Citation Nr: 20034552 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 14-41 708 DATE: May 18, 2020 ORDER Entitlement to a rating of 10 percent, but not higher, for left hand rheumatoid arthritis with osteopenia (left hand disability), prior to August 16, 2019, is granted. Entitlement to a rating in excess of 10 percent for a left-hand disability, from August 16, 2019, is denied. Entitlement to a rating of 10 percent, but not higher, for right hand rheumatoid arthritis with osteopenia (right hand disability), prior to August 16, 2019, is granted. Entitlement to a rating in excess of 10 percent for a right-hand disability, from August 16, 2019, is denied. Entitlement to a 10 percent rating, but not higher, for right hallux valgus, with bunions and degenerative arthritis, (right foot disability) is granted. Entitlement to a compensable rating for erectile dysfunction is denied. REMANDED Entitlement to service connection for lichen planus (skin condition) is remanded. Entitlement to service connection for sinusitis is remanded. Entitlement to service connection for allergic rhinitis is remanded. Entitlement to a rating in excess of 10 percent for a right knee disability, prior to October 22, 2013, is remanded. Entitlement to a rating in excess of 30 percent for residuals of a total right knee replacement, from December 1, 2014, is remanded. Entitlement to a rating in excess of 10 percent for a left knee disability, prior to February 19, 2013, is remanded. Entitlement to a rating in excess of 30 percent for residuals of a total left knee replacement, from April 1, 2014, is remanded. FINDINGS OF FACT 1. For the entire claims period, the Veteran’s rheumatoid arthritis of the left and right hands has been characterized by noncompensable limitation of motion with pain. 2. The Veteran has had painful motion and functional loss of his right great toe due to right foot hallux valgus. 3. The Veteran’s erectile dysfunction has not manifested with penile deformity. CONCLUSIONS OF LAW 1. The criteria for a disability rating of 10 percent, but not higher, for rheumatoid arthritis of the left hand, prior to August 16, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.71a, Diagnostic Code (DC) 5002. 2. The criteria for a disability rating in excess of 10 percent for rheumatoid arthritis of the left hand, from August 16, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.71a, DC 5002. 3. The criteria for a disability rating of 10 percent, but not higher, for rheumatoid arthritis of the right hand, prior to August 16, 2019, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.71a, DC 5002. 4. The criteria for a disability rating in excess of 10 percent for rheumatoid arthritis of the right hand, from August 16, 2019, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.159, 4.1, 4.71a, DC 5002. 5. The criteria for a 10 percent rating, but no higher, for right hallux valgus with arthritis, have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.71a, DC 5280-5281, 5003. 6. The criteria for a compensable rating for erectile dysfunction have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.2, 4.115a, 4.115b, DC 7522. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Air Force from November 1985 to November 2009. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). Legal Criteria for Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. VA has a duty to consider all regulations that are potentially applicable through the assertions and issues raised in the record. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. The Board will consider whether separate ratings may be assigned for separate periods of time based on facts found, a practice known as “staged ratings.” Hart v. Mansfield, 21 Vet. App. 505 (2007). For painful motion with any form of arthritis, the Veteran is entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. The same is true for painful motion in non-arthritis contexts when raised by the claimant or when reasonably raised by the record. Burton v. Shinseki, 25 Vet. App. 1, 5 (2011). When rating musculoskeletal disabilities, VA may, in addition to applying schedular criteria, consider granting a higher rating based on functional loss due to limited or excess movement, pain, weakness, excess fatigability, or incoordination, to include during flare-ups and with repeated use, when those factors are not contemplated in the relevant rating criteria. DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. §§ 4.40, 4.45, 4.59. The provisions of 38 C.F.R. § 4.40 and 38 C.F.R. § 4.45 are to be considered in conjunction with the Diagnostic Codes predicated on limitation of motion. Johnson v. Brown, 9 Vet. App. 7 (1996). Such inquiry is not to be limited to muscles or nerves. Limitation of motion determinations are, if feasible, to be expressed in terms of the degree of additional range of motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. DeLuca, 8 Vet. App. at 207. By itself, pain throughout a joint’s range of motion does not constitute functional loss, but if there is additional pain, the examiner must address any additional loss of motion due to the DeLuca factors. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). If a claimant is already receiving the maximum disability rating available based on symptomatology that includes limitation of motion, it is not necessary to consider whether 38 C.F.R. §§ 4.40 and 4.45 are applicable. Spencer v. West, 13 Vet. App. 376, 382 (2000); Johnston v. Brown, 10 Vet. App. 80, 85 (1997). The provisions of 38 C.F.R. § 4.59, which relate to painful motion, are not limited to arthritis and must be considered when raised by the claimant or when reasonably raised by the record. Burton, 25 Vet. App. at 5. A VA examination of the joints must, wherever possible, include range of motion testing for pain on active motion, passive motion, weight-bearing, nonweight-bearing, and, if possible, with the range of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 16970 (2016); 38 C.F.R. § 4.59. An examiner must provide an opinion regarding additional range of motion loss due to pain. Sharp v. Shulkin, 29 Vet. App. 26 (2017). 1. Entitlement to a rating of 10 percent, but not higher, for left hand rheumatoid arthritis with osteopenia (left hand disability), prior to August 16, 2019 2. Entitlement to a rating in excess of 10 percent for a left-hand disability, from August 16, 2019 3. Entitlement to a rating of 10 percent, but not higher, for right hand rheumatoid arthritis with osteopenia (right hand disability), prior to August 16, 2019 4. Entitlement to a rating in excess of 10 percent for a right-hand disability, from August 16, 2019 By way of procedural history, the Board notes that the Veteran was granted service connection by the RO in a December 2009 rating decision for rheumatoid arthritis (RA) of the bilateral hands. However, such decision was based on an October 2009 VA examination which found actually found no evidence of RA; as such, the Veteran was assigned a zero percent rating based on noncompensable limitation of motion. The Veteran appealed such rating, and in August 16, 2019, the Veteran was afforded another VA examination, in which X-ray diagnostics concluded RA, and the subsequent rating decision granted a 10 percent rating based on the minimum compensable rating for arthritis under Diagnostic Code 5002, from the date of that examination. The Veteran appeals the rating for both staged periods. The Veteran asserts that both ratings in the staged periods, do not adequately account for pain and limitation he experiences in both hands during the claims period. The Board, finds that a close review of the competent evidence of record, shows that the Veteran’s condition has been consistent throughout the claims period, to include RA of both hands, with some (noncompensable level) limitation of motion, and reports of pain. Consequently, an increased rating of 10 percent, but not higher, for both hands prior to August 16, 2019, is warranted; however, a rating in excess of 10 percent, for any part of the claims period is has not been demonstrated by the evidence, and therefore, increased rating for the latter period, from August 16, 2019, must be denied. As an initial matter, the Board also finds that the medical evidence of record to be at least in equipoise with regards to establishing whether the Veteran actually suffered from RA during the entire claims period. The Board notes that while the Veteran was granted service connection for RA for both hands, such grant was based on an October 2009 VA examination, that actually failed to find evidence of arthritis/RA in either hand. As such, a noncompensable rating was assigned, based on findings that the Veteran’s limitation of motion, alone, was not sufficient to warrant a compensable rating under the relevant Diagnostic Codes for range of motion for distinct fingers, and hand, without evidence of arthritis. The Board finds that a thorough review of the contemporaneous medical evidence of record, reveals that there are both positive and negative evidence of record demonstrating that the Veteran has had RA throughout the claims period, to include prior to August 2019. In this regard, the Board acknowledges the October 2009 VA examination which found no X-ray evidence of arthritis or RA in either hand. The examination report also noted, upon testing, no limitation of motion in either hand, with both hands exemplifying, essentially, normal range of motion. While the VA report noted the Veteran’s subjective complaints of ongoing pain, to include limiting his motion, the report itself did not note positively or negatively, any objective findings of pain by the VA examiner. However, in contrast, a review of the contemporaneous VA medical evidence of record during the same relevant claimed period, prior to August 2019, reveal evidence of a diagnosis for RA for both hands. Specifically, VA treatment records from his treating physicians in the VA, consistently noted signs indicating RA in both hands in late 2011. Specifically, in a January 2011 VA radiological report, VA physicians noted findings in the Veteran’s X-ray of his bilateral hands, “consistent with rheumatoid arthritis”. In a December 2011 treatment note, the treating physician noted “small marginal erosions in the NCP joints of both hands consistent with rheumatoid arthritis”. Finally, an April 2012 medical note, reported “inflammatory arthritis since 2002”, finding RA in both hands, with limitation of use of the right hand, to include having a hard time writing. Along with these specific references, the evidence also shows general diagnoses for RA, which symptomatically emanate from the hands. In a March 2013 VA treating note, the physician, while treating other issues, noted the Veteran with a history of RA since service. Likewise, the Veteran provided an opinion letter from his VA treating physician, Dr. T. G., noting that the Veteran had has a history of RA since his initial diagnosis in 2002. The Board, in weighing the totality of the evidence picture, to include references to “evidence” of RA in both hands during the Veteran’s active service, finds that the evidence is at least in equipoise with regards to finding that the Veteran has had RA in both hands since his active service, and, in turn, the inception of his claims. As there are both probative positive and negative evidence of record, the Board must resolve all reasonable doubt in favor of the Veteran. Consequently, the Board finds that consistent with his diagnosis of RA in the August 2019 VA examination, the Veteran’s bilateral hand disability has been characterized by a diagnosis of RA, along with some limitation of motion and pain, since his initial claim. The Board notes that RA is rated under Diagnostic Code 5002; Diagnostic Code 5002 provides compensation for rheumatoid arthritis. 38 C.F.R. § 4.71a. A 20 percent rating is provided for one or two exacerbations a year in a well-established diagnosis. A 40 percent rating is provided for symptom combinations that are productive of definite impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year. A 60 percent rating is provided for symptoms less than the criteria for 100 percent but with weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods. A 100 percent rating is provided for constitutional manifestations associated with active joint involvement that are totally incapacitating. A Note to this code further provides that the ratings for the active process will not be combined with the residual ratings for limitation of motion or ankylosis; rather, assign the higher evaluation. For chronic residuals such as limitation of motion or ankylosis, favorable or unfavorable, the disorder is to be rated under the appropriate diagnostic codes for the specific joints involved. Where, however, the limitation of motion of the specific joint or joints involved is noncompensable under the 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, not added under diagnostic code 5002. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. Id. For the staged period prior to August 16, 2019, the Board finds that throughout the claims period, the Veteran has consistently asserted pain and limitation of motion for both his hands. To this end, in his October 2009 VA examination, the examiner explicitly noted the Veteran’s complaints of limitation of motion and pain in both hand since service, noting that the pain was a seven, on a scale of one to ten for severity. However, upon testing during the October 2009 examination, the examiner noted that the Veteran’s range of motion in both hands were within normal limits, with no objective evidence of pain. The Veteran in his October 2010 Notice of Disagreement (NOD), continued to explicitly note pain and limitation of motion for both his hand, asserting that he could only use his hand for twenty minutes before both hands started hurting with pain, and he had to rest them. Such lay assertions of pain and limitation of use and motion, has persisted throughout the claims period, to include during his hearing before the undersigned. Here, for the period prior to August 16, 2019, the Veteran has consistently and continuously asserted that both his hands suffer from painful motion, throughout the claims period; the Board finds that such lay reports to be ‘satisfactory’ evidence in warranting a 10 percent rating under Diagnostic Code 5002 for chronic residuals of his RA. As the Board has found that the Veteran has had RA throughout the claims period, under Diagnostic Code 5002, the presence of noncompensable limitation of motion with arthritic pain supports entitlement to the minimal compensable rating of 10 percent for each hand. See 38 C.F.R. § 4.59. As such, for the earlier staged period of prior to August 16, 2019, a higher 10 percent rating, but not higher, for both hands are warranted. However, a higher rating, in excess of 10 percent, for either staged period is not warranted. Here, VA examinations in October 2009 and August 2019, do not show that the Veteran suffered from any exacerbations, or a compensable level of limitation of motion of the either hand. During his October 2009 examination, the VA examiner noted that upon range of motion testing, the Veteran’s bilateral hands presented with normal range of motion. The report noted no objective signs of painful motion, and no further decrease in motion upon repeat. Likewise, in the August 2019 VA examination, the medical examiner noted the same “normal” range of motion in both hands, with no evidence of gaps between pad of the thumb and the fingers, or between fingers and proximal transverse creases. While the latter 2019 examination identified objective pain on motion, repeat testing of range of motion revealed no additional limitations. No ankylosis were noted on either examination, along with no evidence of decreased hand strength or dexterity. Neither examiner noted any functional effects of the Veteran’s hand disabilities. A close review of the Veteran’s contemporaneous VA medical records and lay statements for the entire claims period also reveal no complaints of or treatments for exacerbations of either hand. To this end, while there have been noted complaint of pain, especially after prolonged use, such symptoms are already contemplated within his current rating, and does not constitute as an exacerbation. Likewise, while the Veteran has consistently noted that he suffers from painful motion, he has not explicitly reported exacerbations, or a sharp increase in pain or limitation of motion, in which would constitute an exacerbation. In fact, a review of both VA examinations reveals the Veteran denied experiencing flare-ups. As noted above, a rating in excess of 10 percent, under DC 5002 for RA, requires exacerbations of the affected joints. Here, the medical evidence of record, to include the VA examinations reveal no evidence of such exacerbations. Therefore, a rating in excess of 10 percent is not warranted for any period during the claim, as it fails to fulfill the criteria under this Diagnostic Code. The Board also notes that a higher, or separate, rating based on those Diagnostic Codes relating to limitation of motion is also not warranted, as there is no competent evidence demonstrating that the Veteran’s range of motion for either hand is anything but normal. Both VA examinations in 2009 and 2019, show the Veteran’s range of motion, upon testing are all within normal limits, with no changed based on repeat testing, or considering pain. As such, a higher rating, in excess of 10 percent, for either staged period, for either hand, is not warranted. 38 C.F.R. § 4.71a, DC 5220-5230. Therefore, the presence of noncompensable limitation of motion with arthritic pain supports entitlement to the minimal compensable rating for the joint. 38 C.F.R. § 4.59. For the hands, this corresponds to a 10 percent rating. As such, the Veteran’s claim for a 10 percent initial rating, but not higher, for both left and right hand, prior to August 16, 2019, must be granted; and his claim for a rating in excess of 10 percent, for his left and right hands, from August 16, 2019, must be denied. 5. Entitlement to a compensable rating for right hallux valgus, with bunions and degenerative arthritis, (right foot disability) The Veteran claims that his right foot disability, to include hallux valgus, with bunions and degrative arthritis, is more severe than his currently assigned noncompensable rating. The Board finds that, after a review of the relevant medical and lay evidence of record, to include VA examinations, the Veteran’s right foot disability has been diagnosed with hallux valgus and degenerative arthritis, productive of painful motion, with no evidence of operation or severe residuals. As such, a higher rating of 10 percent, but not higher, is warranted, for painful motion, and the Veteran’s claim must be granted. Unilateral hallux valgus warrants the assignment of a 10 percent disability rating for being operated with resection of metatarsal head or for being severe, if equivalent to amputation of great toe. 38 C.F.R. § § 4.71a, Diagnostic Code 5280. However, as recently discussed by the United States Court of Appeal for Veteran Claims (Court), 38 C.F.R. § 4.59 “is one of several regulations that precede the rating schedule for the musculoskeletal system and explain how to arrive at proper evaluations under the DCs appearing in the disability rating schedule.” Petitti v. Shinseki, 27 Vet. App. 415, 424 (2015). In Petitti, the Court held that “[u]nder [38 C.F.R.] § 4.59, the trigger for a minimum disability rating is an actually painful, unstable, or malaligned joint.” Id. at 425. The Veteran had VA examinations in October 2009 and August 2019. In both examination reports, the examiners diagnosed bilateral hallux valgus. During the earlier examination, the examiner noted tenderness, however, noted no painful motion of either foot. The examiner ultimately found the right foot to be normal in both motion and use, with no painful motion. Upon examination in 2019, the VA examiner explicitly noted pain on weight-bearing, causing some functional loss, of the right foot. The examiner, however, noted that the Veteran’s overall condition was considered moderate. During both examinations, the Veteran had not had surgery for hallux valgus. A close review of the contemporaneous medical evidence, and the Veteran’s lay statements during the claims period reveals that the Veteran has complained of painful motion throughout the claims period. To this end, in both his NOD and substantive appeal submissions, the Veteran explicitly noted that he consistently experienced pain on weight-bearing since service. During his hearing before the undersigned, the Veteran noted that his condition forced him to purchase and wear wide shoes that were up to a half size larger so to decreased pain while walking or standing. A June 2013 VA treatment record also corroborated such claims with noted that the Veteran’s right foot bunion disability manifested with pain on direct palpation, and sesamoid pain with hypermobility, noted upon examination. Based on consideration of the totality of the disability picture, to include noted complaints during the Veteran’s active service, continued lay assertions of pain, a June 2013 treatment record, and the August 2019 VA examination showing painful motion of the right foot, the Board finds that a 10 percent rating is warranted. While the 2009 VA examination noted only tenderness, the Board finds that the weight of the balance of the remaining evidence, both lay and medical, show sufficiently that the Veteran has experienced painful motion during the entire claims period consistent with the findings of the August 2019 VA examination. As such, a higher compensable rating of 10 percent, but not higher, must be granted. 38 C.F.R. § 4.59 Although 10 percent is the maximum rating available for hallux valgus, the Board must consider the assignment of an increased evaluation under other potentially applicable codes. Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991). To this end, the Veteran has not been diagnosed with weak foot, claw foot, metatarsalgia, hallux rigidus, hammer toe, pes planus, or malunion of the tarsal or metatarsal bones. As such, Diagnostic Codes 5277, 5278, 5279, 5281, 5282, 5283, and 5284 are not for application. Therefore, as a 10 percent rating is the maximum schedular rating for hallux valgus, and a higher rating is not available under any diagnostic code, the Veteran’s claim for increased rating is considered granted in full. 38 U.S.C. § 5107 (b) (2012); Gilbert v. Derwinski, 1 Vet. App. 49 (1990). 6. Entitlement to a compensable rating for erectile dysfunction The Veteran is in receipt of a noncompensable disability rating for erectile dysfunction under 38 C.F.R. § 4.115b, DC 7599-7522 which provides a single 20 percent disability rating where the evidence shows deformity of the penis with loss of erectile power. There is no schedular rating for loss of erectile power alone. Where the Rating Schedule does not provide a compensable disability rating for a diagnostic code, a noncompensable (0 percent) rating is assigned when the requirements for a compensable disability rating are not met. 38 C.F.R. § 4.31. After reviewing all the evidence, lay and medical, the Board finds that erectile dysfunction has been manifested by some evidence of loss of erectile power, but not by a penile deformity. The Veteran was afforded two VA examinations in October 2009 and August 2019, both VA examiner found no evidence, to include lay reports, of any penile deformity. Upon examination in October 2009, the examiner noted normal findings with no deformities. The Veteran refused an examination by the examiner in the 2019 VA examination, however, reported no physical abnormalities with his penis during the examination. The Veteran, similarly, in all his lay assertions, also does not assert, and the record does not otherwise indicate, that he has a penile deformity. For these reasons, the Board finds that the criteria for an increased (compensable) rating for erectile dysfunction have not been met. As such, the appeal for an increased (compensable) disability rating for erectile dysfunction must be denied. REASONS FOR REMAND 1. Entitlement to service connection for lichen planus (skin condition) is remanded. 2. Entitlement to service connection for sinusitis is remanded. 3. Entitlement to service connection for allergic rhinitis is remanded. With regard to the claim for service connection for a skin condition, sinusitis, and allergic rhinitis, the Board finds that the VA examination of record from October 2009 is incomplete, and remand is required to obtain additional opinion for the VA to fulfill the duty to assist the Veteran. The Board notes that the VA’s statutory duty to assist the Veteran includes the duty to conduct a thorough and contemporaneous examination so that the evaluation of the claimed disability will be a fully informed one. Green v. Derwinski, 1 Vet. App. 121 (1991); Snuffer v. Gober, 10 Vet. App. 400 (1997). Assistance by VA includes providing a medical examination or obtaining a medical opinion when such an examination or opinion is necessary to make a decision on a claim. 38 U.S.C. § 5103A (d); 38 C.F.R. § 3.159 (c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006). When the medical evidence is inadequate, as it is here, VA must supplement the record by seeking an advisory opinion or ordering another medical examination. Colvin v. Derwinski, 1 Vet. App. 171 (1991); Hatlestad v. Derwinski, 3 Vet. App. 213 (1992). The Board finds that in the October 2009 VA examination, the examiner failed to diagnose the Veteran with lichen planus, sinusitis, or allergic rhinitis as a current disability, even though the examiner noted such diagnose for these conditions in service. As such, no opinion was provided with regards to the etiology of any of these claimed conditions, as no current disability was noted at the time. The Board, however, finds that since that examination, the medical evidence of record, to include VA and private treatment records, have identified all three conditions, to include a skin condition/rash, that may relate to his claim for lichen planus. With regards to his claim for lichen planus, or a skin condition, to include rashes, the Board notes that not only are rashes among the observable conditions in which the Veteran, as a lay person may speak competently too, but the medical evidence also demonstrates an ongoing skin condition in which the Veteran received treatment for. In this regard, the Board notes that VA treatment records not only note evidence of hypopigmentation of the inner arm, lesions on the arm, and other skin issues, but such records also note the prescription of topical creams such as Triamcino Aceto, to treat the affected areas. While such conditions were not specifically diagnosed as lichen planus, the Board finds that a broad interpretation of the Veteran’s claim constitutes a claim to include all skin disabilities that can be reasonably encompassed by a claim for lichen planus, which manifests as rashes. Likewise, with regards to the Veteran’s claim for rhinitis and sinusitis, the Board finds that there is also medical evidence that he suffers from these conditions throughout the claims period. To this end, the Veteran has also complained about physical and observable symptoms of these condition, to include during his testimony before the undersigned, and in his lay written statements. However, in addition to these, the Veteran has submitted a March 2020 private medical treatment record which shows actual diagnoses of allergic rhinitis. Therefore, as there is evidence of a diagnosed disability relating to the Veteran’s claimed rhinitis, sinusitis, and skin condition (claimed as lichen planus), the Board finds that the previous VA examination, which does not address the etiology of these conditions, to be inadequate, and another examination or addendum opinion is required for the Board to fulfill its duty to the Veteran. 4. Entitlement to a rating in excess of 10 percent for a right knee disability, prior to October 22, 2013, is remanded. 5. Entitlement to a rating in excess of 30 percent for residuals of a total right knee replacement, from December 1, 2014, is remanded. 6. Entitlement to a rating in excess of 10 percent for a left knee disability, prior to February 19, 2013, is remanded. 7. Entitlement to a rating in excess of 30 percent for residuals of a total left knee replacement, from April 1, 2014, is remanded. With regard to the claim for increased rating for the Veteran’s service-connect bilateral knee disabilities, the Veteran was provided the most recent VA examination in August 2019. The Board recognizes that, generally, the mere passage of time is not a sufficient basis for a new examination. Palczewski v. Nicholson, 21 Vet. App. 174 (2007). However, claims of a worsening condition regarding the Veteran’s bilateral knees have been set forth by the Veteran since that examination, to specifically include during his hearing before the undersigned, where he explicitly noted additional functional loss, loss of range of motion, and flare-ups which require injections to provide relief from pain. When available evidence is too old for an adequate evaluation of the current condition, VA’s duty to assist includes providing a more current examination. Weggenmann v. Brown, 5 Vet. App. 281 (1993). The Board finds that not only is the last examination temporally remote, but the examination appears to no longer indicate the Veteran’s current level of disability. Consequently, after all outstanding medical records are associated with the claims file, a more contemporaneous examination is needed to rate the Veteran’s claim for an increased rating for a bilateral knee disability. Allday v. Brown, 7 Vet. App. 517 (1995); Caffrey v. Brown, 6 Vet. App. 377 (1994); Snuffer v. Gober, 10 Vet. App. 400 (1997). The matters are REMANDED for the following action: 1. Obtain all VA treatment medical records not already of record. 2. After obtaining appropriate authorization, obtain any private treatment records identified by the Veteran, to include any records from private treatment providers that are not already of record. 3. Then, schedule the Veteran for a VA examination for his claimed sinusitis and allergic rhinitis. The examiner must review the claims file and should note that review in the report. All testing deemed necessary should be performed. A complete rationale for all opinions should be provided in the examination report. The examiner is asked to provide opinions regarding the nature and etiology of the claimed respiratory conditions, to include a current diagnosis. The examiner should opine for each disability found, whether it is at least as likely as not (50 percent or greater probability) that any diagnosed respiratory disability was incurred in service or are the result of any incident in service. Additionally, for each disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability is due to or aggravated by any service-connected disabilities or any medications taken for service-connected disabilities. The examiner must speak to any in-service diagnoses or treatments for any potentially related respiratory condition and should discuss prior diagnoses. In providing the requested opinions, the examiner must consider and reconcile any conflicting medical evidence or diagnoses of record. 4. Then, schedule the Veteran for a VA examination for his claimed skin disability, to include lichen planus. The examiner must review the claims file and should note that review in the report. All testing deemed necessary should be performed. A complete rationale for all opinions should be provided in the examination report. The examiner is asked to provide opinions regarding the nature and etiology of the claimed skin conditions, to include a current diagnosis. The examiner should opine for each disability found, whether it is at least as likely as not (50 percent or greater probability) that any diagnosed skin disability was incurred in service or are the result of any incident in service. Additionally, for each disability, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the disability is due to or aggravated by any service-connected disabilities or any medications taken for service-connected disabilities. The examiner must speak to any in-service diagnoses or treatments for any potentially related skin condition and should discuss prior diagnoses. In providing the requested opinions, the examiner must consider and reconcile any conflicting medical evidence or diagnoses of record. (Continued on the next page)   5. Schedule the Veteran for a VA examination of the service-connected disabilities of the bilateral knees. The examiner must review the claims file and should note that review in the report. All testing deemed necessary should be performed. A complete rationale for all opinions should be provided in the examination report. The examiner should provide active and passive ranges of motion, and weight-bearing and nonweight-bearing ranges of motion for both knees and should compare them to a normal opposed joint where appropriate. For each joint, the examiner should state whether there is any additional loss of function due to incoordination, fatigability, painful motion, weakened motion, excess motion, or on flare up. The examiner should state whether there is severe painful motion or weakness of the knees. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Ziheng Zhu, 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.