg. That decision is final. In an April 1999 rating decision, the RO denied the Veteran’s petition to reopen a claim for service connection for shortened left leg, because there was no evidence of a permanent residual or chronic disability subject to service connection. That decision is final. Since the Veteran’s last prior final denial in April 1999, the record includes a July 2013 private treatment record reflecting that the Veteran had a left leg length discrepancy. The Board finds that this evidence is new as it was not previously of record and tends to relate to a previously unestablished fact necessary to substantiate the underlying claim of service connection. The July 2013 private treatment record will be presumed credible for the purpose of reopening the claim. Consequently, the claim of entitlement to service connection for a short left leg is reopened. Service Connection Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Generally, service connection requires: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). Service connection may also be granted for any disease diagnosed after discharge when the evidence establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). 2. Entitlement to service connection for a short left leg At the Veteran’s May 2018 Board hearing, he testified that he noticed that he had a left leg length discrepancy after his in-service slip and fall accident. The question before the Board is whether the Veteran’s short left leg is etiologically related to his active duty service. Based on a careful review of all the subjective and clinical evidence, and resolving all reasonable doubt in favor of the Veteran, the evidence is at least in equipoise that his currently diagnosed left leg length discrepancy began during his active duty service. The evidence shows that the Veteran has a diagnosis for a left leg length discrepancy. See July 2013 private treatment record. In February 1988, the Veteran’s entrance examination did not indicate that he had any leg length discrepancies. According to a September 1994 service treatment record (STR), a biomechanical examination revealed that the Veteran had a persistent recurrence of functional left short leg by one inch. Following service, the Veteran’s private physician, in a November 1996 letter, noted that his left leg measured two inches shorter than his right leg. The private physician found that the condition, diagnosed as functional short leg syndrome, could be contributed to a history of chronic thoracic myofascial strain syndrome, which was being treated during service, and believed to be of a mechanical back origin caused by an injury to the Veteran’s thoracic spine. In a February 1999 VA examination, the VA examiner found no current evidence of a leg length discrepancy. However, the VA examiner noted that there was no evidence of a congenital or developmental condition to account for the previous condition of the Veteran’s legs. In a subsequent August 1999 VA examination, the VA examiner found that the Veteran had a limb length discrepancy where his right limb was one centimeter (cm.) greater than the left. In a June 2000 Disability Evaluation, the examiner found that the Veteran’s left leg was three-quarters of an inch shorter than his right leg. At a July 2002 VA examination, the VA examiner found that the Veteran had a notable leg length discrepancy where his left leg was shorter than his right leg by 1.5 cm. Private treatment records in 2012 and 2013 document that the Veteran continued to have a left leg length discrepancy. The Board finds that the evidence documents that the Veteran’s functional short left leg was diagnosed during service. Further, the clinical evidence shows that his left leg length discrepancy was a mechanical, not a congenital or developmental, condition. Finally, the evidence demonstrates that the Veteran’s short left leg continued following service. In summary, resolving all reasonable doubt in favor of the Veteran, and taking into consideration the totality of the evidence, the Board finds that the evidence is at least in equipoise that his current left leg length discrepancy began during his active duty service. Therefore, the Veteran’s service connection claim for a short left leg must be granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 3. Entitlement to service connection for sciatica At the Veteran’s June 2014 Decision Review Officer (DRO) hearing, he testified that his sciatica problem developed within one or two years of his problems with his feet, upper back, and right knee. The question before the Board is whether the Veteran has a current diagnosis for sciatica. Based on a careful review of all the subjective and clinical evidence, the Board finds that the preponderance of the evidence weighs against finding service connection for sciatica is warranted. The Veteran’s STRs do not document any findings related to any complaints, treatment, or diagnosis for any peripheral nerve problems. In an August 2000 VA treatment record, the VA treating physician documents that the Veteran had no neurologic deficit. According to an August 2002 VA electromyography (EMG) study, there was no electrodiagnostic evidence of peripheral neuropathy. At an October 2011 VA clinic visit, the Veteran complained of left and right leg pain from his buttock to the calf. The VA treating physician noted that the Veteran had bilateral lower extremity radicular pain without focal neurological deficit and normal lumbar spine x-rays conducted in November 2010. In October 2011, the Veteran underwent a VA spine examination. No complaints of radiating pain were made. The VA examiner found that the Veteran had normal sensory examination results, normal reflexes and muscle strength testing results, and negative straight leg raising test results bilaterally. No radiculopathy was found. At a November 2011 VA clinic visit, the Veteran continued to report having bilateral lower extremity radiculopathy. No objective findings were made. July 2013 and August 2013 private treatment records document the Veteran’s reported symptoms of radiating pain down his bilateral lower extremities. In August 2014, the Veteran was afforded a VA spine examination. The Veteran did not indicate that he was experiencing symptoms of radiating pain. Objective findings showed that the Veteran had normal muscle strength and reflexes, normal sensory examination results, and a negative straight leg raising test bilaterally. The VA examiner found no evidence of radiculopathy. Noting that the Veteran had a normal EMG in August 2002, the VA examiner found no nerve root compression or sciatica in the current examination. At his most recent VA spine examination in July 2016, the Veteran continued to present with normal muscle strength, reflexes and sensory examination results. Straight leg raising test results were negative bilaterally. No radiculopathy was found. No reports of bilateral lower extremity pain were documented. In a recent case, Saunders v. Wilkie, 888 F.3d 1356 (Fed. Cir. 2018), the U.S. Court of Appeals for the Federal Circuit (Federal Circuit) held that pain can constitute a disability under 38 U.S.C. § 1110. However, the Federal Circuit did not hold that the Veteran could demonstrate service connection simply by asserting subjective pain. Rather, to establish a disability, the Veteran’s pain must amount to a functional impairment. The Federal Circuit held that to establish the presence of a disability, the Veteran will need to show that his or her pain reaches the level of a functional impairment of earning capacity. Id. at 28. The Board finds that in this case, the decision in Saunders can be distinguished from the facts of this case. Here, although there are sporadic reports of bilateral lower extremity radiating pain found in VA and private treatment records, the findings at the Veteran’s multiple VA examinations consistently show no objective evidence to support that the Veteran has a diagnosis of sciatica. Further, it is notable that the Veteran did not complain of his sciatica at his VA examinations. Finally, at those clinic visits and even at his June 2014 DRO hearing, where the Veteran did report having radiating lower extremity pain, he did not indicate the extent to which he experienced any functional impairment due to his pain. Accordingly, the Board finds that the Veteran’s reported sciatica does not amount to a functional impairment of earning capacity, and Saunders is not applicable in this case. The Veteran is certainly competent to report his history of bilateral lower extremity pain, and any treatment that he may have undergone. Layno v. Brown, 6 Vet. App. 465, 470 (1994). However, the Veteran has not presented any competent and credible evidence of a current diagnosis for sciatica, and the available evidence does not support that the Veteran has any persistent symptomatology that would suggest that he has an underlying chronic disability. No underlying disability has been clinically diagnosed during the appeal period or proximate thereto. McClain v. Nicholson, 21 Vet. App. 319 (2007); Romanowsky v. Shinseki, 26 Vet. App. 289 (2013). In summary, the preponderance of the evidence weighs against finding in favor of the Veteran’s service connection claim for sciatica. Therefore, the benefit-of-the-doubt rule applies, and the service connection claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Effective Date Generally, the effective date of an award of a claim is the date of receipt of the claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110 (a); 38 C.F.R. § 3.400. The effective date of an award of disability compensation based on new and material evidence under 38 C.F.R. § 3.156 (other than service department records) which is received within the appeal period or prior to the appellate decision shall be as though the former decision had not been rendered. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(q)(1). In cases where the evidence is received after a final disallowance, the effective date shall be the date of receipt of the new claim or the date entitlement arose, whichever is later. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(q)(2). Similarly, the effective date of an award of disability compensation based on a reopened claim under the provisions of 38 C.F.R. §§ 3.109, 3.156, 3.157, and 3.160(e) shall be the date of receipt of the claim or the date entitlement arose, whichever is later. 38 C.F.R. § 3.400(r). A finally adjudicated claim is an application, formal or informal, which has been allowed or disallowed by the agency of original jurisdiction and the action having become final by the expiration of 1 year after the date of notice of the disallowance, or by denial on appellate review, whichever is the earlier. 38 C.F.R. § 3.160(d) (2014). A reopened claim is any application for a benefit received after final disallowance of an earlier claim. 38 C.F.R. § 3.160(e) (2014). VA has amended the regulations concerning the filing of claims, including no longer recognizing informal claims and eliminating the provisions of 38 C.F.R § 3.157. See Fed. Reg. 57,660, 57,695 (Sept. 25. 2014). The amendments, however, are only effective for claims and appeals filed on or after March 24, 2015. As the claim at issue in the appeal was filed before these amendments, the prior regulatory provisions apply. The date of receipt of a claim is the date on which a claim, information, or evidence is received by VA. 38 C.F.R. § 3.1(r) (2014). A claim is a formal or informal communication in writing requesting a determination of entitlement, or evidencing a belief in entitlement, to a benefit. 38 C.F.R. §§ 3.1(p), 3.155 (2014). The regulation which governs informal claims, 38 C.F.R. § 3.155, provides that any communication or action, indicating an intent to apply for one or more benefits under the laws administered by [VA], from a claimant...may be considered an informal claim. Such informal claim must identify the benefit sought. Id. When a claim has been filed that meets the requirements of 38 C.F.R. § 3.151 or 3.152, an informal request for increase or reopening will be accepted as a claim. 4. Entitlement to an effective date earlier than May 2, 2011 for the award of the grant of service connection for retropatellar left knee syndrome The Veteran generally asserts that he warrants an earlier effective date for his retropatellar left knee syndrome. On March 27, 1995, the RO received the Veteran’s initial claim for entitlement to service connection for left knee pain. This initial claim was denied in a December 1995 rating decision. The Veteran did not submit a NOD to the December 1995 rating decision, and the decision became final and binding on him based on the evidence of record. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104(a), 3.160(d); 20.200, 20.302, 20.1103. On May 2, 2011, the RO received an informal request from the Veteran to reopen his previously denied claim for service connection for a left knee disability. This claim was subsequently granted in an August 2014 rating decision and assigned an effective date of May 2, 2011. The Veteran disagreed with the decision and appealed for an earlier effective date. There was no communication, either formal or informal, prior to May 2, 2011 that constitutes as a claim for service connection for a left knee disability, and the Veteran has not otherwise established that there exists any such claim. The Board is sympathetic to the Veteran’s assertions that his left knee disability began during service. However, the record shows that the Veteran did not appeal the initial denial of his claim in 1995, and he does not dispute that he received proper notification of the December 1995 rating decision. Moreover, since his initial claim was denied in December 1995, the Veteran did not submit any communication which evidenced his intention to file an application for benefits prior to May 2, 2011. According to applicable regulation, the effective date of the grant of service connection for a left knee disability can be no earlier than May 2, 2011, the date of the receipt of his petition to reopen his previously disallowed final claim. 38 C.F.R. § 3.400(q)(2). The pertinent legal authority governing effective dates is clear and specific, and the Board is bound by that authority. The Board finds that the preponderance of the evidence is against the assignment of an effective date for the grant of service connection for retropatellar left knee syndrome earlier than May 2, 2011. Thus, since the Board finds no legal basis for the assignment of any earlier effective date, the claim must be denied. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 5. Entitlement to an effective date earlier than March 27, 2013 for the award of the grant of service connection for scars on the lateral side of both feet The Veteran generally asserts that he warrants an earlier effective date for his scars on the lateral side of both feet. The Board agrees. Here, the record does not indicate that the Veteran filed an explicit claim for service connection for scars on both feet. Instead, service connection was awarded in an October 2016 rating decision in connection with the findings of a March 2013 VA examination, which was conducted in connection with an increased rating claim for his status post closed wedge osteotomy, bilateral metatarsals, with screw fixation. The Veteran’s increased rating claim for his status post closed wedge osteotomy, bilateral metatarsals, with screw fixation, was filed on September 9, 2011. The RO determined that the March 2013 VA examination found small, stable, and non-painful scars on both feet. The Veteran was awarded service connection for scars on the lateral side of both feet effective March 27, 2013, the date of the VA examination. Given that the relevant appeal period for the implicit service connection claim for scars on both feet stemmed from the Veteran’s increased rating claim for status post closed wedge osteotomy, bilateral metatarsals, with screw fixation, which was filed on September 9, 2011, the Board considered whether there was any medical evidence earlier than March 2013 that showed scarring of both feet. A careful review of the record shows that the Veteran’s scarring of both feet was found in an earlier VA examination in October 2011. Upon further review of the record, the Board also found that at a June 1995 VA examination, scars of surgical procedures medially on both feet were identified. In this case, the implicit date of receipt of the claim (September 9, 2011) is later than the date entitlement arose (June 1995); thus, the earliest effective date permitted by law for the Veteran’s scarring on the lateral side of both feet is as of September 9, 2011. Resolving all reasonable doubt in favor of the Veteran, the Board concludes that the evidence demonstrates that the implicit date of receipt of claim for scarring on the lateral side of both feet was on September 9, 2011, but no earlier. In summary, the Veteran’s claim for an effective date as of September 9, 2011, but no earlier, for the award of the grant of service connection for scarring on the lateral sides of both feet is granted. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). REASONS FOR REMAND 1. Whether new and material evidence has been received to reopen a claim for entitlement to service connection for scoliosis of the lumbar spine is remanded. As discussed above, in an August 2011 rating decision, the RO denied reopening the service connection claim for scoliosis of the lumbar spine. In a March 2012 NOD, the Veteran appealed for service connection for scoliosis of the lumbar spine. However, a careful review of the record shows that the RO has not issued a SOC with regard to the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for scoliosis of the lumbar spine. See Manlincon v. West, 12 Vet. App. 238 (1999). Therefore, this matter is remanded for issuance of a SOC. 2. Entitlement to an evaluation in excess of 20 percent for thoracic strain with scoliosis is remanded. The Veteran’s last VA examination for his service-connected thoracic strain with scoliosis was in July 2016. At the Veteran’s May 2018 Board hearing, he testified that since his last VA examination, his thoracic spine had worsened. In particular, he reported that his range of motion had decreased, he could not bend over, and in order to pick up items, he had to brace himself with a table and stoop down. He also experienced back spasms. VA is required to afford the Veteran a contemporaneous VA examination to assess the current nature, extent, and severity of his service-connected disabilities. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. § 3.326(a). As the evidence suggests that the Veteran’s thoracic strain with scoliosis may have worsened since his last VA examination, a remand is required to determine the current severity of his service-connected disability. 3. Entitlement to an evaluation in excess of 10 percent for post-operative right knee meniscectomy is remanded. 4. Entitlement to an initial evaluation in excess of 10 percent for retropatellar left knee syndrome is remanded. The Veteran’s last VA examination for his service-connected post-operative right knee meniscectomy and retropatellar left knee syndrome was in July 2016. At the Veteran’s May 2018 Board hearing, he testified that since his last VA examination, his bilateral knee disabilities had worsened. In particular, he reported having a limited range of motion, which was worse on the right, but his left knee had been worsening. His primary care doctor recommended that he undergo a left knee meniscectomy. His right knee gave out more than the left knee. He experienced left knee catching. Due to his bilateral knee symptoms, he has fallen. VA is required to afford the Veteran a contemporaneous VA examination to assess the current nature, extent, and severity of his service-connected disabilities. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. § 3.326(a). As the evidence suggests that the Veteran’s service-connected bilateral knee disabilities may have worsened since his last VA examination, a remand is required to determine the current severity of his service-connected disabilities. 5. Entitlement to an evaluation in excess of 20 percent for status post closed wedge osteotomy, left fifth metatarsal, with screw fixation is remanded. 6. Entitlement to an evaluation in excess of 20 percent for status post closed wedge osteotomy, right fifth metatarsal, with screw fixation is remanded. 7. Entitlement to an evaluation in excess of 50 percent for bilateral flat feet is remanded. The Veteran’s last VA examination for his service-connected status post closed wedge osteotomy, bilateral metatarsals, with screw fixation and bilateral flat feet was in July 2016. At the Veteran’s May 2018 Board hearing, he testified that since his last VA examination, his service-connected bilateral foot disabilities had worsened. VA is required to afford the Veteran a contemporaneous VA examination to assess the current nature, extent, and severity of his service-connected disabilities. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. § 3.326(a). As the evidence suggests that the Veteran’s service-connected bilateral foot disabilities may have worsened since his last VA examination, a remand is required to determine the current severity of his service-connected disabilities. 8. Entitlement to an initial compensable evaluation for scars on the lateral side of both feet is remanded. The Veteran’s last VA examination for his service-connected scars on the lateral side of both feet was in July 2016. At the Veteran’s May 2018 Board hearing, the Veteran testified that since his last VA examination, his service-connected scars had worsened. In particular, he reported having severe pain on the scarring on both sides of his feet. He avoided wearing shoes at home because of the pain from his scars. His scars affected his ability to move his foot at his left fourth and fifth toes. VA is required to afford the Veteran a contemporaneous VA examination to assess the current nature, extent, and severity of his service-connected disabilities. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. § 3.326(a). As the evidence suggests that the Veteran’s service-connected scars on the lateral side of both feet may have worsened since his last VA examination, a remand is required to determine the current severity of his service-connected disability. 9. Entitlement to a compensable evaluation for status post septorhinoplasty for deviated nasal septum is remanded. At the Veteran’s May 2018 Board hearing, he testified that his service-connected status post septorhinoplasty for deviated nasal septum caused breathing problems, and he was using an inhaler. In July 2016, the Veteran underwent a VA examination to evaluate his service-connected status post septorhinoplasty for deviated nasal septum. The VA examiner diagnosed the Veteran with sinusitis and found that he had seven or more non-incapacitating episodes of sinusitis characterized by headaches, pain and purulent or crusting in the past 12 months. However, no finding was made as to whether the Veteran’s sinusitis was associated with his service-connected status post septorhinoplasty for deviated nasal septum. Further, the Veteran is currently being evaluated for his service-connected disability under 38 C.F.R. § 4.97, Diagnostic Code 6502. However, the VA examiner did not provide any relevant clinical findings to evaluate the disability under Diagnostic Code 6502. For all the foregoing reasons, the Board finds that the record is inadequate for rating purposes, and a remand is required. 10. Entitlement to an evaluation in excess of 20 percent for hypertension is remanded. The Veteran’s last VA examination for his service-connected hypertension was in March 2017. At the Veteran’s May 2018 Board hearing, he testified that since his last VA examination, his hypertension had worsened. In particular, he explained that his blood pressure, which he took at home, had ranged from 140 to 120 systolic and from 98 to 127 diastolic. VA is required to afford the Veteran a contemporaneous VA examination to assess the current nature, extent, and severity of his service-connected disabilities. See Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); see also 38 C.F.R. § 3.326(a). As the evidence suggests that the Veteran’s hypertension may have worsened since his last VA examination, a remand is required to determine the current severity of his service-connected disability. 11. Entitlement to a TDIU is remanded. The Board finds that as the issue of whether the Veteran is entitled to a TDIU may be affected by the outcome of the increased evaluation claims discussed above, it would be premature to adjudicate the TDIU claim until those increased evaluation claims have been considered. Therefore, the issues are inextricably intertwined, and the TDIU claim must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following actions: 1. Issue the Veteran an SOC, to include notification of the need to timely file a Substantive Appeal, regarding the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for scoliosis of the lumbar spine. The issue shall not be returned to the Board unless a sufficient substantive appeal is submitted. 2. Obtain all the outstanding treatment records for the Veteran’s thoracic strain with scoliosis, status post closed wedge osteotomy, bilateral metatarsals, with screw fixation, bilateral flat feet, post-operative right knee meniscectomy, retropatellar left knee syndrome, scars on lateral side of both feet, status post septorhinoplasty for deviated nasal septum, and hypertension that are not currently of record. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected thoracic strain with scoliosis. To the extent possible, the examiner should provide current findings regarding all symptoms associated with the service-connected thoracic strain with scoliosis and should opine as to its severity. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of his thoracic spine symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. 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 comment on the extent of any functional impairment caused by the Veteran’s service-connected thoracic strain with scoliosis, to include in an occupational setting and in performing ordinary, daily activities. All findings should be fully documented in the examination report. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected status post closed wedge osteotomy, bilateral metatarsals, with screw fixation and bilateral flat feet. To the extent possible, the examiner should provide current findings regarding all symptoms associated with the service-connected status post closed wedge osteotomy, bilateral metatarsals, with screw fixation and bilateral flat feet and should opine as to their severity. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of his bilateral foot symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. 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 comment on the extent of any functional impairment caused by the Veteran's service-connected status post closed wedge osteotomy, bilateral metatarsals, with screw fixation and bilateral flat feet, to include in an occupational setting and in performing ordinary, daily activities. All findings should be fully documented in the examination report. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected post-operative right knee meniscectomy and retropatellar left knee syndrome. To the extent possible, the examiner should provide current findings regarding all symptoms associated with the service-connected post-operative right knee meniscectomy and retropatellar left knee syndrome and should opine as to their severity. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of his bilateral knee symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. 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 comment on the extent of any functional impairment caused by the Veteran’s service-connected post-operative right knee meniscectomy and retropatellar left knee syndrome, to include in an occupational setting and in performing ordinary, daily activities. All findings should be fully documented in the examination report. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected scars on the lateral side of both feet. The examiner should provide current findings regarding all symptoms associated with the service-connected scars on the lateral side of both feet and should opine as to their severity. The examiner should comment on the extent of any functional impairment caused by the Veteran’s service-connected scars on the lateral side of both feet, to include in an occupational setting and in performing ordinary, daily activities. All findings should be fully documented in the examination report. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected status post septorhinoplasty for deviated nasal septum. The examiner should provide current findings regarding all symptoms associated with the service-connected status post septorhinoplasty for deviated nasal septum and should opine as to its severity. The examiner should address whether the findings of the July 2016 VA examination indicate that the Veteran’s service-connected status post septorhinoplasty for deviated nasal septum include the symptoms associated with his currently diagnosed sinusitis. The examiner should also provide findings relevant to the rating criteria under Diagnostic Code 6502. The examiner should comment on the extent of any functional impairment caused by the Veteran's service-connected status post septorhinoplasty for deviated nasal septum, to include in an occupational setting and in performing ordinary, daily activities. All findings should be fully documented in the examination report. 8. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected hypertension. To the extent possible, the examiner should provide current findings regarding all symptoms associated with the service-connected hypertension and should opine as to its severity. The examiner should comment on the extent of any functional impairment caused by the Veteran’s service-connected hypertension, to include in an occupational setting and in performing ordinary, daily activities. (Continued on the next page)   All findings should be fully documented in the examination report. 9. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Journet Shaw