Citation Nr: 20049945 Decision Date: 07/28/20 Archive Date: 07/28/20 DOCKET NO. 15-34 072 DATE: July 28, 2020 REMANDED Entitlement to a rating in excess of 20 percent for left ankle achilles tendonitis is remanded. Entitlement to a rating in excess of 20 percent for right ankle achilles tendonitis with degenerative changes is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from July 1968 to July 1971 with service in Vietnam from October 1969 to October 1970. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2012 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran presented sworn testimony at a hearing before the undersigned Veterans Law Judge (VLJ) in October 2016. This case was previously remanded by the Board in a December 2018 decision for further development. 1. Entitlement to a rating in excess of 20 percent for left ankle achilles tendonitis is remanded. 2. Entitlement to a rating in excess of 20 percent for right ankle achilles tendonitis with degenerative changes is remanded. In the December 2018 Board decision, the Board noted that the Veteran reported at the October 2016 hearing and in his March 2017 TDIU application that his left knee tendonitis worsened. The Board also was unable to determine from the June 2015 VA examination whether the Veteran had ankylosis in his right ankle. The case was remanded for an additional VA examination. Post-remand, the Veteran was afforded a VA examination in May 2019 for his bilateral ankle disabilities. His diagnoses of bilateral achilles tendonitis with degenerative changes was reaffirmed, and Veteran reported functional bilateral ankle pain, with ankles locking up after walking for more than 10 minutes and the inability to dorsiflex his ankle. He reported instability that requires bilateral braces and a cane when he walks distances that are beyond the normal household distances. The Veteran did not report flare-ups. Range of motion for the right ankle was noted at 0 to 5 degrees for dorsiflexion and 0 to 5 degrees for plantar flexion. Range of motion for the left ankle was noted at 0 to 10 degrees for dorsiflexion and 0 to 10 degrees for plantar flexion. Pain was noted upon testing and there was objective evidence of localized tenderness, mild TTP of lateral malleolar and superior Achilles tissues bilaterally. The Veteran was tested on repeated use over time, and pain plus weakness were found to significantly limit functional ability. As to additional factors contributing to disability, the examiner remarked the Veteran did not have complete bony ankylosis bilaterally, but he had decreased movement due to soft tissue adhesions and mononeuropathy. No ankylosis was diagnosed, while bilateral ankle instability or dislocation was suspected. As to functional impact, the Veteran has difficulty with occupations that require frequent walking, climbing, or running. The examiner opined that the Veteran’s functional limitation of the range in his bilateral ankles is not due to any fixed bony ankylosis. The Board finds, however, that the May 2019 VA examination did not address Veteran’s reports of neurological impairments due to his service-connected ankle disabilities. Specifically, in November 2016 attachment to Veteran’s VA Form 21-8940, he reported highly unstable ankles due to several problems with bones, tendons, ligaments, and peripheral neuropathy. In the March 2017 attachment to another submitted VA Form 21-8940, he reported severe problems with his ligaments and nerves in his feet and ankles, including peripheral neuropathy. He further reported that pain in his tendons and muscle spasms in the ankles leave him unable to walk for several months at a time, and peripheral neuropathy has substantially reduced feeling in his feet. In light of the Veteran’s contentions noted above, the Board finds that reexamination is needed to thoroughly ascertain the current nature and etiology of the Veteran’s service-connected bilateral ankle disabilities. Additionally, it is also necessary in a new examination to ascertain whether any current ankle disability represents a neurological abnormality associated with the service-connected left and right ankle tendonitis with degenerative arthritis. Despite the VA examiner ruling out ankylosis in either ankle in the May 2019 VA examination, it is also necessary to render a medical opinion on whether the Veteran’s nature and severity of his bilateral ankle disabilities is tantamount to ankylosis. 3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. As to the issue of entitlement to a TDIU, all the VA examinations of record show the Veteran’s ankle tendonitis adversely impact his ability to work. The TDIU claim, however, must be remanded because his right and left ankle tendonitis is inextricably intertwined with his claim for a TDIU. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The matters are REMANDED for the following action: 1. Obtain any outstanding VA and non-VA medical treatment records. 2. Notify the Veteran that he may submit lay statements from himself and from other individuals who have first-hand knowledge about the nature, extent and severity of his left and right ankle disabilities and the impact of these conditions, as well as his other service-connected disabilities on his ability to work. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for the appropriate VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the current nature and severity of his left and right ankle disabilities. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The examiner is also to clarify the nature of any current ankle impairment, to include whether such represents a neurological manifestation of the service-connected ankle disabilities. The examiner is also to provide an opinion on whether the nature and severity of Veteran’s left and right service-connected ankle disabilities is tantamount to ankylosis of the ankles. A detailed rationale supporting each examiner’s opinion should be provided. In forming the opinion, the examiner must consider all lay statements of record. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required or the examiner does not have the needed knowledge or training). Jones v Shinseki, 23 Vet. App. 382 (2010). STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zarar Ahmed, Attorney Advisor 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.