Citation Nr: 18158747 Decision Date: 12/17/18 Archive Date: 12/17/18 DOCKET NO. 10-08 824 DATE: December 17, 2018 REMANDED Entitlement to an initial rating greater than 10 percent for left knee patellofemoral osteoarthritis is remanded. Entitlement to an initial rating greater than 10 percent for left hip osteoarthritis is remanded. Entitlement to an initial rating greater than 10 percent for right hip osteoarthritis is remanded. Entitlement to an initial rating greater than 10 percent for right knee patellofemoral osteoarthritis is remanded. Entitlement to an increased rating greater than 10 percent for headaches is remanded. Entitlement to a total disability rating for compensation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1991 to March 1995. The Veteran testified at a hearing before the undersigned Veterans Law Judge in June 2014. A transcript of that hearing is associated with the claims file. 1. Entitlement to an initial rating greater than 10 percent for left knee patellofemoral osteoarthritis; entitlement to an initial rating greater than 10 percent for left hip osteoarthritis; entitlement to an initial rating greater than 10 percent for right hip osteoarthritis; and entitlement to an initial rating greater than 10 percent for right knee patellofemoral osteoarthritis are remanded. In September 2018, the Veteran underwent VA examinations addressing the severity of his service-connected right and left hip disabilities and his right and left knee disabilities. In Correia v. McDonald, 28 Vet. App. 158, 168-70 (2016), the U.S. Court of Appeals for Veterans Claims (Court) held that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. 28 Vet. App. 158. The final sentence of 38 C.F.R. § 4.59 provides that “[t]he joints involved should be tested for pain on both active and passive range of motion, in weight-bearing and nonweight-bearing and, if possible, with the range of motion of the opposite undamaged joint.” The Court found that, to be adequate, a VA examination of the joints must include the results of the range of motion testing described in the final sentence of 38 C.F.R. § 4.59. The September 2018 VA examinations are inadequate as they do not fully comply with the requirements of 38 C.F.R. § 4.59, as discussed in Correia. The September 2018 VA examinations provided only one set of range of motion results for each knee and hip, and did not indicate whether these results were from testing conducted in active motion, passive motion, weight-bearing, or nonweight-bearing. Accordingly, they do not satisfy the requirements of 38 C.F.R. § 4.59 as discussed in Correia, and are inadequate. Based on the foregoing, the Board finds that these issues should be remanded, and that the Veteran should be afforded additional VA examinations that fully satisfy the requirements of Correia. 2. Entitlement to an increased rating greater than 10 percent for headaches is remanded. The Veteran most recently underwent a VA examination to assess the severity of his service-connected headache disability in September 2018. The VA examiner concluded that the Veteran did not experience “characteristic prostrating attacks of migraine / non-migraine headache pain.” However, the VA examiner also noted that the Veteran’s headaches sometimes required him “to lay down and rest.” Additionally, the Veteran has provided lay statements and testimony indicating that his headaches occurred most days of the week, that they made him late for work, that they sometimes made him unable to go to work, and that the pain essentially required him to sit or lay down in bed. He also explained that he was unable to drive during a headache, so he stayed home to take care of himself. The September 2018 VA examination does not appear to take the Veteran’s competent lay statements into consideration in determining whether the Veteran’s headaches are prostrating. In that regard, the September 2018 VA examination is internally inconsistent in noting first that the Veteran’s headaches required him “to lay down and rest” but then concluding that the Veteran did not experience characteristic prostrating attacks. Additionally, it is unclear from the examination report whether the examiner considered the previous lay statements and testimony of record detailing the Veteran’s potentially prostrating attacks of headache pain. As the September 2018 VA examination does not address this pertinent evidence, the Veteran must be provided with a new VA examination which adequately addresses the impact of the Veteran’s headaches and discusses the Veteran’s competent lay statements and testimony in determining whether he experiences prostrating attacks and, if so, the frequency of such attacks. 3. Entitlement to a total disability rating for compensation based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. The Veteran’s claim for entitlement to a TDIU is inextricably intertwined with the claims remanded herein. Accordingly, the claim for entitlement to a TDIU must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that two issues are “inextricably intertwined” when they are so closely tied together that a final Board decision cannot be rendered unless both are adjudicated). The matters are REMANDED for the following action: 1. Schedule the Veteran for VA examinations by an appropriate clinician to determine the current severity of his service-connected right and left hip disabilities and his right and left knee disabilities. The examiner should provide a full description of each disability and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. Range of motion should be reported in degrees, noting by comparison the normal range of motion. The examiner should also test and report the range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing. If there is pain on range of motion, the examiner must state at which point pain began. 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 the joint arthritis 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). 2. Schedule the Veteran for a VA examination to determine the current severity of his headache disability. The examiner must review the claims file and should note that review in the report. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed and the examiner should describe all symptoms due to the headache disability. The examiner should specifically state whether there are prostrating attacks of headaches, and if so, the frequency and duration of those attacks. In determining whether the Veteran experiences prostrating attacks, the examiner is requested to address the Veteran’s lay statements and testimony of record which indicate that his headaches require him to either sit or lay down, miss work, and/or refrain from driving. The examiner is reminded that the Veteran is competent to report symptoms capable of lay observation, such as headache pain. Regardless of whether the examiner determines the Veteran’s headaches to be prostrating, the examiner should state the frequency with which the Veteran experiences headaches which require him to lay down, refrain from driving, stay home, and/or miss work. 3. After completing the above actions, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claims on appeal must be readjudicated. If any claim remains denied, a supplemental statement of the case must be provided to the Veteran and her representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Katz, Counsel