Citation Nr: 20006261 Decision Date: 01/24/20 Archive Date: 01/24/20 DOCKET NO. 16-53 186 DATE: January 24, 2020 REMANDED Entitlement to service connection for varicose veins is remanded. Entitlement to an initial compensable rating for vasomotor rhinitis is remanded. Entitlement to a rating in excess of 10 percent for right shoulder impingement syndrome is remanded. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee is remanded. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the left knee is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1987 to May 2007. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a hearing in November 2019. For clarity, the Board notes that on Board hearing the Veteran confirmed her intent to continue her appeals for entitlement to increased ratings for her service-connected bilateral knee and right shoulder disabilities. As a result, these issues are listed above. 1. Entitlement to service connection for varicose veins. The Veteran asserts that she suffers from varicose veins and was treated for the condition in-service. Service treatment records confirm she suffered from, and received treatment for, a “longstanding” spider vein condition in both legs in April and July 2003. She has yet to be afforded a VA examination which addresses her contentions as to these service records. On remand, she must be afforded a VA examination and opinion addressing the nature and etiology of her claimed condition. 2. Entitlement to an initial compensable rating for vasomotor rhinitis. 3. Entitlement to a rating in excess of 10 percent for right shoulder impingement syndrome. 4. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the right knee. 5. Entitlement to a rating in excess of 10 percent for degenerative arthritis of the left knee. The record reflects that the Veteran was scheduled for, and received, a VA Sinus Examination addressing her service-connected vasomotor rhinitis in 2015. The claims file is currently negative for a copy of this examination. On remand, this examination must be obtained and associated with the claims file. On Board hearing, the Veteran reported worsening in her service-connected shoulder, knee, and rhinitis disabilities. She also reported receiving on-going treatment for her conditions. The claims file is negative for VA examination reports and treatment medical records date after 2015. Given the reported worsening and the lack of contemporaneous evidence as to severity, a remand for new examination and to obtain all outstanding treatment medical records is warranted. See Snuffer v. Gober, 10 Vet. App. 400 (1997). The matters are REMANDED for the following action: 1. Obtain all outstanding treatment medical records dated after 2015 and associate them with the claims file. In addition, obtain the VA Sinus DBQ requested on May 19, 2015. The Veteran must be informed of any unobtainable treatment medical records or examination reports. 2. Schedule the Veteran for an examination to ascertain the nature and etiology of her varicose veins. Any indicated evaluations, studies and tests deemed necessary by the examiner should be accomplished. The claims file should be made available to the examiner designated to provide an opinion. The examiner must elicit a detailed medical history from the Veteran, and the examination report must include a discussions of the Veteran’s documented medical history and assertions. The examiner should offer comments, an opinion and a supporting rationale that address the following: (a.) Does the Veteran have, or has she been diagnosed with, varicose veins during the pendency of the appeal? (b.) Is it at least as likely as not that the Veteran’s varicose veins were incurred in, aggravated by, or are otherwise etiologically related to the Veteran’s active duty service? In providing this opinion, the examiner must address the Veteran’s testimony contending that she first noted varicosities in service, and they have continued even after treatment until the present. (c.) Is it at least as likely as not that the Veteran’s varicose veins are caused or aggravated by her service-connected bilateral knee arthritis? (d.) The examiner must address service medical records which confirm she suffered from and received treatment for a “longstanding” spider vein condition in both legs in at least April and July 2003. (e.) The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports and specific assertions at Board hearing must be considered. If the examiner rejects the Veteran’s reports, the examiner must provide a reason for doing so. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected allergic rhinitis. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to allergic rhinitis alone and discuss the effect of the Veteran’s rhinitis on any occupational functioning and activities of daily living. If it is not possible to provide an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. 4. Schedule the Veteran for an examination to determine the nature and severity of her right shoulder and bilateral knee disabilities. The examination should include all tests and evaluations deemed necessary by the examiner. The examiner should report all manifestations related to the disability. The claims file must be made available to the examiner for review. a. The examiner is requested to test the range of motion of the right shoulder and bilateral knee disabilities in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, or concludes such testing is not necessary, he or she should clearly explain why that is so. b. With regard to flare-ups, the examiner is asked to describe whether pain significantly limits functional ability during flares, and if so, the examiner must estimate range of motion during flares. If the examination does not take place during a period of flare-up, the examiner should glean information regarding the flares’ severity, frequency, duration, and functional loss manifestations from the Veteran, medical records, and other available sources. Efforts to obtain such information must be documented. c. If there is no pain and/or no limitation of function, such facts must be noted in the report. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. L. Burroughs, 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.