Citation Nr: 20022574 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 18-34 738 DATE: April 1, 2020 REMANDED Entitlement to service connection for a right knee disability is remanded. Entitlement to an initial compensable disability rating for painful scars of the right wrist is remanded. REASONS FOR REMAND The Veteran served honorably in the United States Army from January 1962 through May 1982. For his meritorious service, the Veteran was awarded (among other decorations) the Bronze Star Medal, the Army Commendation Medal, and Vietnam Service and Campaign Medals. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In December 2019, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing has been associated with the claims file. 1. Entitlement to service connection for right knee disability is remanded. The Veteran contends he is entitled to service connection for his right knee disability, which he contends is a result of his in-service knee injuries. The Board finds that the October 2016 VA examination is inadequate. The United States Court of Appeals for the Federal Circuit (Federal Circuit) held in Saunders v. Wilkie, 886 F.3d 1356 (2018), that when pain alone results in functional impairment, even if there is no identified underlying diagnosis, it can constitute a disability. In the present case, an October 2016 VA examiner concluded there was no evidence the Veteran’s knee disability has been a chronic problem since 1982, when the Veteran separated from service. The VA examiner did note the Veteran had in-service knee injuries and that he has abnormal range of motion and pain which causes functional loss. The VA examiner also noted the Veteran has objective evidence of crepitus. The VA examiner noted recent x-rays do not show any abnormalities. The Veteran contends he sought treatment after retiring from service, but the El Paso VA Medical Center reported they did not have any records for the Veteran. The other facility the Veteran noted he received treatment only documented treatment for the left lower extremity, not the right knee. However, in regard to his right knee, the Veteran reported he has flares of pain in his knee when the weather changes and that he cannot get up from the floor. At his December 2019 hearing, the Veteran discussed his in-service knee injuries. He reported he has had knee discomfort over time and pain with use. As such, in light of the recent standard established by the Federal Circuit in Saunders, the Board finds that the examination is inadequate. On remand, consideration should be given to whether the Veteran has a right knee disability due to functional impairment caused by pain even in the absence of a specific diagnosis, pursuant to Saunders. The Federal Circuit limited its holding, stating, “[w]e do not hold that a veteran could demonstrate service connection simply by asserting subjective pain. To establish the presence of a disability, the veteran will need to show that his pain reaches the level of functional impairment of earning capacity.” In other words, subjective pain in and of itself will not establish a current disability. Consideration should be given to the impact, or lack thereof, from pain, focusing on evidence of functional limitation caused by pain. Thus, on remand the examiner must elicit information relating to the functional impairment caused by the Veteran’s claimed right knee disability. 2. Entitlement to an initial compensable disability rating for painful scars of the right wrist is remanded. Entitlement to service connection for right wrist scars was awarded in April 2016 with a noncompensable evaluation. The Veteran contends his scars are painful and unstable. The Veteran underwent a VA examination in October 2016 for his scars. The VA examiner noted the scars were not painful or unstable and did not have frequent loss of covering of skin over the scar. The VA examiner noted the scars result in limitation of function, the Veteran is unable to keep his third and fourth fingers straight related to nerve damage. The Veteran also reports he is unable to overexert his wrist and hand as his fingers will lock up and become very painful. The Veteran submitted a lay statement stating that during his VA examination, he reported the scars cause pain and are unstable, which is not reflected in the VA examination. The Veteran’s statement explains he often experiences numbness in the third and fourth fingers and he puts pressure on the outside of his right hand which causes a sharp, shooting pain in and around the scar on the outside of his right hand. He also reported his anterior right wrist scar causes discomfort and pain by touching the large build-up of scar tissue on the anterior right wrist scar. He also reports minimal pain in the circular scar on his wrist. Due to the location and raised appearance of the scar, the Veteran reports he has difficulty with long sleeves, as they irritate the scar and remove the skin. He contends the VA examiner focused on his nerve pain and not his scar pain. The Veteran testified at his December 2019 hearing that the scars cause a large bulge on his wrist that rubs against his clothes and causes pain up through his two fingers. The Veteran additionally reported his wrist cramps while he works in the yard or during similar activities. He often wears a brace. The Veteran testified the scar has not reopened but the scars are sensitive. The Veteran also testified the scars cause pain. The Veteran submitted a private Disability Benefits Questionnaire (DBQ) for the wrist. The private opinion noted the scar diagnosis, tenodesis, and carpal tunnel syndrome. The private DBQ focuses on wrist pain and loss of motion. The private opinion notes the scar is painful with adhesion and nerve issues. This opinion is inadequate to grant a compensable rating for the Veteran’s scars. The private opinion focuses on the wrist disability and it is unclear the impact on the scars. Though the opinion notes the scars are painful, it is unclear from this opinion if that is due to the Veteran’s scars or other service-connected disabilities. Though this opinion is not adequate for the Board to grant a compensable rating for scars based on it alone, it certainly triggers the need for an additional VA examination. Based on the foregoing, the Board finds that a remand is necessary to obtain another examination due to the inconsistent findings across both the VA and private evidence of record. On remand, the VA examiner is also asked to consider whether the Veteran’s scar pain can be distinguished from his other service-connected disabilities. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate examiner to determine the nature and possible relationship to service of any right knee disability. The examiner should identify to the extent possible, any symptoms and functional impairments due to right knee pain and discuss the effect of the pain on any occupational functioning and activities of daily living. The examiner must then state whether any identified functional impairment is at least as likely as not related to the Veteran’s active service. 2. Schedule a VA examination to ascertain the severity and manifestations of the Veteran’s service- connected scars. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file and to comment on the severity of the Veteran’s service-connected disability. The examiner should report all signs and symptoms necessary for rating the Veteran’s disability under the rating criteria. The examiner is also requested to consider and discuss whether the Veteran’s scar symptoms can be distinguished from his service-connected carpal tunnel syndrome and right distal ulna fracture. In offering the requested opinion, the examiner must address the statements from the Veteran regarding his symptoms, the private opinion, and hearing testimony. Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Mouzakis, Associate 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.