Citation Nr: 18158162 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-13 580 DATE: December 14, 2018 REMANDED Entitlement to service connection for a left knee disorder is remanded. Entitlement to service connection for a right knee disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for bilateral foot plantar fasciitis is remanded. Entitlement to an initial compensable rating for right hand arthritis with status post right thumb fracture is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps, primarily as a pilot, from December 1986 to July 2013. The Board notes that the Veteran’s representative submitted an Appellant’s Brief in May 2018 that references a claim of service connection for a dorsal back condition. There is no appeal for such a back condition currently perfected before the Board. 1. Entitlement to service connection for bilateral knee, bilateral ankle, and bilateral foot plantar fasciitis disorders are remanded. The Veteran was afforded VA examinations for these conditions by a QTC contracted provider in July 2013. In each of these service connection claims, the examiner found no current disability for which service connection could be established. The Veteran argues, however, that the examinations were inadequate as they did not include adequate diagnostic imaging, particularly for the Veteran’s knee and ankle disabilities. The Board notes that the examiner’s report indicates that imaging studies had been performed and the results were available to the examiner, but no abnormal findings were indicated. The examiner did not reflect any further information about what the nature or date of the imaging studies were, and merely made conclusory statements that there was no pathology on which to render a diagnosis. No additional detail is provided about the imaging studies reviewed. The examiner also did not document any consideration of the Veteran’s lay statements of ongoing pain and functional impairment during service. These examinations do not provide an adequate picture of the Veteran’s disability upon which the Board may base a determination. As such, a more complete examination is necessary. Additionally, with respect to the Veteran’s claimed left ankle disability, the record is clear that the Veteran experienced a left ankle injury prior to service as reflected in multiple Reports of Medical History within his service treatment records. The Veteran was noted to have no sequelae and no current disability of the left ankle at the time of his service entrance examination in February 1986. His lower extremities were clinically evaluated as normal at the time. However, the Board cannot make a fully-informed decision on the issue of service connection for the left ankle because no VA examiner has opined whether the left ankle injury existing prior to service was not aggravated by such service. See 38 C.F.R. § 3.304(b). 2. Entitlement to an initial compensable rating for right hand arthritis with status post right thumb fracture is remanded. While the record also contains a May 2017 VA examination regarding the Veteran’s service-connected right hand and thumb disability, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner identified flare-ups of the Veteran’s condition, but stated that an opinion could not be provided without resort to speculation regarding the range of motion during a flare-up, and the examiner did not indicate that the speculation was due to lack of knowledge within the medical community. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the nature and etiology of any current ankle, knee, or plantar fasciitis disabilities, as any such disability affects either or both lower extremities. The examiner must then opine whether each identified current disability is at least as likely as not related to an in-service injury, event, or disease, including the documented right knee sprain in July 2010, plantar fasciitis in August 2010, or chronic ankle sprains reported by the Veteran in March 2013, as well as any competent and credible lay history of in-service injuries or events provided by the Veteran. If arthritis is diagnosed, opine whether it at least as likely as not (1) began during active service, (2) manifested within 1 year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The Veteran’s service treatment records clearly and unmistakably reflect a left ankle injury occurring around 1980 that resulted in the Veteran wearing a cast for several weeks during childhood. This injury is referenced after the fact as a status-post undisplaced fracture, and as it being unclear whether the injury was a fracture versus a sprain in the Veteran’s service treatment records. Please opine on the nature of the left ankle injury that clearly and unmistakably preexisted the Veteran’s active service. The examiner must also opine whether this left ankle injury was clearly and unmistakably not aggravated beyond its natural progression by service. (Continued on the next page)   2. Schedule the Veteran for an examination of the current severity of his right hand and thumb disability. 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, including any loss in grip strength and range of motion, due to right hand arthritis and status post right thumb fracture alone and discuss the effect of the Veteran’s disability 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). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. McDonald