Citation Nr: 18106902 Decision Date: 06/01/18 Archive Date: 05/31/18 DOCKET NO. 15-08 815 DATE: June 1, 2018 REMANDED Entitlement to service connection for a disability manifested by dizziness is remanded. Entitlement to service connection for a right ankle disability is remanded. Entitlement to an initial rating in excess of 10 percent for left knee strain is remanded. Entitlement to an initial rating in excess of 10 percent for right knee strain is remanded. Entitlement to a rating in excess of 10 percent for mechanical thoracolumbar strain with sacroiliac degenerative joint disease and degenerative disc disease of the lumbar spine is remanded. Entitlement to a rating in excess of 10 percent for left ankle ligament strain is remanded. Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. REASONS FOR REMAND The Veteran had active service from August 2002 to August 2006 and from January 2009 to April 2009. These matters come before the Board of Veterans’ Appeals on appeal from an October 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned at a March 2018 Board videoconference hearing. 1. Entitlement to service connection for a disability manifested by dizziness is remanded. The Board cannot make a fully-informed decision on the issue of a disability manifested by dizziness, as the Veteran testified that he continues to experience dizziness, including with his service-connected migraine headaches. Therefore, a new examination should be provided to determine whether the Veteran now has a diagnosed disability manifested by dizziness, or whether it is part of an undiagnosed or multi-symptom chronic illness. 2. Entitlement to service connection for a right ankle disability. The Board cannot make a fully-informed decision on the issue of a right ankle disability, as the Veteran testified that he continues to have right ankle problems. Therefore, a new examination should be provided to determine whether he now has a diagnosed right ankle disability. 3. Entitlement to an initial rating in excess of 10 percent for left knee strain is remanded. In his Board testimony, the Veteran asserted that his last VA examination did not provide an accurate depiction of the severity of his left knee strain, as the examiner pushed past the point of pain when measuring range of motion. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of the left knee strain. 4. Entitlement to an initial rating in excess of 10 percent for right knee strain is remanded. In his Board testimony, the Veteran asserted that his last VA examination did not provide an accurate depiction of the severity of his right knee strain, as the examiner pushed past the point of pain when measuring range of motion. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of the right knee strain. 5. Entitlement to a rating in excess of 10 percent for mechanical thoracolumbar strain with sacroiliac degenerative joint disease and degenerative disc disease of the lumbar spine is remanded. In his Board testimony, the Veteran asserted that his last VA examination did not provide an accurate depiction of the severity of his back disability, as the examiner pushed past the point of pain when measuring range of motion. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of the back disability. 6. Entitlement to a rating in excess of 10 percent for left ankle ligament strain is remanded. In his Board testimony, the Veteran asserted that his last VA examination did not provide an accurate depiction of the severity of his left ankle disability, as the examiner pushed past the point of pain when measuring range of motion. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of the left ankle disability. 7. Entitlement to a rating in excess of 30 percent for posttraumatic stress disorder (PTSD) is remanded. In his Board testimony, the Veteran asserted that his last VA examination did not provide an accurate depiction of the severity of his PTSD, due in part to lack of communication with the examiner. The Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of the PTSD. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2015 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any disability manifested by dizziness. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including environmental hazards in the Persian Gulf. (a) Identify (by diagnosis) all disabilities found related to the Veteran’s claim of dizziness. If no diagnoses are made, indicate whether the Veteran’s symptoms represent the manifestation of an undiagnosed illness. (b) If, instead of an undiagnosed illness, there is a known clinical diagnosis, offer an opinion as to whether the diagnosed disability is at least as likely as not (a 50% or higher degree of probability) related to the Veteran’s service. It is requested that the rationale include some discussion of the Veteran’s conceded exposure to environmental hazards in the Persian Gulf. (c) If, instead of an undiagnosed illness, there is a known clinical diagnosis, offer an opinion as to whether each diagnosed disability is at least as likely as not (a 50% or higher degree of probability) proximately due to his service-connected disabilities, specifically migraine headaches. (d) If, instead of an undiagnosed illness, there is a known clinical diagnosis, offer an opinion as to whether each diagnosed disability is at least as likely as not (a 50% or higher degree of probability) aggravated by his service-connected disabilities, specifically migraine headaches. Aggravation is an increase in severity beyond the natural progress of the disorder. Detailed reasons for all opinions should be provided. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed right ankle disability. (a) Identify all diagnosed conditions of the right ankle. (State if there are no diagnoses pertaining to either ankle). (a) As to any diagnosed right ankle disability, is it at least as likely as not (a 50% or higher degree of probability) that it is related to service? (b) As to any diagnosed right ankle disability, is it at least as likely as not (a 50% or higher degree of probability) that it is proximately due to his service-connected left ankle ligament strain? (c) As to any diagnosed right ankle disability, is it at least as likely as not (a 50% or higher degree of probability) that it has been aggravated by his service-connected left ankle ligament strain? Aggravation is an increase in severity beyond the natural progress of the disorder. 4. Schedule the Veteran for examinations by appropriate clinicians to determine the current severity of his service-connected left knee strain, right knee strain, thoracolumbar strain, left ankle ligament strain, and PTSD. The examiners should provide full descriptions of the disabilities and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. The examiners 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 examiners should identify any symptoms and functional impairments due to the disabilities in question alone and discuss the effect of the Veteran’s disabilities 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 examiners 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). Nathaniel J. Doan Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Dean, Counsel