Citation Nr: 19168403 Decision Date: 09/04/19 Archive Date: 09/04/19 DOCKET NO. 13-33 084 DATE: September 4, 2019 ORDER Entitlement a disability rating in excess of 10 percent for residuals of snake bite to left long finger with residual limitation of motion of left wrist is denied. Entitlement to an initial disability rating in excess of 20 percent for compartment syndrome on the left is denied. Prior to October 19, 2017, entitlement to an initial compensable rating for a scar of the left forearm is denied. Beginning October 19, 2017, an initial compensable rating of 10 percent for a scar of the left forearm, but no higher, is granted. Entitlement to an initial compensable rating for left forearm musculocutaneous nerve damage prior to October 19, 2016 is denied. Entitlement to an initial rating of 30 percent for left forearm musculocutaneous nerve damage beginning October 19, 2016 is granted. The Veteran’s petition to reopen a claim for entitlement to service connection for a right shoulder disorder is denied. REMANDED The issue of whether the reduction of the rating for left knee instability from 20 percent to noncompensable, effective February 1, 2018, was proper is remanded. Entitlement to an initial disability rating in excess of 20 percent for left knee instability is remanded. Entitlement to an initial disability rating in excess of 10 percent for left knee degenerative arthritis is remanded. Entitlement to total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran’s residuals of snake bite to left long finger with residual limitation of motion of left wrist is rated as 10 percent disabling, which is the maximum schedular rating permitted for limitation of motion of the wrist without ankylosis. 2. The Veteran’s compartment syndrome on the left is rated as 20 percent disabling, which is the maximum schedular rating permitted for disabilities of Muscle Group VIII for the nondominant hand. 3. Prior to October 16, 2017, the Veteran’s linear left forearm scar was not manifest by any disabling effects not considered under Diagnostic Codes 7800-7804. 4. Beginning October 16, 2017, the Veteran’s linear left forearm scar was manifested by pain. 5. Prior to October 19, 2016, the Veteran’s left forearm musculocutaneous nerve damage did not cause pain, paresthesias, dysesthesias, or numbness; strength, reflex, and sensory testing were normal. 6. Beginning October 19, 2016, the Veteran’s left forearm musculocutaneous nerve damage has been manifested by no more than moderate incomplete paralysis of the minor extremity. 7. An August 2006 Board decision denied entitlement to service connection for a right shoulder disability. 8. When considered by itself or in connection with the evidence previously assembled, the Veteran has not submitted evidence that relates to an unestablished fact necessary to substantiate the claim or raises a reasonable possibility of substantiating the claim of entitlement to service connection for a right shoulder disorder. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 10 percent for residuals of snake bite to left long finger with residual limitation of motion of left wrist have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, Diagnostic Code 5215. 2. The criteria for a rating in excess of 20 percent for compartment syndrome on the left have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.73, Diagnostic Code 5308. 3. Prior to October 16, 2017, the criteria for a compensable disability rating for a linear left forearm scar were not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 4. Beginning October 16, 2017, the criteria for a 10 percent disability rating, but no higher, for a linear left forearm scar have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.118, Diagnostic Code 7805. 5. Prior to October 19, 2016, the criteria for a compensable disability rating for left forearm musculocutaneous nerve damage have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8517. 6. Beginning October 19, 2016 the criteria for a disability rating of 30 percent, but no higher, for left forearm musculocutaneous nerve damage have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.124a, Diagnostic Code 8513. 7. New and material evidence has not been added to the record since the August 2006 Board decision; thus, the claim of entitlement to service connection for a right shoulder disability is not reopened. 38 U.S.C. §§ 5108, 7104; 38 C.F.R. §§ 3.156, 20.1100. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1975 to December 1978. These matters come before the Board of Veterans’ Appeals (Board) on appeal from March 2010, September 2016, October 2017, and November 2017 rating decisions by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran has contended that he cannot work due to his service-connected disabilities on appeal. As such, the Board takes jurisdiction of the issue of entitlement to TDIU because it was part and parcel to the issue on appeal. Rice v. Shinseki, 22 Vet. App. 447, 453-54 (2009). The issues of increased ratings for residuals of a snake bite to left long finger with residual limitation of motion of left wrist, compartment syndrome on the left, a scar of the left forearm, and left forearm musculocutaneous nerve damage were dismissed by the Board in a September 2017 decision. The Board noted that on August 5, 2016, VA received an “appeals satisfaction notice” signed by the Veteran reflecting his satisfaction with a decision rendered and his intent to withdraw the four issues on appeal at that time. The Board noted that on August 26, 2016, VA received correspondence from the Veteran’s representative, in which she stated that the Veteran “erroneously submitted” the appeals satisfaction notice, “did not fully appreciate the ramifications of his actions,” and did not wish to withdraw his appeal. She asked VA to disregard the withdrawal. However, the Board found that the withdrawal was valid, and dismissed the issues. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court), and in an October 2018 Memorandum Decision, the Court vacated and remanded the decision for the Board to reconsider whether, under the relevant provisions of the VA’s Adjudication Procedure M21-1 (M21-1), the Veteran had revoked or retracted his withdrawal. The Board notes that the provisions set out in M21-1, III.ii.2.G.4.a., Processing a Retraction of a Request to Withdraw a Claim, as they relate to his case, are essentially based on how soon the retraction was filed with the VA following the withdrawal of the appeal. The Board must determine whether the VA received the retraction within 30 days of the date VA notified the Veteran that it had acted on his request to withdraw his claim. In this case, the retraction of the withdrawal of appeal was received by the VA about two weeks after the withdrawal was filed—prior to the Veteran being informed that he his issues were being dismissed. The M21-1 guidance in situations such as this one is to reestablish the claim and proceed to adjudicate the issues on appeal. The M21-1 is not binding on the Board’s decisions. Disabled Am. Veterans v. Sec'y of Veterans Affairs, 859 F.3d 1072, 1077 (Fed. Cir. 2017). However, Court has held that the Board is required to discuss any relevant provisions contained in the M21-1 as part of its duty to provide adequate reasons or bases, but because it is not bound by those provisions, it must make its own determination before it chooses to rely on an M21-1 provision as a factor to support its decision. Overton v. Wilkie, 30 Vet. App. 257, 264 (2018). The Court added that the Board is required to provide a reasoned explanation for why it finds the M21-1 an accurate guideline for its decision. Id. In this case, the Board finds that the guidance provided in the M21-1 with regard to the retraction of the Veteran’s withdrawal of appeal to be appropriate, given the short amount of time that passed between the filing of the withdrawal and the retraction. As such, the Board finds that, in light of the guidance provided by the M21-1, the retraction of the issues before the Board in September 2017 is valid, and these issues are on appeal before the Board. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran’s service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that evaluation; otherwise, the lower evaluation will be assigned. 38 C.F.R. § 4.7. In view of the number of atypical instances it is not expected, especially with the more fully described grades of disabilities, that all cases will show all the findings specified. Findings sufficiently characteristic to identify the disease and the disability therefrom, and above all, coordination of rating with impairment of function will, however, be expected in all instances. 38 C.F.R. § 4.21. Residuals of Snake Bite to Left Long Finger with Residual Limitation of Motion of Left Wrist The Veteran's service-connected residuals of snake bite to left long finger with residual limitation of motion of left wrist is rated under Diagnostic Codes 5154-5215. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the evaluation assigned; the additional code is shown after the hyphen. 38 C.F.R. § 4.27. The hyphenated diagnostic code here indicates that the Veteran is service connected for amputation of long finger by analogy and limitation of motion of the right wrist. Under Diagnostic Code 5215 (the code under which the Veteran's right wrist disability is rated), a 10 percent rating is warranted for limitation of dorsiflexion of the wrist to less than 15 degrees, or for palmar flexion limited in line with the forearm. This is the maximum possible schedular rating under Diagnostic Code 5215. 38 C.F.R. § 4.71a, Diagnostic Code 5215. Higher ratings are available under Diagnostic Code 5214 for ankylosis of the wrist. Under Diagnostic Code 5214, a 30 percent rating is warranted where there is favorable ankylosis of the wrist in 20 to 30 degrees of dorsiflexion. A 40 percent rating is warranted where there is ankylosis of the wrist in any other position, except favorable. A maximum 50 percent rating is warranted where there is unfavorable ankylosis in any degree of palmar flexion, or with ulnar or radial deviation. A note to Diagnostic Code 5214 states that extremely unfavorable ankylosis will be rated as loss of use of hands under Diagnostic Code 5125. 38 C.F.R. § 4.71a, Diagnostic Codes 5214, 5125. Normal range of motion of the wrist includes dorsiflexion (extension) from zero to 70 degrees, palmar flexion from zero to 80 degrees, ulnar deviation from zero to 45 degrees, and radial deviation from zero to 20 degrees. 38 C.F.R. § 4.71a, Plate I. The evaluation of a service-connected musculoskeletal disability requires adequate consideration of functional loss due to pain under 38 C.F.R. § 4.40 and of functional loss due to weakness, fatigability, incoordination or pain on movement of a joint under 38 C.F.R. § 4.45. See DeLuca v. Brown, 8 Vet. App. 202 (1995); Mitchell v. Shinseki, 25 Vet. App. 32, 38 (2011) (quoting 38 C.F.R. § 4.40). Examiners must also provide an opinion as to whether pain significantly limits functional ability on use and during flare-ups. Sharp v. Shulkin, 29 Vet. App. 26, 34 (2017). Furthermore, in Correia v. McDonald, 28 Vet. App. 158, 168 (2016), the Court held that to be adequate, a VA examination of the joints must, wherever possible, include the results of range of motion testing on both active and passive motion, in weight bearing and non-weight bearing, and, if possible, with the range of the opposite undamaged joint. Id. at 169-70. Here, however, the Veteran is in receipt of the maximum schedular rating available under Diagnostic Code 5215 for limitation to range of motion. As the maximum schedular evaluation is in effect, no additional schedular discussion is necessary and discussion of 38 C.F.R. §§ 4.40 and 4.45 and the DeLuca and Mitchell factors are moot. Johnston v. Brown, 10 Vet. App. 80, 85 (1995) (If the maximum schedular rating is in effect for loss of motion of a joint, and the disability does not meet the criteria for a higher evaluation under any other applicable diagnostic code, further consideration of functional loss is not required). The intent of the Rating Schedule is to recognize actually painful, unstable, or malaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. In this instance, the minimum compensable rating for the Veteran’s wrist disability under Diagnostic Code 5215 is also the maximum compensable rating under the relevant diagnostic code, 10 percent. The Veteran underwent a VA examination in February 2010, which showed dorsiflexion to 30 degrees and palmer flexion to 40 degrees. A February 2016 VA examination showed dorsiflexion to 30 degrees and palmer flexion to 45 degrees. An October 2017 VA examination showed dorsiflexion to 45 degrees and palmer flexion to 40 degrees. A March 2018 VA examination showed dorsiflexion and palmer flexion were both limited to 20 degrees. These examiners found no ankylosis to be present, flare ups involved increased pain on movement, and there was no additional loss of motion after repetitive use. The Veteran has consistently reported that the pain and stiffness in his right wrist affects his daily activities. The VA examinations of record show that the Veteran's right wrist disability has been manifested primarily by limited motion and pain, but that he has not had ankylosis of his right wrist. The Veteran is currently in receipt of a 10 percent rating based on these examinations and reported symptoms, and 10 percent is the maximum possible schedular rating under the applicable diagnostic code for pain for limitation of wrist motion. Compartment Syndrome on the Left The Veteran’s compartment syndrome on the left has been rated as 20 percent disabling under Diagnostic Code 5308. Diagnostic Code 5308 applies to impairment of Muscle Group VIII. This muscle group involves the functions of extension of the wrist, fingers and thumb; and abduction of the thumb. This includes the muscles arising mainly from the external condyle of the humerus: extensors of the carpus, fingers, and thumb; supinator. The non-dominant side ratings of Diagnostic Code 5308 are applicable in this case because the Veteran is right-handed, and the service-connected disability affects the Veteran's non-dominant (left) forearm. 38 C.F.R. § 4.69. Under Diagnostic Code 5308, moderately severe impairment of a non-dominant muscle is rated 20 percent disabling; and severe impairment of a non-dominant muscle is rated 20 percent disabling. 38 C.F.R. § 4.73. The Board notes that 20 percent is the highest rating available for severe injury to a non-dominant muscle in Group VIII under Diagnostic Code 5308. The Board has considered whether other diagnostic codes could provide a higher rating for the Veteran's service-connected muscle injury; however, based on the evidence of record, the Board finds that the other diagnostic codes used to evaluate muscle injuries are simply not applicable to this case. Initial Compensable Rating for a Scar of the Left Forearm The Veteran’s left forearm scar has been assigned a noncompensable rating under Diagnostic Code 7805. Under the Diagnostic Code, any disabling effects not considered in a rating provided under Diagnostic Codes 7800-7804 should be evaluated under an appropriate diagnostic code. 38 C.F.R. § 4.118, DC 7805. Scars rated under Diagnostic Code 7805 may also receive an evaluation under Diagnostic Code 7804 for painful or unstable scars when applicable. 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (3). Under Diagnostic Code 7804, a 10 percent rating is assigned for one or two scars that are unstable or painful. A 20 percent rating is warranted for three or four painful or unstable scars and a 30 percent rating is warranted for 5 or more painful or unstable scars. 38 C.F.R. § 4.118, Diagnostic Code 7804. The Veteran’s scar was examined in February 2010, February 2016, July 2017. In these examinations, the Veteran’s scar was described as a superficial linear scar precisely located on the left lateral elbow down to the left long finger. The entire scar measured 49 centimeters by 1 centimeter. There was no skin breakdown. There was no underlying tissue damage. Inflammation was absent. Edema was absent. There was no keloid formation. The scar was not disfiguring and did not limit the Veteran’s motion. There was no limitation of function due to the scar. The Veteran denied any pain associated with the scar. As such, prior to October 16, 2017, the Veteran’s scar does not warrant compensable disability rating. However, at his October 16, 2017 VA examination, the Veteran reported that the scar was painful, and the examiner noted pain on palpation. As the Veteran has one scar that is painful but not unstable, a 10 percent rating under Diagnostic Code 7804 is warranted. 38 C.F.R. § 4.118, Diagnostic Code 7804. The Board finds that this evidence warrants a compensable disability rating as of October 16, 2017, based on a painful scar. While the criteria for a compensable evaluation has been met as of this date, the Board finds that a higher evaluation is not warranted as there is only one painful scar. To warrant a higher rating, the evidence would need to show that the Veteran has three scars or more that are painful. Pursuant to Note (2) to Diagnostic Code 7804, if one or more scars are both unstable and painful, a 10 percent evaluation should be added to the rating. However, in this case, there is no evidence that the Veteran’s right forearm scar is unstable. As such, an additional 10 percent rating is not warranted. The Board thus finds that a compensable rating for the Veteran’s left forearm scar is not warranted prior to October 16, 2017, but that a 10 percent disability rating is warranted beginning October 16, 2017. Left Forearm Musculocutaneous Nerve Damage As noted above, ratings for the non-dominant side are applicable in this case because the Veteran is right-handed and the service-connected disability his non-dominant (left) forearm. The Veteran’s nerve damage in his left forearm was rated as noncompensable under Diagnostic Code 8517 prior to October 4, 2017. Under Diagnostic Code 8517, incomplete paralysis of all musculocutaneous nerve warrants a noncompensable rating when mild, a 10 percent rating when moderate, and a 20 percent rating when severe. Complete paralysis warrants a 20 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8517. Beginning October 4, 2017, the Veteran’s left upper extremity disability was rated under Diagnostic Code 8513, which provides the rating criteria for paralysis of all radicular groups. 38 C.F.R. § 4.124a. Under Diagnostic Code 8513, for the minor upper extremity, incomplete paralysis of all radicular groups warrants a 20 percent rating when mild, a 30 percent rating when moderate, and a 60 percent rating when severe. Complete paralysis warrants an 80 percent rating. 38 C.F.R. § 4.124a, Diagnostic Code 8513. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. The term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is only sensory, the rating should be for the mild, or at most, the moderate degree. 38 C.F.R. § 4.123. The Veteran was provided with VA examination in July 2016. The examiner noted no constant or intermittent pain, paresthesias or dysesthesias, or numbness. Muscle strength and reflex examinations were normal. Sensory examination was normal with the exception that the Veteran had decreased sensation in the forearm. The examiner found that the nerves of the Veteran’s left upper extremity were normal. He underwent another VA examination in July 2017. The Veteran reported that his disability had worsened and that he had severe constant pain, paresthesias and dysesthesias, and numbness. Upon examination, muscle strength, reflex, and sensory examinations were normal. The Veteran was provided with a VA examination in October 2017. He reported that his disability had worsened over the prior year, and that he had begun experiencing pins and needles and burning pain. The examiner noted moderate constant pain, paresthesias and dysesthesias, and numbness. He found reduced strength, reflexes, and sensation in the Veteran’s left forearm, and diagnosed moderate incomplete paralysis of the radial, median, and ulnar nerves. He noted that this was a progression of the previous diagnosis. The Board finds that, resolving all reasonable doubt in favor of the Veteran, his left upper forearm disability warrants a 30 percent disability rating as of a year prior to the October 2017 examination, or October 19, 2016. At his October 2017 examination, the Veteran contended that his disability had worsened over the prior year, and this was at least in part corroborated by his similar reports at his July 2017 VA examination. As such, the Board finds that this increase was factually ascertainable as of one year prior to his October 2017 examination. See Swain v. McDonald, 27 Vet. App. 219, 224 (2015) (stating that, in determining when an increase is factually ascertainable, a date should not be assigned mechanically from the date of an examination, but from the date that the increase in disability can be first factually ascertainable). In addition, the Board finds that the Veteran’s left forearm nerve disability warrants a rating increase to 30 percent, based on the findings at his October 2017 examination reflecting moderate incomplete paralysis. A higher rating would be warranted if the evidence reflected severe incomplete paralysis or severe disability. However, in this case, the evidence does not show that his left forearm nerve disability is severe. As such, a rating in excess of 30 percent beginning October 19, 2016 is not warranted. For the period prior to October 19, 2016, the Board finds that the evidence does not support a grant of a compensable disability rating. At his July 2016 examination, the Veteran denied pain, paresthesias, dysesthesias, and numbness. The physical examination was essentially normal, and the examiner did not determine that a diagnosis was warranted. As such, under Diagnostic Code 8517, a compensable disability rating is not warranted prior to October 19, 2016. Petition to Reopen – right shoulder disorder Where a claim has been finally adjudicated, a claimant must present new and material evidence to reopen the previously denied claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). New evidence is evidence not previously submitted to agency decision makers. 38 C.F.R. § 3.156(a). Material evidence is evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. Id. New and material evidence cannot be either cumulative or redundant of the evidence of record at the time of the last prior final denial and must raise a reasonable possibility of substantiating the claim. Id. The Court has interpreted the language of 38 C.F.R. § 3.156(a) as creating a low threshold and viewed the phrase “raises a reasonable possibility of substantiating the claim” as “enabling rather than precluding reopening.” The Court emphasized that the regulation is designed to be consistent with 38 C.F.R. § 3.159(c)(4), which “does not require new and material evidence as to each previously unproven element of a claim.” Shade v. Shinseki, 24 Vet. App. 110 (2010). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. Shade, 24 Vet. App. at 117. For the purpose of establishing whether new and material evidence has been submitted, the credibility of the evidence, although not its weight, is presumed. See Justus v. Principi, 3 Vet. App. 510, 513 (1992). The question of whether to reopen a claim should be considered under the standard of 38 C.F.R. § 3.159(c)(4)(iii), consistent with McLendon v. Nicholson, 20 Vet. App. 79 (2006), for determining whether a VA examination is necessary. If the McLendon standard is met, the claim should be reopened. See id. The provisions of 38 U.S.C. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-3 (1996). Historically, the RO initially denied the Veteran’s claim for service connection for a shoulder disability in an April 1990 rating decision, finding that there was no evidence of a shoulder dislocation during service. The Veteran filed a timely notice of disagreement (NOD) and was provided with a statement of the case in June 1990 but did not perfect the appeal. The decision became final. The Veteran filed to reopen the claim in August 2000, alleging that he had hurt his shoulder in service while lifting weights. The Veteran submitted lay evidence in support of his claim. In April 2001, the RO reopened the claim and denied service connection for a right shoulder disability, finding that, while post-service medical records reflected that the Veteran had a rotator cuff tear, there was no evidence showing that the Veteran had right shoulder condition related to service or subject to service connection. The Veteran perfected his appeal of the April 2001 denial. In a July 2003 decision, the Board denied the Veteran’s claim for entitlement to service connection for a right shoulder disability. The Board addressed the Veteran’s claims of an in-service injury to his shoulder and the medical evidence of record and found that the competent, credible evidence of record reflected that the Veteran’s right shoulder disability did not have its inception in military service, nor did it manifest within one year of his separation from service. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court), and in August 2004, the Court vacated and remanded the decision in order for the Board to obtain additional records. The Board complied with the remand directive and again denied the Veteran’s claim in an August 2006 decision, concluding that the Veteran’s right shoulder disability, arthritis, was not incurred in service and first manifested many years after service, and that there was no evidence of a relationship between the current right shoulder disability and service. Since the August 2006 Board decision, new evidence has been added to the claims file. The Veteran’s representative has now claimed that his osteoarthritis of the right shoulder may be due to his in-service rattle snake bite. The Board notes that new theories of entitlement are not a basis for reopening a claim, but if evidence supporting a new theory of entitlement constitutes new and material evidence, then VA must reopen the claim. Boggs v. Peake, 520 F.3d 1330, 1336-37 (Fed. Cir. 2008. In support of this contention, the Veteran’s representative submitted a study published in November 2016 purporting to link snake bites to musculoskeletal disorders in about 3.2 percent of snake bite victims. The Board finds significant differences between the situations addressed in the study and the Veteran’s situation. First, the study notes that the snakes causing disabilities were cobra, Russell’s viper, and hump-nosed viper. The Veteran in this case suffered a bite from a rattle snake. In addition, the study found that, on average, the musculoskeletal disabilities addressed lasted for 13.4 years. In this case, the Veteran’s snake bite occurred in April 1976—over 40 years ago. Medical articles or treatises can provide important support when combined with the opinion of a medical professional if they discuss generic relationships with a degree of certainty such that, under the facts of a specific case, there is at least plausible causality based upon objective facts rather than on an unsubstantiated lay medical opinion. Mattern v. West, 12 Vet. App. 222 (1999); Sacks v. West, 11 Vet. App. 314 (1998); Wallin v. West, 11 Vet. App. 509 (1998). Moreover, generic medical literature that does not apply medical principles regarding causation or etiology to the facts of an individual case, or facts more or less similar to the individual case is not competent evidence that can establish causation. See Sacks v. West, 11 Vet. App. 314 (1998). The Board finds that the differences between the situations studied in the submitted medical literature and the Veteran’s case are so substantial as to render the evidence immaterial to the present case. As such, this evidence does not meet the criteria of 38 C.F.R. § 3.159(c)(4)(iii), and McLendon, 20 Vet. App. 79, for providing a VA examination. See Shade, 24 Vet. App. 110. The Board accordingly finds that new and material evidence has not been received to reopen the claim of service connection for a right shoulder disability. Hence, the petition to reopen the claim is denied. REASONS FOR REMAND Increased Rating - Left Knee Degenerative Arthritis The Veteran underwent a VA examination in March 2018. The Board finds that this examination is inadequate for the following reasons. First the examination did not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016). While the examiner in one instance on the examination report that the Veteran did not have pain with weight-bearing, in another instance, he noted that the Veteran reported continued pain, locking and buckling of the left knee, primarily with prolonged weight bearing. He also noted pain on passive range of motion and non-weight bearing range of motion. However, the examiner did not include measurements for range of motion testing on active and passive motion and in weight-bearing and nonweight-bearing, and did not specifically state whether all required testing was completed to adequately assess the Veteran’s pain on motion. In addition, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). While the examiner elicited relevant information regarding the description of the Veteran’s flare-ups and additional functional loss suffered during flare-ups, he did not provide an estimate of that functional loss in terms of the degree of additional loss in range-of-motion. Rather, the examiner noted that the severity of the Veteran’s flare-ups varied, and he did not feel that he could provide an estimate. However, the Board finds that another attempt should be made to estimate the functional loss in terms of the degree of additional loss in range-of-motion during flare-ups (if any) on remand. Rating Reduction - Left Knee Instability The Veteran disagrees with the November 2017 reduction of his rating from 20 percent to noncompensable, effective February 1, 2018. The Veteran filed a timely Notice of Disagreement (NOD) to this reduction on August 23, 2018. However, the RO has not acknowledged the NOD as an NOD to the November 2017 rating decision that implemented the reduction, and no statement of the case (SOC) has been issued addressing whether the reduction in rating was proper. Therefore, the Board finds this matter should be remanded for the issuance of a SOC. See Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). Increased Rating - Left Knee Instability; TDIU The Board finds that a decision on the remanded issue of whether the rating reduction for left knee instability was proper could significantly impact a decision on the issue of an increased rating for left knee instability. Both of these issues would impact the Veteran’s claim for TDIU. Thus, the issues are inextricably intertwined. Thus, the claims of entitlement to an increased rating for left knee instability and TDIU are remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination of the current severity of his left knee degenerative arthritis. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing and clearly indicate that such range of motion testing has been completed. The examiner must also 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 to left knee degenerative arthritis alone and discuss the effect of this 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 based on direct observation, the examiner must provide an estimate of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. 2. Send the Veteran and his representative a statement of the case that addresses the issues of whether the reduction of the rating for left knee instability from 20 percent to noncompensable, effective February 1, 2018, was proper. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Harrigan Smith 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.