Citation Nr: 19174635 Decision Date: 09/26/19 Archive Date: 09/25/19 DOCKET NO. 16-57 523 DATE: September 26, 2019 ORDER The claim for an extension of temporary total convalescence rating under paragraph 30 following surgery for the right knee is denied. REMANDED The claim for service connection for traumatic brain injury (TBI) to include headaches is remanded. The claim for service connection for a psychiatric disorder is remanded. The claim for service connection for a left elbow disability is remanded. The claim for service connection for right elbow arthritis is remanded. The claim for service connection for right carpal tunnel syndrome arthritis is remanded. The claim for service connection for a skin disorder to include parapsoriasis is remanded. The claim for service connection for sleep apnea is remanded. The claim for a rating in excess of 10 percent for degenerative arthritis of the right knee (excluding period of temporary total rating) is remanded. The claim for a rating in excess of 10 percent for degenerative arthritis of the left knee. The claim for an initial rating in excess of 10 percent for right shoulder recurrent dislocation and mild osteoarthritis is remanded. The claim for a rating in excess of 10 percent for left shoulder strain is remanded. The claim for a rating in excess of 10 percent for pes planus is remanded. The claim for a rating in excess of 10 percent for plantar fasciitis is remanded. FINDINGS OF FACT The Veteran’s surgery in September 2014 for the right knee disability did not necessitate a period of convalescence beyond October 31, 2014. CONCLUSION OF LAW The criteria for an extension of a temporary total convalescent rating beyond September 1998, based on a period of convalescence following left knee surgery in August 1997 have not been met. 38 C.F.R. § 4.30. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from February 1988 to December 1995. These matters come before the Board of Veterans’ Appeals (Board) on appeal from May and August 2015 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a March 2019 hearing at the RO before the undersigned Veterans Law Judge (VLJ). Entitlement to a temporary total rating based on convalescence following surgery The Veteran maintains that after his right knee surgery in September 2014, he needed additional time to convalesce beyond the date of October 31, 2014. VA medical records show that the Veteran underwent right knee arthroscopic medial meniscectomy, chondroplasty trochlea and medial plica extremity on September 17, 2014. A May 2015 rating action granted a temporary total evaluation based on a period of convalescence between the period of September 17, 2014, and October 31, 2014. Under 38 C.F.R. § 4.30, a temporary total disability rating will be assigned from the date of hospital admission and continue for 1, 2, or 3 months from the first day of the month following hospital discharge when treatment of a service-connected disability results in: (1) Surgery necessitating at least one month of convalescence; (2) Surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body case, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) Immobilization by cast, without surgery, of one major joint or more. The record does not show the presence of severe postoperative residuals. Rather, the surgical notes indicate there were no complications. He was undergoing physical therapy according to November 2014 VA outpatient records. He received steroid injections later that month and in December 2014, but there was no indication that there was any severe restriction placed on the Veteran’s activities subsequent to this surgical procedure, as required under 38 C.F.R. § 4.30. The Veteran has not provided any medical records that show he was required to convalesce for any period of time following the surgery; the evidence of record weighs against a finding that convalescence was required beyond that previously granted. Accordingly, the Board concludes that the Veteran is not entitled to a temporary total convalescent rating under 38 C.F.R. § 4.30, based on a period of convalescence following the surgery on the right knee in September 2014. REASONS FOR REMAND Service connection for right elbow arthritis, left elbow disability, traumatic brain injury to include headaches, right carpal tunnel syndrome, and a psychiatric disorder The Veteran originally claimed that he had various joint disabilities as a result of an undiagnosed illness; however, at his hearing he clarified his contentions. He states that his orthopedic and psychiatric disorders resulted from multiple inservice injuries to include football injuries; an automobile accident in November 1988, neck strain in November 1989; and head injury in November 1992. He further clarified that his claim for headaches should include a claim for traumatic brain injury. He also states that he has right carpal tunnel syndrome (CTS) and bilateral elbow disabilities secondary to his service connected bilateral shoulder disabilities. Further examination and opinion are needed. Service connection for a skin disorder The Veteran also contends that he has a skin disorder that had its onset in service. The service treatment record show treatment for tine cruris. Although he has undergone dermatologic examination, the Veteran’s representative argues that the examiner did not comment on whether he currently has a skin disorder to include tinea cruris directly related to military service. Moreover, since that examination the Veteran has submitted evidence of an additional skin disorder possible T-cell lymphoma. (See private dermatopathology report dated in December 2018.) Further examination and opinion are needed. Service connection for sleep apnea The Veteran’s representative further noted that the VA examination conducted in April 2015 did not address whether sleep apnea is directly related to military service. Further examination and opinion are needed. Entitlement to higher ratings for degenerative arthritis of the knees, disabilities of the shoulders, pes planus and plantar fasciitis At his hearing the Veteran indicated that his service connected disabilities had increased in severity since the last VA examination. In light of the Veteran’s contentions of increased symptomatology and a review of the medical evidence of record, the Board finds that a contemporaneous examination should be conducted. The matters are REMANDED for the following action: 1. Ask the Veteran to identify all healthcare providers (both VA and non-VA) for his claimed disabilities. Make arrangements to obtain all records that he adequately identifies. 2. After completion of directive #1, schedule the Veteran for VA examination by an appropriate medical professional in connection with his claims of entitlement to service connection for traumatic brain injury to include headaches, a psychiatric disorder, left elbow disability, right elbow arthritis, right carpal tunnel syndrome, a skin disorder, and sleep apnea. The entire e file must be reviewed by the examiner. The examiner(s) should then provide the following medical opinions: traumatic brain injury to include headaches and psychiatric disability The examiner should verify diagnoses of traumatic brain injury and identify all current psychiatric disabilities. Then opine as to whether it is at least as likely as not (a 50 percent or greater probability) that any diagnosed disability, either commenced during or is otherwise etiologically related to the Veteran’s period of service, or is secondary to (caused or aggravated) his service connected shoulder disabilities. left elbow disability The examiner should verify diagnosis of any left elbow disability. If a chronic disability is identified, then opine as to whether it is at least as likely as not (a 50 percent or greater probability) that the diagnosed disability of the left elbow, either commenced during or is otherwise etiologically related to the Veteran’s period of service, or if a left elbow disability is secondary to (caused or aggravated) his service connected shoulder disabilities. right elbow arthritis and right carpal tunnel syndrome The examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) right elbow arthritis or right carpal tunnel syndrome had clinical onset during active service or is related to any in-service disease, event, or injury, or is secondary to (caused or aggravated) his service connected disabilities of the shoulders. skin disorder The examiner must identify all skin disorders found to be present to include tinea cruris, parapsoriasis, and T-cell lymphoma. The examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) any skin disorder had clinical onset during active service or is related to any in-service disease, event, or injury. sleep apnea The examiner should provide an opinion as to whether it is at least as likely as not (50% or greater probability) sleep apnea had clinical onset during active service or is related to any in-service disease, event, or injury. 3. After completing directive #1, schedule the Veteran for a VA examination to determine the severity of the service connected degenerative arthritis of the knees, disabilities of the shoulders, pes planus and plantar fasciitis. Nathaniel Doan Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A.D. Jackson, Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.