Citation Nr: 20073556 Decision Date: 11/17/20 Archive Date: 11/17/20 DOCKET NO. 12-25 406 DATE: November 17, 2020 REMANDED Entitlement to a rating in excess of 50 percent prior to August 8, 2017, and in excess of 70 percent on and after August 8, 2017, for an anxiety disorder is remanded. Entitlement to a rating in excess of 30 percent prior to August 14, 2017, and in excess of 50 percent on and after August 14, 2017, for left temporal parietal arteriovenous malformation and headaches, to include entitlement to a separate compensable rating, is remanded. Entitlement to an initial rating in excess of 10 percent for right knee degenerative joint disease with patellofemoral syndrome is remanded. Entitlement to an initial rating in excess of 10 percent for left knee degenerative joint disease with patellofemoral syndrome is remanded. REASONS FOR REMAND The Veteran had active service from January 2006 to May 2005. He served in Iraq. The Veteran appeared at a February 2016 videoconference hearing before the undersigned Veterans Law Judge. A hearing transcript is of record. The record shows that the Veteran received an October 2020 Board letter indicating that the Veteran could request a virtual hearing instead of waiting for a travel board hearing. After further review of the record, the Board finds that the Veteran does not have a pending hearing request. The Veteran provided testimony at a hearing with the undersigned Veterans Law Judge. The Board has considered the transcript of that hearing as evidence in this adjudication. The issue of entitlement to an increased rating for grand mal seizures is the subject of a separate Board decision and will not be addressed below. In March 2019, the Board remanded the issues of service connection for a neck disability and a back disability to the Agency of Original Jurisdiction for additional development of the record. The requested action has not been completed and the issues have not been returned to the Board. Therefore, the issues are not on appeal and will not be addressed below. 1. Entitlement to a rating in excess of 30 percent prior to August 14, 2017, and in excess of 50 percent on and after August 14, 2017, for left temporal parietal arteriovenous malformation and headaches, to include entitlement to a separate compensable rating, is remanded. The rating schedule does not specifically address arteriovenous malformation of the brain. In such situations, it is permissible to rate the service connected disability under provisions of the rating schedule which pertain to a closely related disease or injury which is analogous in terms of the function affected, anatomical localization and symptomatology. 38 C.F.R. § 4.20. The Board finds that the service-connected disability is most closely analogous to an embolism of the vessels of the brain. Vascular disabilities of the brain are to be rated as 100 percent disabling for six months and thereafter evaluated on the basis of recurrent residuals. A minimum 10 percent rating will be assigned. It is required for the minimum ratings for residuals under Diagnostic Codes 8000 through 8025 that there be ascertainable residuals. Determinations as to the presence of residuals not capable of objective verification, i.e., headaches, dizziness, and fatigability, must be approached on the basis of the diagnosis recorded; subjective residuals will be accepted when consistent with the disease and not more likely attributable to other disease or no disease. It is of exceptional importance that when ratings in excess of the prescribed minimum ratings are assigned, the diagnostic codes utilized as bases of evaluation be cited, in addition to the codes identifying the diagnoses. 38 C.F.R. § 4.124a, Diagnostic Code 8007. A 50 percent rating for headaches associated with the service connected cerebrovascular disability has been assigned under 38 C.F.R. § 4.124a, Diagnostic Code 8100. That is the maximum rating under the diagnostic code. A June 2019 VA magnetic resonance imaging study of the brain notes that the Veteran was diagnosed with a cavernous malformation in the left suprainsular parietal lobe and “smaller foci of susceptibility involving the left frontal subcortical white matter as well as the right frontal periventricular white matter at the corona radiata level as well as a lesion in the right frontal periventricular white matter at the centrum semiovale most consistent with areas of hemosiderin deposition probably reflective of additional tiny cavernomas especially in the context of the larger lesion.” The Veteran was scheduled for VA neurological clinic follow up. Clinical documentation of that evaluation, if conducted, is not of record. VA clinical documentation dated after October 2019 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran’s claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). VA’s duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121 (1991). The Veteran has not been provided a VA cerebrovascular examination to determine the current nature and severity of left temporal parietal arteriovenous malformation. 2. Entitlement to a rating in excess of 50 percent prior to August 8, 2017, and in excess of 70 percent on and after August 8, 2017, for an anxiety disorder is remanded. VA clinical documentation dated in July 2016 and October 2019 states that the Veteran’s active disabilities included both bipolar disorder and generalized anxiety disorder. The report of an August 2017 psychiatric examination conducted for VA shows that the Veteran was diagnosed with an unspecified anxiety disorder. The examiner reported that the Veteran did not have another psychiatric disability. The examiner did not note or otherwise address the diagnosed bipolar disorder and whether it was related to the service-connected psychiatric and cerebrovascular disabilities. Because of that deficiency, the Board finds that the examination report is of limited probative value and further VA psychiatric evaluation is needed. In addition, further examination is needed because of the time which has passed since the most recent VA examination. 3. Entitlement to initial ratings in excess of 10 percent for right knee degenerative joint disease with patellofemoral syndrome and left knee degenerative joint disease with patellofemoral syndrome are remanded. The report of an August 2017 knee examination conducted for VA states that the Veteran complained of constant bilateral knee pain which impaired his ability to keep the knees bent for prolonged periods of time and to run long distances. He was diagnosed with right knee and left knee degenerative joint disease. On examination of the knees, the Veteran exhibited a right knee range of motion of 0 to 120 degrees with pain on flexion and weight bearing; a left knee range of motion of 0 to 140 degrees with pain on flexion and weight bearing; and no joint instability. The examiner did not indicate at what degree the reported knee pain began. The examining nurse practitioner stated that “pain noted on exam but does not result in/cause functional loss” and that the service-connected knee disabilities impacted the Veteran’s occupational activities as they “limited his ability to sit and stand for long periods of time.” Because of the discrepancy and deficiencies, the Board finds that further knee evaluation is needed. The matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who treated him for the service connected cerebrovascular, psychiatric, and knee disabilities. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Associate with the record any VA medical records for treatment provided since October 2019 not already of record. 3. Schedule the Veteran for a VA examination conducted by the appropriate physician to assist in determining the current nature and severity of service-connected left temporal parietal arteriovenous malformation. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should diagnose all disabilities identified, other than headaches, associated with the left temporal parietal arteriovenous malformation and should describe the severity of that disability. 4. Schedule the Veteran for a VA psychiatric examination to assist in determining the current nature and severity of the service-connected psychiatric disability. The examiner must review the record and should note that review in the report. The examiner should opine as to the levels of social and occupational impairment caused by the service-connected psychiatric disability and should describe the symptoms, their frequency, and their severity, that result in those levels of social and occupational impairment. 5. Schedule the Veteran for a VA knee examination conducted by a physician to assist in determining the nature and severity of the service-connected right and left knee degenerative joint disease with patellofemoral syndrome. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Provide ranges of motion for weight-bearing and nonweight-bearing and passive and active motion of both knees. The examiner should specifically indicate the degree at which the Veteran experiences pain on motion of the knees. (b) State whether there is any additional loss of knee function due to painful motion, weakened motion, excess motion, fatigability, incoordination, or on flare up. (c) State whether there is any recurrent subluxation or lateral instability of either knee, and if so, opine as to the severity. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Hutcheson, 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.