Citation Nr: 18160995 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-61 850 DATE: December 28, 2018 ORDER Entitlement to an earlier effective date than February 6, 2014, for a 60 percent rating for left total knee arthroplasty (TKA) is denied. Entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for a left femur fracture is denied. Entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for left hip limitation of rotation is denied. Entitlement to an earlier effective date than December 11, 2013 for a grant of service connection for a left femur scar is denied. Entitlement to an earlier effective date than December 11, 2013, for a grant of service connection for left hip limitation of rotation is denied. Entitlement to an earlier effective date than December 11, 2013, for a grant of service connection for left hip limitation of extension is denied. Entitlement to an initial rating greater than 10 percent prior to June 26, 2015, and greater than 20 percent thereafter, for a left femur scar is dismissed. REMANDED Entitlement to service connection for left knee nerve damage, including as due to service-connected left TKA, is remanded. Entitlement to a disability rating greater than 30 percent prior to February 6, 2014, and greater than 60 percent thereafter, for left TKA is remanded. Entitlement to an initial rating greater than 10 percent disabling for left hip limitation of extension is remanded. Entitlement to an initial compensable rating prior to June 26, 2015, and to an initial rating greater than 10 percent thereafter, for left hip limitation of rotation is remanded. Entitlement to a compensable disability rating prior to June 26, 2015, and to a disability rating greater than 10 percent thereafter, for a left femur fracture is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The record evidence shows that the Veteran’s original claims of service connection for left hip limitation of extension, left hip limitation of rotation, and for a left femur scar were included in statements on a VA Form 9 dated on December 9, 2013, and date-stamped as received by the Agency of Original Jurisdiction (AOJ) on December 11, 2013. 2. The record evidence shows that, in statements on a VA Form 21-4138 dated on February 4, 2014, and date-stamped as received by the AOJ on February 6, 2014, the Veteran requested an increased rating for his service-connected left TKA. 3. In the currently appealed rating decision dated on July 28, 2014, the AOJ granted, in pertinent part, the Veteran’s claims of service connection for a left femur scar, assigning a 10 percent rating effective December 11, 2013, left hip limitation of rotation, assigning a zero percent rating effective December 11, 2013, and for left hip limitation of extension, assigning a 10 percent rating effective December 11, 2013, and assigned a 60 percent rating effective February 6, 2014, for his service-connected left TKA. 4. In statements on a VA Form 21-0958, “Notice of Disagreement,” dated on April 1, 2015, and date-stamped as received electronically by the AOJ on April 6, 2015, the Veteran disagreed with the effective dates assigned for the grant of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension, and also disagreed with the effective date assigned for the 60 percent rating for his service-connected left TKA. 5. The record evidence shows that, in statements on a VA Form 21-8940, “Veterans Application For Increased Compensation Based On Unemployability,” dated on June 18, 2015, and date-stamped as received electronically by the AOJ on June 26, 2015, the Veteran essentially contended that his service-connected left femur fracture and left hip limitation of rotation were more disabling than currently evaluated. 6. The record evidence shows that, on VA knee and lower leg conditions DBQ in January 2012, the Veteran’s service-connected left TKA is manifested by intermediate degrees of residual weakness, pain, or limitation of motion. 7. The record evidence shows that, on VA knee and lower leg conditions DBQ dated on May 29, 2014, the Veteran’s service-connected left TKA is manifested by chronic residuals consisting of severe painful motion or weakness. 8. The record evidence shows that, on VA hip and thigh conditions DBQ dated on January 28, 2014, the Veteran’s service-connected left femur fracture is manifested by left hip flexion to 90 degrees with no objective evidence of painful motion. 9. The record evidence shows that, on VA hip and thigh conditions DBQ dated on August 7, 2015, the Veteran’s service-connected left femur fracture is manifested by left hip flexion limited to 35 degrees. 10. The record evidence shows that, on VA hip and thigh conditions DBQ dated on January 28, 2014, the Veteran does not experience any left hip limitation of rotation. 11. The record evidence shows that, on VA hip and thigh conditions DBQ dated on August 7, 2015, the Veteran’s service-connected left hip limitation of rotation is manifested by left hip adduction limited so that he cannot cross his legs. 12. In a rating decision dated on October 20, 2016, the AOJ assigned separate 10 percent ratings effective August 7, 2015, for the Veteran’s service-connected left femur fracture and left hip limitation of rotation. 13. In a rating decision dated on November 29, 2017, the AOJ assigned an earlier effective date of June 26, 2015, for the separate 10 percent ratings for the Veteran’s service-connected left femur fracture and left hip limitation of rotation. 14. The record evidence shows that the earliest factually ascertainable date for the assignment of separate 10 percent ratings for a left femur fracture and for left hip limitation of rotation is June 26, 2015 (the date of the Veteran’s VA Form 21-8940 alleging worsening left femur and left hip symptomatology). 15. The record evidence does not indicate that, prior to December 11, 2013, the Veteran filed formal or informal claims of service connection for a left femur scar, left hip limitation of rotation, or for left hip limitation of extension. 16. In a letter dated on August 17, 2018, and electronically date-stamped as received by the AOJ on August 27, 2018, the Veteran, through his attorney, requested withdrawal of his appeal for an initial rating greater than 10 percent prior to June 26, 2015, and greater than 20 percent thereafter, for a left femur scar; this withdrawal was explicit, unambiguous, and done with a full understanding of the consequences of such action by the Veteran. CONCLUSIONS OF LAW 1. The criteria for entitlement to an earlier effective date than February 6, 2014, for a 60 percent rating for left TKA have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110 (West 2012); 38 C.F.R. §§ 3.151(a), 3.156, 3.400, 4.7, 4.71a, Diagnostic Code (DC) 5055 (2017). 2. The criteria for entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for a left femur fracture have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110 (West 2012); 38 C.F.R. §§ 3.151(a), 3.156, 3.400, 4.7, 4.71a, DC 5252 (2017). 3. The criteria for entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for left hip limitation of rotation have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110 (West 2012); 38 C.F.R. §§ 3.151(a), 3.156, 3.400, 4.7, 4.71a, DC 5253 (2017). 4. The criteria for entitlement to an earlier effective date than December 11, 2013 for a grant of service connection for a left femur scar have not been met. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400 (2017). 5. The criteria for entitlement to an earlier effective date than December 11, 2013, for a grant of service connection for left hip limitation of rotation have not been met. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400 (2017). 6. The criteria for entitlement to an earlier effective date than December 11, 2013, for a grant of service connection for left hip limitation of extension have not been met. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400 (2017). 7. The criteria for withdrawal of an appeal on the issue of entitlement to an initial rating greater than 10 percent prior to June 26, 2015, and greater than 20 percent thereafter, for left femur scar have been met. 38 U.S.C. §§ 7105(b)(2), (d)(5) (West 2012); 38 C.F.R. § 20.204 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had a period of active duty for training (ACDUTRA) in the U.S. Army from October 1971 to February 1972. He also had additional unverified U.S. Army Reserve service. The Veteran appointed his current attorney to represent him before VA by filing a completed VA Form 21-22a at the AOJ in November 2014. This case has a long and complicated procedural history. Most recently, the Veteran’s attorney withdrew the appeal for an initial rating greater than 10 percent prior to June 26, 2015, and greater than 20 percent thereafter, for a left femur scar in August 2018 correspondence. See 38 U.S.C. § 7105 (West 2012); 38 C.F.R. § 20.204 (2017). The Veteran’s attorney subsequently clarified her understanding of the issues currently on appeal to the Board in September 2018 correspondence. In that correspondence, it appears to the Board that this attorney suggested that VA delay adjudicating the Veteran’s claims for an earlier effective date than June 26, 2015, for separate 10 percent ratings for a left femur fracture and for left hip limitation of rotation until a docket letter is issued on these claims. The Board disagrees with this suggestion, finding that both of these earlier effective date claims are the subject of a timely perfected appeal (VA Form 9) and a valid VA Form 8, “Certification of Appeal,” issued by the AOJ in September 2018 which properly confers jurisdiction over them to the Board. The Board notes in this regard that a standard docket letter provides that a Veteran and his or her representative has 90 days from the date of the letter or until the Board issues a decision (whichever comes first) in order to submit additional evidence or argument. See generally 38 C.F.R. § 20.1304 (2017) (emphasis added). The Board notes in this regard that the Veteran’s attorney did not request an extension of time to submit additional evidence or argument in support of either of these claims in her September 2018 correspondence and finds that, in the absence of a request for extension of time, any additional delay in adjudicating these claims likely would prejudice the Veteran. In summary, having reviewed the record evidence, the Board finds that the issues on appeal are as stated above. Effective Date The Veteran essentially contends that he is entitled to an earlier effective date than February 6, 2014, for the 60 percent rating assigned for his service-connected left TKA, an earlier effective date than December 11, 2013, for the grants of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension, and an earlier effective date than June 26, 2015, for the separate 10 percent ratings assigned for his service-connected left femur fracture and left hip limitation of rotation. 1. Entitlement to an earlier effective date than February 6, 2014, for a 60 percent rating for left TKA The Board finds that the preponderance of the evidence is against granting the Veteran’s claim of entitlement to an earlier effective date than February 6, 2014, for a 60 percent rating for left TKA. Contrary to the Veteran’s lay assertions, the record evidence does not support assigning a 60 percent rating for his service-connected left TKA prior to February 6, 2014. It shows instead that, prior to this date, the Veteran’s service-connected left TKA is manifested by intermediate degrees of residual weakness, pain, or limitation of motion (i.e., a 30 percent rating under DC 5055). See 38 C.F.R. § 4.71a, DC 5055 (2017). For example, on VA knee and lower leg conditions DBQ in January 2012, no relevant complaints were noted. The Veteran’s history of a left TKA was noted. He denied experiencing any flare-ups of left knee pain. Range of motion testing of the left knee showed flexion to 115 degrees with no objective evidence of painful motion, no limitation of extension, no additional limitation of motion on repetitive testing. Physical examination of the left knee showed less movement than normal, excess fatigability, no tenderness to palpation of the joint or soft tissues, 5/5 muscle strength, no joint instability, and no history of recurrent patellar subluxation/dislocation. It was noted that, after the Veteran’s left TKA in August 2011, he currently experienced residuals of intermediate degrees of residual weakness, pain, or limitation of motion. He constantly used a cane for ambulation. X-rays showed traumatic arthritis of the left knee. The diagnosis was status-post left knee TKA. As noted above, in statements on a VA Form 21-4138 dated on February 4, 2014, and date-stamped as received by the AOJ on February 6, 2014, the Veteran requested an increased rating for his service-connected left TKA. He asserted that he experienced “constant pain in and surrounding the entire [left] knee.” He also asserted: The more I exercise and use the left leg, the greater the pain, which increases the physical activity. It also tends to feel like it is ‘giving out’ on me as I get tired. I cannot laterally move my left leg without immense pain and practically falling down…I can barely carry anything of weight because of the intense pain that hits the left knee and travels up the leg, causing the knee to feel unstable, that it is going to buckle and give out on me. He further asserted having numerous falls, a left knee jerk, “and my left foot has accelerated in its ‘flopping’ as I walk.” The AOJ reasonably interpreted this form as an informal increased rating claim for the Veteran’s service-connected left TKA. On VA knee and lower leg conditions DBQ in May 2014, the Veteran’s complaints included worsening left knee pain and limited walking and climbing. Range of motion testing of the left knee showed flexion to 110 degrees with objective evidence of painful motion beginning at 80 degrees, no limitation of extension, and no additional limitation of motion on repetitive testing. Physical examination of the left knee showed less movement than normal, pain on movement, disturbance of locomotion, interference with standing, tenderness to palpation for the joint line or soft tissues, 5/5 muscle strength, no joint instability, and no history of recurrent patellar subluxation/dislocation. It was noted that, after the Veteran’s left TKA in August 2011, he currently experienced chronic residuals consisting of severe painful motion or weakness. The Veteran regularly used a brace and a cane for ambulation. The diagnosis was left knee replacement with femur fracture and open reduction internal fixation (ORIF). The Board observes that the effective date for increased ratings generally will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date; otherwise, the effective date is the date of receipt of claim. 38 U.S.C. § 5110 (West 2012); 38 C.F.R. § 3.400(o)(2) (2017). The record evidence shows that the Veteran asserted – for the first time – that the symptomatology associated with his service-connected left TKA had worsened in statements on a VA Form 21-4138 received by VA on February 6, 2014. VA examination in July 2014 confirmed that the Veteran’s service-connected left TKA had worsened and is manfiested by chronic residuals consisting of severe painful motion or weakness (i.e., a 60 percent rating under DC 5055). See 38 C.F.R. § 4.71a, DC 5055 (2017). The Board has reviewed the record evidence and finds that there was no factually ascertainable increase in the disability attributable to the Veteran’s service-connected left TKA prior to this examination. The AOJ concluded in the currently appealed rating decision issued in July 2014 that February 6, 2014, was the appropriate effective date for the assignment of a 60 percent rating for the Veteran’s service-connected left TKA because that was the date when VA received his informal increased rating claim for this disability. The Board agrees, noting that the July 2014 VA examination occurred within 1 year of the date that VA received this claim. The regulation governing effective dates for increased ratings is clear – the effective date is the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date or the date of receipt of the claim. See 38 C.F.R. § 3.400(o)(2). In this case, it is not factually ascertainable that an increase in disability occurred prior to February 6, 2014, the date when VA received the Veteran’s informal increased rating claim for his service-connected left TKA. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to an earlier effective date than February 6, 2014, for the 60 percent rating for service-connected left TKA. In summary, the Board finds that the criteria for an earlier effective date than February 6, 2014, for a 60 percent rating for left TKA have not been met. 2. Entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for a left femur fracture and for a 10 percent rating for left hip limitation of rotation The Board next finds that the preponderance of the evidence is against granting the Veteran’s claims of entitlement to an earlier effective date than June 26, 2015, for a 10 percent rating for a left femur fracture and for a 10 percent rating for left hip limitation of rotation. Contrary to the Veteran’s lay assertions, the record evidence does not support assigning 10 percent ratings for either his service-connected left femur fracture or his service-connected left hip limitation of rotation prior to June 26, 2015. It shows instead that, prior to this date, the Veteran’s service-connected left femur fracture is manifested by left hip flexion to 90 degrees with no objective evidence of painful motion and he does not experience any limitation of rotation in the left hip. As noted above, the record evidence shows that the Veteran’s informal claims of service connection for left hip limitation of rotation and for an increased rating for his service-connected left femur fracture were received by VA on December 11, 2013. On VA hip and thigh conditions DBQ on January 28, 2014, no relevant complaints were noted. Range of motion testing of the left hip showed flexion to 90 degrees with no objective evidence of painful motion, no additional limitation of motion on repetitive testing, and no limitation of adduction (or rotation). The Veteran was able to cross his legs and toe-out more than 15 degrees. Physical examination of the left hip showed less movement than normal, no localized tenderness to palpation in the joint or soft tissues, 5/5 muscle strength, and no ankylosis, malunion or non-union of the femur, flail hip joint, or leg length discrepancy. The Veteran constantly used a wheelchair and brace for ambulation. X-rays of the left femur showed an old healed fracture deformity/post-surgical deformity involving the distal shaft and orthopedic screws and plate in place from the proximal shaft to the distal intercondylar region. The diagnoses were status-post left femur fracture with ORIF and hip strain. As noted above, the Veteran essentially contended that his service-connected left femur fracture and left hip limitation of rotation were more disabling than currently evaluated in statements on a VA Form 21-8940, “Veterans Application For Increased Compensation Based On Unemployability,” dated on June 18, 2015, and date-stamped as received electronically by the AOJ on June 26, 2015. The AOJ reasonably interpreted this form as an informal notice of disagreement with the currently appealed rating decision issued in July 2014 which granted the Veteran’s claim of service connection for left hip limitation of rotation, assigning a zero percent rating effective December 11, 2013, and denied the Veteran’s increased rating claim for his service-connected left femur fracture. On VA hip and thigh conditions DBQ on August 7, 2015, the Veteran complained of worsening symptomatology due to his service-connected left femur fracture. He experienced flare-ups of left hip pain which he described as difficulty walking, standing, and sitting, and an inability to do any climbing. Range of motion testing of the left hip showed flexion to 35 degrees with pain contributing to functional loss (limited standing, sitting, and walking) and no additional limitation of motion on repetitive testing. Physical examination of the left hip showed localized tenderness to palpation of the joint line or soft tissues, evidence of pain with weight bearing, no objective evidence of crepitus, less movement than normal, disturbance of locomotion, interference with sitting and standing, 5/5 muscle strength, no muscle atrophy, and no ankylosis, malunion or non-union of femur, flail hip joint, or leg length discrepancy. Pain, fatigue, and lack of endurance significantly limited functional ability with repeated use over a period of time. Left hip adduction was limited so that the Veteran could not cross his legs. He regularly used a cane for ambulation. The diagnoses were status-post ORIF left femur and limited left hip range of motion. As also noted above, in a rating decision dated on October 20, 2016, the AOJ assigned separate 10 percent ratings effective August 7, 2015, for the Veteran’s service-connected left femur fracture and left hip limitation of rotation. In a rating decision dated on November 29, 2017, the AOJ assigned an earlier effective date of June 26, 2015, for the separate 10 percent ratings for the Veteran’s service-connected left femur fracture and left hip limitation of rotation. The Board again observes that the effective date for increased ratings generally will be the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date; otherwise, the effective date is the date of receipt of claim. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(o)(2). The record evidence shows that the Veteran essentially disagreed with the effective dates assigned for the zero percent ratings for his service-connected left femur fracture and left hip limitation of rotation in statements on a VA Form 21-8940 received by VA on June 26, 2015. The Board has reviewed the record evidence and finds that there was no factually ascertainable increase in the disability attributable to the Veteran’s service-connected left femur fracture prior to his VA hip and thigh conditions DBQ on August 7, 2015, which showed that the Veteran’s left hip flexion is limited to 35 degrees with pain (i.e., a 10 percent rating under DC 5252) and his left hip adduction is limited so that he cannot cross his legs (i.e., a 10 percent rating under DC 5253). See 38 C.F.R. §§ 4.71a, DCs 5252 and 5253 (2017). The AOJ essentially concluded in the November 2017 rating decision that June 26, 2015, was the appropriate effective date for the assignment of separate 10 percent ratings for the Veteran’s service-connected left femur fracture and left hip limitation of rotation because that was close enough in time to receipt of evidence (VA hip and thigh conditions DBQ dated in August 2015) showing worsening symptomatology attributable to each of these disabilities. The Board agrees, noting that the August 2015 VA examination occurred within 1 year of the date that VA received the Veteran’s informal notice of disagreement with the zero percent ratings assigned for his service-connected left femur fracture and left hip limitation of rotation. The regulation governing effective dates for increased ratings is clear – the effective date is the earliest date as of which it is factually ascertainable that an increase in disability had occurred if the claim is received within 1 year from such date or the date of receipt of the claim. See 38 C.F.R. § 3.400(o)(2). In this case, it is not factually ascertainable that an increase in disability occurred prior to June 26, 2015, the date when VA received the Veteran’s informal notice of disagreement with the zero percent ratings assigned for his service-connected left femur fracture and left hip limitation of rotation. The Veteran finally has not identified or submitted any evidence demonstrating his entitlement to an earlier effective date than June 26, 2015, for the 10 percent ratings for service-connected left femur fracture and left hip limitation of rotation. In summary, the Board finds that the criteria for an earlier effective date than June 26, 2015, for a 10 percent rating for a left femur fracture and for a 10 percent rating for left hip limitation of rotation have not been met. 3. Entitlement to an earlier effective date than December 11, 2013 for a grant of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension The Board finally finds that the preponderance of the evidence is against granting the Veteran’s claims of entitlement to an earlier effective date than December 11, 2013, for a grant of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension. Despite the Veteran’s assertions to the contrary, the record evidence does not indicate that he filed formal or informal service connection claims for a left femur scar, left hip limitation of rotation, or for left hip limitation of extension prior to December 11, 2013. It shows instead that his original service connection claims for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension were not received by the AOJ until December 11, 2013, when he submitted a VA Form 9 attempting to perfect prior claims. The AOJ subsequently notified the Veteran in December 19, 2013, correspondence that, although his VA Form 9 was untimely for purposes of perfect prior claims, it would consider newly filed informal claims as of the date that this form was received. See 38 U.S.C. § 5110(a); 38 C.F.R. § 3.400. It is not clear from a review of the record evidence what earlier effective date for a grant of service connection for a left femur scar, left hip limitation of rotation, and left hip limitation of extension the Veteran considers appropriate. Nevertheless, the record evidence does not support granting an earlier effective date than December 11, 2013, for service connection for any of these disabilities. It shows instead that, prior to receipt of his informal service connection claims on December 11, 2013, the record evidence does not show any intent to file formal or informal claims for any of these disabilities. A review of the record evidence shows instead that, prior to this date, the Veteran sought VA disability compensation for multiple disabilities, to include Charcot-Marie-Tooth disease, obstructive sleep apnea, a respiratory condition, and a heart condition. The Veteran provided detailed information and argument regarding each of his newly submitted informal service connection claims for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension in statements on a VA Form 21 4138 which was dated on February 4, 2014, and date-stamped as received by the AOJ on February 6, 2014. In the currently appealed rating decision dated on July 28, 2014, the AOJ granted, in pertinent part, the Veteran’s claims of service connection for a left femur scar, assigning a 10 percent rating effective December 11, 2013, left hip limitation of rotation, assigning a zero percent rating effective December 11, 2013, and for left hip limitation of extension, assigning a 10 percent rating effective December 11, 2013. The AOJ essentially concluded that December 11, 2013, was the appropriate effective date for the grant of service connection for each of these disabilities because that was the date that VA received the Veteran’s claims. As noted above, in statements on a VA Form 21-0958, “Notice of Disagreement,” dated on April 1, 2015, and date-stamped as received electronically by the AOJ on April 6, 2015, the Veteran disagreed with the effective dates assigned for the grant of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension. The Board observes here that the effective date for service connection claims generally will be the day following separation from active service or date entitlement arose if the claim is filed within one year of discharge from service; otherwise, the effective date is the date of receipt of claim or date entitlement arose, whichever is later. 38 C.F.R. § 3.400(b)(2)(i). Despite the Veteran’s assertions to the contrary, the record evidence does not indicate an intent to file service connection claims for a left femur scar, left hip limitation of rotation, or for left hip limitation of extension prior to December 11, 2013, when VA received his informal claims for each of these disabilities. It is undisputed that these service connection claims were not filed within 1 year of his discharge from active service in February 1972 (or by February 1973). Instead, the December 11, 2013, VA Form 9 constituted his informal service connection claims for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension, filed almost 42 years after his service separation. In other words, the date of receipt of the Veteran’s informal service connection claims for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension is December 11, 2013. The evidence otherwise does not suggest an intent to file service connection claims for any of these disabilities to this date. In summary, the Board finds that the criteria for an earlier effective date than December 11, 2013, for the grant of service connection for a left femur scar, left hip limitation of rotation, and for left hip limitation of extension have not been met. Dismissed Claims Entitlement to an initial rating greater than 10 percent prior to June 26, 2015, and greater than 20 percent thereafter, for a left femur scar The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105 (West 2012). An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204 (2017). Withdrawal may be made by the appellant or by his or her authorized representative. Id. In Acree, the United States Court of Appeals for the Federal Circuit held that the withdrawal must be explicit, unambiguous, and done with a full understanding of the consequences of such action by the appellant and the subsequent Board dismissal must include findings as to all three elements. See Acree v. O’Rourke, 891 F.3d 1009 (Fed. Cir. 2018), 2018 U.S. App. LEXIS 14959, adopting the rule of DeLisio v. Shinseki, 25 Vet. App. 45, 57-58 (2011). As noted in the Introduction, after the Veteran perfected a timely appeal on his claim for a higher initial rating for a left femur scar, he explicitly, unambiguously, and with a full understanding of the consequences of such action, withdrew this claim in a letter from his attorney dated on August 17, 2018, and electronically date-stamped as received by the AOJ on August 27, 2018. The Board finds it highly persuasive that the Veteran knew the consequences of this withdrawal because he has been represented by his attorney since November 2014. He also understood the consequences of this withdrawal because he continued to pursue his other currently appealed claims for VA disability compensation after withdrawing his appeal for a higher initial rating for a left femur scar, including a claim for an earlier effective date for the grant of service connection for this disability (discussed above). Having reviewed the record evidence, the Board finds that withdrawal of this claim was explicit, unambiguous, and done with a full understanding of the consequences of such action by the Veteran. See Acree, 891 F.3d at 1009. Accordingly, this claim is dismissed. REASONS FOR REMAND 1. Entitlement to service connection for left knee nerve damage, including as due to service-connected TKA is remanded. The Veteran contends that he incurred left knee nerve damage during active service or, alternatively, his service-connected left TKA caused or aggravated (permanently worsened) his current left knee nerve damage. The Board acknowledges that the Veteran’s left knee nerve damage was examined for VA adjudication purposes in July 2014. Unfortunately, a review of the July 2014 VA peripheral nerves conditions DBQ shows that the examiner who completed this DBQ did not provide an opinion concerning whether the Veteran’s current left knee nerve damage (diagnosed as residual peroneal nerve injury) is related directly to active service. See also 38 C.F.R. §§ 3.303, 3.304 (2017). Thus, the Board finds that, on remand, the July 2014 VA peripheral nerves conditions DBQ should be returned to the examiner who completed it or another appropriate clinician for an addendum opinion which addresses whether the Veteran’s current left knee nerve damage is related directly to active service. 2. Entitlement to a disability rating greater than 30 percent prior to February 6, 2014, and greater than 60 percent thereafter, for left TKA, an initial rating greater than 10 percent disabling for left hip limitation of extension, an initial compensable rating prior to June 26, 2015, and an initial rating greater than 10 percent thereafter, for left hip limitation of rotation, and to a compensable disability rating prior to June 26, 2015, and to a disability rating greater than 10 percent thereafter, for a left femur fracture is remanded. The Veteran contends that his service-connected left TKA, left hip limitation of extension, left hip limitation of rotation, and left femur fracture are all more disabling than currently (or initially) evaluated. The Board notes in this regard that all of these service-connected disabilities were examined most recently in 2014 or 2015, respectively. The Board next notes that, following these examinations, the Court issued a decision in Correia mandating new requirements for VA examinations of musculoskeletal disabilities (including disabilities of the left knee, left hip, and left femur, as in this case) in order to satisfy judicial review in increased rating claims. See Correia v. McDonald, 28 Vet. App. 158 (2016). The Court held in Correia that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Id.; see also 38 C.F.R. § 4.59. A review of the record evidence shows that the Veteran’s most recent VA examinations for each of these service-connected disabilities in 2014 or 2015, respectively, did not comply with Correia. For example, there is no indication in these examination reports whether the ranges of motion for the Veteran’s left knee, left hip, and left femur obtained are active or passive or in weight-bearing or non-weight-bearing. Accordingly, the Board finds that, on remand, the Veteran should be scheduled for updated VA examinations to determine the current nature and severity of his service-connected left TKA, left hip limitation of extension, left hip limitation of rotation, and left femur fracture. See also Southall-Norman v. McDonald, 28 Vet. App. 346 (2016) (finding 38 C.F.R. § 4.59 not limited to diagnostic codes involving range of motion and extending Correia to disabilities involving painful joint or periarticular pathology). 3. Entitlement to a TDIU is remanded. The Board finally notes that adjudication of the other claims being remanded likely will impact adjudication of the TDIU claim. Accordingly, the Board finds that all of these claims are inextricably intertwined and adjudication of the TDIU claim must be deferred. See Henderson v. West, 12 Vet. App. 11, 20 (1998), citing 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 on one issue cannot be rendered until the other issue has been considered). The matters are REMANDED for the following action: 1. Send the July 2014 VA peripheral nerves conditions DBQ to the examiner who completed it or another appropriate clinician for an addendum opinion. In the addendum opinion, the VA examiner who completed the July 2014 VA peripheral nerves conditions DBQ or another appropriate clinician is asked to opine whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s current residual peroneal nerve injury of the left knee is related to active service or any incident of service. A rationale also should be provided for any opinions expressed. The July 2014 VA peripheral nerves conditions DBQ examiner or another appropriate clinician is advised that the lack of contemporaneous records showing complaints of or treatment for a residual peroneal nerve injury of the left knee, alone, is insufficient rationale for a medical nexus opinion. 2. Schedule the Veteran for updated VA examination to determine the current nature and severity of his service-connected left total knee arthoplasty. 3. Schedule the Veteran for updated VA examination to determine the current nature and severity of his service-connected left hip limitation of extension and his service-connected left hip limitation of rotation. 4. Schedule the Veteran for updated VA examination to determine the current nature and severity of his service-connected left femur fracture. 5. Readjudicate the appeal. R. FEINBERG Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Michael T. Osborne, Counsel