Citation Nr: 21062050 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 18-38 043 DATE: October 6, 2021 REMANDED The issue of entitlement to an initial compensable evaluation for the period prior to March 14, 2018, and in excess of 10 percent disabling for the period thereafter, for service-connected nephrolithiasis, claimed as kidney stones, is remanded. The issue of entitlement to an initial evaluation in excess of 10 percent disabling for service-connected right knee strain, is remanded. The issue of entitlement to service connection for lower back disability is remanded. The issue of entitlement to service connection for left knee disability is remanded. The issue of entitlement to service connection for gallstones is remanded. The issue of entitlement to service connection for bilateral ankle disability is remanded. The issue of entitlement to service connection for lower gastrointestinal problems is remanded. The issue of entitlement to service connection for breathing problems with shortness of breath is remanded. REASONS FOR REMAND The Veteran served on active duty from July 2002 to November 2002, from January 2003 to January 2005, from September 2007 to October 2008. The Veteran's service included service in Afghanistan from December 2007 to September 2008. In September 2021, the Veteran testified under oath at a travel board hearing before the undersigned Veterans Law Judge. 1. Entitlement to an initial compensable evaluation for the period prior to March 14, 2018, and in excess of 10 percent disabling for the period thereafter, for service-connected nephrolithiasis, claimed as kidney stones. 2. Entitlement to an initial evaluation in excess of 10 percent disabling for service-connected right knee strain. The Board finds that additional development is needed prior to final adjudication of the issues on appeal. First, the Board asks that any outstanding records, to include VA treatment records and records pertaining to the Veteran's service in the National Guard, be obtained and associated with the claim file. In particular, the Board asks that the AOJ clarify all periods of active duty, active duty for training, and inactive duty for training. In addition, regarding the Veteran's requests for increased evaluations, the Board finds that new VA examinations are needed to address potentially worsened symptoms. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). In addition, the Board finds that the March 2018 VA examination pertaining to the Veteran's knee is inadequate. For example, the examination report notes that there is evidence of pain on passive range of motion testing. However, it does not indicate which knee exhibits pain on passive range of motion testing, nor does it report in degrees of range of motion, where this pain occurs. Accordingly, it is inadequate, and a new VA examination is needed. See Correia v. McDonald, 28 Vet. App. 158 (2016). 3. Entitlement to service connection for lower back disability. 4. Entitlement to service connection for left knee disability. 5. Entitlement to service connection for gallstones. 6. Entitlement to service connection for bilateral ankle disability. 7. Entitlement to service connection for lower gastrointestinal problems. 8. Entitlement to service connection for breathing problems with shortness of breath. Regarding the remaining claims for service connection, based on testimony provided at the September 2021 travel board hearing, the Board finds that VA examinations and opinions are needed. In particular, the Board finds that VA opinions are needed that address a theory of entitlement under secondary service connection. For example, the Board asks that an examiner address whether there is a connection between the Veteran's service-connected right knee strain and the following claimed disabilities: lower back disability; left knee disability; bilateral ankle disability. Similarly, the Board asks that an examiner address whether there is a connection between the Veteran's service-connected posttraumatic stress disorder (PTSD) with unspecified depressive disorder and the claimed lower gastrointestinal problems. The matters are REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issues on appeal. In addition, please obtain any outstanding records pertaining to the Veteran's service in the National Guard. The Board asks that all periods of active duty, active duty for training, and inactive duty for training be clearly identified. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for the following VA examinations. For all examinations, the examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. Nephrolithiasis Schedule the Veteran for an examination in order to determine the current severity of his service-connected nephrolithiasis, claimed as kidney stones. Right knee strain Schedule the Veteran for an examination in order to determine the current severity of his service-connected right knee strain. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner is asked specifically to provide range of motion testing (ROM) for both knees for active motion, passive motion, weight-bearing, and nonweight-bearing. Full ROM testing also must be conducted on the opposite joint unless the opposite joint is damaged, which includes any disorder that would make the joint in question abnormal. If the opposite joint is determined to be damaged, and no ROM on testing is conducted, this must be explained in the report. In addition, for both knees the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: (a) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use. (b) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM. (c) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. In addition, for both knees the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (a) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. (b) If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (c) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. For all ranges and planes of motion where pain is noted, the exact point at which pain starts must be clearly noted. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups, as expressed in range of motion. To the extent possible, the examiner should identify any symptoms and functional impairments due to the knee disabilities and discuss the effect of the Veteran's knee disabilities on any occupational functioning and activities of daily living. The examiner should state whether or not there is any neurologic disability that is the result of the knee disabilities. Service Connection Schedule the Veteran for VA examinations to clarify the diagnoses and to address the etiologies of the claimed service-connected disabilities on appeal. For each disability diagnosed, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was caused by the Veteran's active duty service. In addition, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that claimed lower back disability, left knee disability, and bilateral ankle disability are proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran's service-connected right knee strain. In addition, the examiner should provide an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that claimed lower gastrointestinal problems are proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran's service-connected PTSD with unspecified depressive disorder. 3. If upon completion of the above action the issues are denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Foster, 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.