Citation Nr: 20003258 Decision Date: 01/15/20 Archive Date: 01/14/20 DOCKET NO. 17-07 983 DATE: January 15, 2020 ORDER Entitlement to service connection for a right shoulder disability is denied. Entitlement to service connection for residuals of an injury to the right fourth (ring) finger is denied. Entitlement to service connection for hiatal hernia is denied. Entitlement to service connection for peripheral nerve condition, right lower extremity, is denied. Entitlement to a compensable evaluation for epicondylitis, right elbow is denied. Entitlement to a compensable evaluation for epicondylitis, left elbow is denied. Entitlement to a compensable evaluation for bilateral epididymal cyst and recurrent hydrocele is denied. REMANDED Entitlement to a compensable evaluation for patellofemoral pain syndrome, status post fibula fracture, right knee is remanded. Entitlement to a compensable evaluation for patellofemoral pain syndrome, left knee, is remanded. FINDINGS OF FACT 1. The Veteran has not had a disability of the right shoulder at any time since contemporaneous to when he filed his claim to the present. 2. The Veteran has not had a disability the right ring finger at any time since contemporaneous to when he filed his claim to the present. 3. The Veteran does not have current peripheral nerve condition in the right lower extremity. 4. The Veteran does not have a separate diagnosis of hiatal hernia, and the current symptomatology of hiatal hernia is associated with the service-connected gastroesophageal reflux disease (GERD) with hiatal hernia. 5. The Veteran's epicondylitis of the right elbow is not manifested by limitation of flexion of less than 100 degrees, limitation of extension greater than 45 degrees, and no pain on motion. 6. The Veteran's epicondylitis of the left elbow is not manifested by limitation of flexion of less than 100 degrees, limitation of extension greater than 45 degrees, and no pain on motion. 7. The Veteran's epididymal cysts have not resulted in poor renal function, long-term drug therapy, 1-2 hospitalizations per year, and/or required intermittent intensive management. CONCLUSIONS OF LAW 1. The criteria for service connection for a right shoulder disability have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for residuals of an injury to the right fourth (ring) finger have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 3. The criteria for service connection for peripheral nerve condition, right lower extremity, have not been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.313. 4. The criteria for service connection for hiatal hernia have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for a compensable initial evaluation for epicondylitis of the right elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5024. 6. The criteria for a compensable initial evaluation for epicondylitis of the left elbow have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.71a, Diagnostic Code 5024. 7. The criteria for a compensable evaluation for epididymal cysts are not met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.7, 4.115a, 4.115b, Diagnostic Code 7525. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1989 to January 2015. This matter comes before the Board of Veterans' Appeals (hereinafter Board) on appeal from an August 2015 rating decision by the Fargo, North Dakota, Regional Office (RO). On September 5, 2019, the Veteran appeared at the RO and testified at a videoconference hearing before the undersigned Veterans Law Judge, sitting in Washington, DC. A transcript of the hearing is of record. Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. See 38 U.S.C. §§ 1110, 1131 (2012); 38 C.F.R. § 3.303 (a) (2018). "To establish a right to compensation for a present disability, a Veteran must show: "(1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service"- the so-called "nexus" requirement." Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2010) (quoting Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Veteran can provide competent reports of factual matters of which he has first-hand knowledge, such as experiencing pain in service, reporting to sick call, being placed on limited duty, and undergoing physical therapy. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). Lay evidence can be competent and sufficient to establish a diagnosis of a condition when (1) a lay person is competent to identify the medical condition (noting that sometimes the lay person will be competent to identify the condition where the condition is simple, for example a broken leg, and sometimes not, for example, a form of cancer), (2) the lay person is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Jandreau v. Nicholson, 492 F. 3d 1372 (Fed. Cir. 2007). In such cases, the Board is within its province to weigh that testimony and to make a determination as to whether the evidence supports a finding of service incurrence and continuity of symptomatology sufficient to establish service connection. See Barr v. Nicholson, 21. Vet. App. 303 (2007). Similarly, laypersons are competent to diagnose and provide nexus opinions to some extent, notably where the diagnosis or opinion is not of a complex nature. Id., see also Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. 1. Entitlement to service connection for residuals of an injury to the right ring finger 2. Entitlement to service connection for a right shoulder disability 3. Entitlement to service connection for peripheral nerve condition, right lower extremity The Veteran essentially contends that he developed pain in his right shoulder as a result of physical activity during service. The Veteran also maintains that he injured his right ring finger during service, and he continues to experience pain in the finger. Lastly, the Veteran maintains that the right lower extremity nerve condition developed as a result of his service-connected back disorder. After review of the evidentiary record, the Board finds that service connection is not warranted for a right shoulder disability, residuals of an injury to the right ring finger, or peripheral nerve disorder involving the right lower extremity. In this regard, the Board notes that the service treatment records (STRs) show that the Veteran was seen in an emergency room in September 1997, with avulsion to right fifth digit pinky finger. The assessment was degloving injury to right fifth digit. In June 2007, the Veteran was seen with complaints of intermittent right shoulder pain; it was noted that he dislocated the shoulder in 1993, and he now had pain after vigorous weight lifting sessions. Following an examination, the Veteran was diagnosed with joint pain, localized in the shoulder. The STRs also show that in February 2008, the Veteran was placed on profile regarding limitations due to right ring finger; additional listed problems included joint pain in the shoulder. However, an x-ray of the right fourth finger in December 2013 revealed no evidence of acute injury to the right fourth finger or hand, with minimal degenerative change at the first carpometacarpal joint. In addition, all available VA and non-VA treatment records are silent for a complaint of, or treatment for, any shoulder, right ring finger or nerve condition in the right lower extremity. The Veteran has not submitted any evidence, other than his own statements, supporting the claim that he has a current right shoulder disability, residuals of a right ring finger injury, or a nerve condition of the right lower extremity. Moreover, following a DBQ examination in May 2015, the examiner stated that the Veteran does not have a bilateral shoulder condition. He stated that a clinical examination of the shoulders was negative, and no pathology was found; no current bilateral shoulder diagnosis. Following an examination for hand and fingers in May 2015, the examiner stated that there was no evidence of right ring finger condition. And, following an examination for peripheral nerves conditions in May 2015, the DBQ examiner indicated that the Veteran did not have a peripheral nerve condition or peripheral neuropathy, nor did he have any symptoms attributable to any peripheral nerve conditions. The examiner noted that the examination was normal. The threshold requirement here (as in any claim seeking service connection) is that there must be competent evidence that the Veteran has (or during the pendency of the claim has had) the disability for which service connection is sought, i.e., a right shoulder disability, residuals of a right ring finger injury, and peripheral nerve condition of the right lower extremity. See 38 U.S.C. § 1131. The record does not include any such evidence. Notably, the treatment records associated with the record do not show any diagnosis or treatment for any right shoulder disability, right ringer finger or a nerve condition involving the right lower extremity. The Veteran's contentions do not support a finding that he has had persistent or recurrent symptoms of such disabilities. Accordingly, there is no valid claim of service connection for a right shoulder disability, residuals of a right ring finger injury, and peripheral nerve condition of the right lower extremity. Brammer v. Derwinski, 3 Vet. App. 223 (1992). In so finding, the Board notes that the Veteran is considered competent to describe his symptoms, but he is not competent to render or provide a current diagnosis of a chronic orthopedic disability which requires knowledge of the musculoskeletal system or the neurological system. See Barr v. Nicholson, 21 Vet. App. 303 (2007); see also Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). See also Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006) (addressing lay evidence as potentially competent to support presence of disability even where not corroborated by contemporaneous medical evidence). The evidence does not show that the Veteran has a right shoulder disability, residuals of a right ring finger injury, or peripheral nerve condition of the right lower extremity. Absent a current disability, service connection is not warranted. Even in consideration of the Veteran's testimony, he has not specifically alleged a current disability, but instead has merely made arguments regarding the occurrence of an in-service incident which caused him to develop a right shoulder, right ring finger and right leg nerve problems. Such does not amount to a report of a contemporaneous disability as contemplated by Jandreau. Consequently, the preponderance of the evidence is against the claim for service connection for a right shoulder disability, residuals of a right ring finger injury, or peripheral nerve condition of the right lower extremity. The Board recognizes that a medical diagnosis is not the only way of demonstrating a current disability and that pain, itself, can qualify as a disability. Here, however, the Veteran’s statements do not show that he has any impairment due to any right shoulder, right ring finger, or right leg symptoms that he may perceived. In light of the foregoing, the Board concludes that the preponderance of the evidence is against the Veteran's claims of service connection for a right shoulder disability, residuals of a right ring finger injury, or peripheral nerve condition of the right lower extremity. Accordingly, they must be denied. In denying these claims, the Board has considered the doctrine of reasonable doubt; however, as the preponderance of the evidence is against the Veteran's claims, the doctrine is not for application. See generally Gilbert v. Derwinski, 1 Vet. App. 49 (1990); Ortiz v. Principi, 274 F. 3d 1361 (Fed. Cir. 2001). 4. Entitlement to service connection for hiatal hernia The Veteran contends that he has hiatal hernia which developed as a result of service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. While evidence shows that the Veteran complained of chest pain, stomach pain, epigastric distress and other related symptoms during service, the Board concludes that the Veteran does not have a current diagnosis of hiatal hernia separate and apart from his service-connected gastroesophageal reflux disease (GERD) and has not had one at any time during the pendency of the claim or recent to the filing of the claim. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); Romanowsky v. Shinseki, 26 Vet. App. 289, 294 (2013); McClain v. Nicholson, 21 Vet. App. 319, 321 (2007); 38 C.F.R. § 3.303 (a), (d). Following the May 2015 DBQ examination and diagnostic imaging studies, the examiner reported a diagnosis of GERD. The Veteran has not submitted or identified any private medical providers who have diagnosed hiatal hernia. The Board recognizes that the Veteran has complained of difficulty swallowing, a burning sensation and epigastric discomfort which requires medication for acid reflux. While the Veteran believes he has a current diagnosis of hiatal hernia, he is not competent to provide a diagnosis in this case. The issue is medically complex, as it requires specialized medical education/knowledge of the interaction between multiple organ systems in the body/the ability to interpret complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Instead, the medical evidence indicates the Veteran’s subjective complaints are a tion of his GERD, not a hiatal hernia. Consequently, the Board gives more probative weight to the competent medical evidence. In summary, the preponderance of the evidence is against a finding that the Veteran has hiatal hernia disability that was caused or aggravated by service or a service-connected disability. Thus, the claim for service connection is denied. Increased Rating Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. §§ 4.1. Separate diagnostic codes identify the various disabilities. While the Board typically considers only those factors contained wholly in the rating criteria, it is appropriate to consider factors outside the specific rating criteria when appropriate in order to best determine the level of occupational and social impairment. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. §§ 4.7. When evaluating musculoskeletal disabilities based on limitation of motion, 38 C.F.R. §§ 4.40 requires consideration of functional loss caused by pain or other factors listed in that section that could occur during flare-ups or after repeated use and, therefore, not be reflected on range-of-motion testing. 38 C.F.R. §§ 4.45 requires consideration also be given to less movement than normal, more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement. See DeLuca v. Brown, 8 Vet. App. 202 (1995); see also Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011). Nonetheless, even when the background factors listed in § 4.40 or 4.45 are relevant when evaluating a disability, the rating is assigned based on the extent to which motion is limited, pursuant to 38 C.F.R. §§ 4.71a (musculoskeletal system) or § 4.73 (muscle injury); a separate or higher rating under § 4.40 or 4.45 itself is not appropriate. See Thompson v. McDonald, 815 F.3d 781, 785 (Fed. Cir. 2016) ("[I]t is clear that the guidance of § 4.40 is intended to be used in understanding the nature of the veteran's disability, after which a rating is determined based on the § 4.71a [or 4.73] criteria."). When there is an approximate balance of evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. 5. Entitlement to a compensable evaluation for epicondylitis, right elbow 6. Entitlement to a compensable evaluation for epicondylitis, left elbow The Veteran maintains that his bilateral elbow disability is more disabling than reflected by the noncompensable rating currently assigned. The Veteran's right and left elbow disabilities are each rated at zero percent, or noncompensably disabling, under 38 C.F.R. § 4.71a, Diagnostic Code 5024, which evaluates impairment from tenosynovitis. Diagnostic Code 5024 in turn calls for the disability to be rated on limitation of motion, as arthritis, degenerative. Degenerative arthritis is rated under 38 C.F.R. § 4.71a, Diagnostic Code 5003. Under Diagnostic Code 5206, limitation of flexion of either the major or minor forearm to 100 degrees warrants a 10 percent rating; limitation of flexion of either forearm to 90 degrees warrants a 20 percent rating; limitation of flexion of the major forearm to 70 degrees warrants a 30 percent rating; limitation of flexion of the major forearm to 55 degrees warrants a 40 percent rating; and limitation of flexion of the major forearm to 45 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5206. Under Diagnostic Code 5207, limitation of extension of either the major or minor forearm to 45 or 60 degrees warrants a 10 percent rating; limitation of extension of either forearm to 75 degrees warrants a 20 percent rating; limitation of extension of the major forearm to 90 degrees warrants a 30 percent rating; limitation of extension of the major forearm to 100 degrees warrants a 40 percent rating; and limitation of extension of the major forearm to 110 degrees warrants a 50 percent rating. 38 C.F.R. § 4.71a, Diagnostic Code 5207. Also, under Diagnostic Code 5213, a 10 percent rating requires impairment of supination to 30 degrees or less for either the major or minor forearm and a 20 percent rating for limitation of pronation, when pronation is lost beyond the middle or last quarter of the arc in either major or minor forearm. The normal range of motion of the elbow is flexion to 145 degrees and extension to 0 degrees. Normal pronation is from zero to 80 degrees and normal supination is from zero to 85 degrees. 38 C.F.R. § 4.71, Plate I. Degenerative arthritis established by X-ray findings will be rated on the basis of limitation of motion under the appropriate diagnostic codes for the specific joint or joints involved. When however, the limitation of motion of the specific joint or joints involved is noncompensable under the appropriate diagnostic codes, a rating of 10 percent is for application for each such major joint or group of minor joints affected by limitation of motion, to be combined, no added under diagnostic code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. In the absence of limitation of motion, a 20 percent evaluation will be assigned with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups, with occasional incapacitating exacerbation. A 10 percent evaluation will be assigned with X-ray evidence of involvement of 2 or more major joints or 2 or more minor joint groups. 38 U.S.C. § 4.71 a, Diagnostic Code 5003 (2018). On the occasion of a DBQ examination in May 2015, the Veteran complained of continued pain in both elbows. He has a full range of motion in the right and left elbows; the examiner reported motion 0 degrees to 145 degrees. There was no evidence of pain with weight bearing. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. The Veteran was able to perform repetitive use testing with at least three repetitions. No muscle atrophy was noted. No ankylosis was noted. It was noted that the Veteran uses a lateral epicondylitis strap. The pertinent diagnosis was bilateral epicondylitis elbow. The examiner indicated that there is no evidence of flare-up of lateral epicondylitis right elbow; therefore, no opinion of functional loss and additional limitation in range of motion was given. The examiner further noted that, as for when the joint is used repeatedly over a period of time, he was unable to give an opinion as the only evaluation done after exercise is with repetitive use testing with 3 repetitions. Based on the evidence of record, the Board finds that compensable initial ratings are not warranted for the right elbow and left elbow disabilities. The DBQ examination of record does not show that the Veteran's right elbow and left elbow had limitation of flexion of the forearm to 100 degrees or less or limitation of extension of the forearm to 45 degrees or more, or supination of 30 degrees or less. Therefore, compensable ratings are not warranted under Diagnostic Codes 5206, 5207, or 5213. The evidence also fails to show that the Veteran's right elbow and left elbow had objective evidence of pain on motion. The VA examination reports show that following repetitive use, the range of motion of both the right and left elbows was not additionally limited by pain, fatigue, weakness or lack of endurance. As discussed above, under Diagnostic Code 5024, the Veteran's right and left elbow disabilities are rated on limitation of motion of affected parts, as arthritis, degenerative. However, in this case, the evidence of record has not confirmed the presence of arthritis. The Board has considered the factors noted in DeLuca and has considered the clinical findings; however, even with such consideration, the evidence does not reflect that the Veteran's symptoms were synonymous with pain on motion warranting compensable evaluations. The Board has considered whether the Veteran is entitled to higher ratings under other rating criteria. There is no evidence of joint fracture, with marked cubitus varus or cubitus valgus deformity or with ununited fracture of head of radius. Therefore, a higher rating for either elbow is not warranted under Diagnostic Code 5209. In conclusion, the Board finds that compensable initial ratings are not warranted for the right and left elbow disabilities. Consequently, the benefit-of-the-doubt rule is not applicable, and the claim must be denied. 7. Entitlement to a compensable evaluation for bilateral epididymal cysts and recurrent hydrocele The Veteran maintains that he is entitled to a compensable rating for his bilateral epididymal cysts. At his personal hearing in September 2019, the Veteran reported problems with pain and difficulty urinating. The service-connected epididymal cysts are assigned a 0 percent (noncompensable) rating under Diagnostic Code 7599-7525, pertaining to chronic epididymo-orchitis. A hyphenated diagnostic code generally reflects a rating by analogy (see 38 C.F.R. §§ 4.20 and 4.27). A condition without a diagnostic code, such as epididymal cysts, may be rated under a closely related disease or injury in which not only the functions affected but the anatomical localization and symptomatology are closely analogous. See 38 C.F.R. § 4.20. Diagnostic Code 7525 is specific to chronic epidiymo-orchitis. The disability is rated as a urinary tract infection, except for tubercular infections, which are rated under § 4.88b or § 4.89. The evidence in this case does not indicate tubercular infections. Criteria for rating a urinary tract infection are in 38 C.F.R. § 4.115a, which provides a 10 percent rating for long term drug therapy, 1-2 hospitalizations per year, and/or requiring intermittent intensive management. A maximum 30 percent rating is provided for poor renal function, recurrent symptomatic infection requiring drainage/frequent hospitalization (greater than two times per year), and/or requiring continuous intensive management. When poor renal function is associated with the urinary tract infection, the condition is to be rated as renal dysfunction. 38 C.F.R. § 4.115a. On examination in May 2015, the Veteran indicated that he developed chronic scrotum pain after his vasectomy in 2003 and it caused occasional erectile dysfunction. The Veteran was prescribed Viagra for his erectile dysfunction resulting from chronic scrotum pain. On examination, it was noted that there was no renal dysfunction, no voiding dysfunction and no erectile dysfunction. It was noted that the Veteran was diagnosed with chronic scrotum pain developed status post vasectomy in 2003, at today's examination but does state that he is able to achieve an erection sufficient for penetration and ejaculation. Occasionally he is not able to achieve an erection for penetration, ejaculation, and uses medication. It was noted that the Veteran had a small right epididymal cyst measuring 6 mm in its greatest dimension; he had a small left epididymal cyst measuring 4 mm in its greatest dimension. There was no significant hydrocele and no varicocele. The Veteran was afforded a recent DBQ examination in August 2019. At that time, it was noted that the Veteran continues to have bilateral testicle pain daily, and he has a documented history of antibiotic treatment of chronic epididymitis in 2009 and 2015. VA records reveal no urinary flow issues and no history of recurrent urinary tract infection. Here, the evidence of record reveals no renal dysfunction. Neither did the Veteran undergo long-term drug therapy, nor required one or two hospitalizations per year or intermittent intensive management. The evidence of record does not support a compensable rating for epididymal cysts. Diagnostic codes pertaining to the kidneys, bladder, and urethra are not relevant, as the Veteran did not report, and evidence does not show involvement of kidney, bladder, or urethra associated with epididymal cysts. See 38 C.F.R. § 4.115b, Diagnostic Codes 7500-7519. Nor is there any finding of penile deformity to warrant a compensable rating under Diagnostic Code 7522. A compensable rating for epididymal cysts is not supported by the evidence of record at any time; the preponderance of evidence is against the claim, and there is no reasonable doubt to be resolved. REASONS FOR REMAND After examining the record, the Board concludes that further assistance to the Veteran is required in order to comply with the duty to assist as mandated by 38 U.S.C. § 5103A (2012). The specific bases for remand are set forth below. 1. Entitlement to a compensable rating for patellofemoral pain syndrome, status post fibula fracture, right knee, is remanded. 2. Entitlement to a compensable rating for patellofemoral pain syndrome, left knee, is remanded. The Veteran seeks compensable ratings for his right and left knee disorders. He maintains that his left and right knee disabilities are more disabling than reflected by the ratings currently assigned. The Veteran was most recently afforded a DBQ examination for evaluation of his disabilities in May 2015. Since that time, the Court of Appeals for Veterans' Claims (CAVC) has held "that the final sentence of 38 C.F.R. § 4.59 creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities." Correia v. McDonald, 28 Vet. App. 158 (2016). The CAVC also stated that in order "to be adequate, a VA examination of the joints must, wherever possible, include the results of the range of motion testing described in the final sentence of § 4.59." Id. at 169-70. Here, it does not appear the range of motion testing conducted on the May 2015 DBQ knee examinations is in accord with this requirement. Thus, a remand is necessary in order to afford the Veteran a new VA examination to determine the severity of his left and right knee disabilities and addresses the CAVC's directive. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (when VA undertakes to provide a medical examination, it must ensure that the examination and opinions therein are adequate). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any existing relevant VA treatment records not already associated with the claims file. 2. Then, ensure that the Veteran is scheduled for a VA orthopedic examination, to determine all manifestations of and the severity of his knees. The claims file must be reviewed by the examiner(s) in conjunction with the examination(s). In order to comply with the Court's recent precedential decision in Correia v. McDonald, 28 Vet. App. 158 (2016), the examiner(s) must test and record the range of motion for both knees in active motion, passive motion, weight-bearing, and nonweight-bearing. If any examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. 3. Then, readjudicate the claims that are the subject of this Remand. If any benefit sought is not granted in full, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and allow an appropriate opportunity to respond thereto before returning the case to the Board. JAMES G. REINHART Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.