Citation Nr: 21062061 Decision Date: 10/06/21 Archive Date: 10/06/21 DOCKET NO. 12-17 149 DATE: October 6, 2021 REMANDED Entitlement to service connection for a left leg disorder is remanded. Entitlement to service connection for a right leg disorder is remanded. Entitlement to service connection for a left hand disorder is remanded. Entitlement to service connection for a right hand disorder is remanded. Entitlement to service connection for migraines is remanded. Entitlement to service connection for frequent urination is remanded. Entitlement to an initial disability rating in excess of 20 percent for thoracolumbar spine status post discectomy with residual intervertebral disc syndrome (IVDS) and degenerative arthritis ("low back disability") is remanded. Entitlement to an initial disability rating in excess of 10 percent for right lower extremity radiculopathy is remanded. Entitlement to an initial disability rating in excess of 10 percent for right elbow bursitis is remanded. Entitlement to an initial disability rating in excess of 10 percent for right hip strain with limitation of extension is remanded. Entitlement to an initial compensable rating for right hip strain with limitation of flexion is remanded. Entitlement to an initial disability rating in excess of 10 percent for right hip strain with limitation of adduction is remanded. Entitlement to an initial disability rating in excess of 10 percent for left hip strain with limitation of extension is remanded. Entitlement to an initial compensable rating for left hip strain with limitation of flexion is remanded. Entitlement to an initial disability rating in excess of 10 percent for right knee patellofemoral syndrome is remanded. Entitlement to an initial disability rating in excess of 10 percent for left knee patellofemoral syndrome is remanded. Entitlement to an initial disability rating in excess of 20 percent for left foot plantar fasciitis is remanded. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. Entitlement to an initial compensable rating for hypertension is remanded. Entitlement to an initial compensable rating for left testicle vasocongestion is remanded. Entitlement to an initial disability rating in excess of 10 percent for status post head concussion is remanded. Entitlement to an initial disability rating in excess of 10 percent for head scar status post head concussion, prior to April 20, 2017, and in excess of 30 percent thereafter is remanded. Entitlement to an initial compensable rating for a lumbar scar status post discectomy is remanded. Entitlement to an initial compensable rating for an umbilicus scar status post hernia repair surgery is remanded. Entitlement to a higher level of special monthly compensation (SMC) is remanded. Preliminary Matters The Veteran had honorable active duty service with the United States Air Force from October 1985 to August 2010, to include service in the Southwest Asia (SWA) Theater of operations during the Persian Gulf War. This matter is before the Board of Veterans' Appeals (Board) on appeal from October 2010 and June 2013 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that in his June 2012 substantive appeal (VA Form 9), the Veteran requested a hearing before the Board. Accordingly, the Veteran was scheduled for a Board hearing in May 2015. In April 2015, the Veteran withdrew his request for a hearing. Therefore, a hearing has not been conducted and the Board will proceed to adjudicate the claims currently on appeal. In March 2016, the Board, in pertinent part, remanded the instant issues on appeal for further development. The Board also remanded the issue of entitlement to service connection for left lower extremity radiculopathy. While the matter was in remand status, in a January 2020 rating decision, the RO granted entitlement to service connection for left lower extremity radiculopathy. Thus, this issue has been granted in full and is no longer before the Board. The remaining issues have returned to the Board for further appellate consideration. As regards to the increased rating claim for head scar status post head concussion, while the matter was in remand status, in a January 2020 rating decision, the RO increased the Veteran's evaluation to 10 percent disability, effective September 1, 2010, the date of service connection, and to 30 percent from April 20, 2017. When a Veteran seeks an increased rating, it is generally presumed that the maximum benefit allowed is sought, and a claim remains in controversy where less than the maximum benefit is awarded. AB v. Brown, 6 Vet. App. 35 (1993). The issue has been restated accordingly. REASONS FOR REMAND Although further delay is regrettable, the Board finds that a remand is necessary in this case to ensure that due process is followed and that there is a complete record upon which to decide the Veteran's claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The Veteran has a right, as a matter of law, to compliance with remand instructions, and the Board has a duty to ensure compliance with the terms of the remand. Stegall v. West, 11 Vet. App. 268, 271 (1998). In the March 2016 remand, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding, relevant VA treatment records, including from the Elgin VA Community Based Outpatient Clinic, the Pensacola VA Joint Ambulatory Center, and the Biloxi VA Medical Center (VAMC). The record does not reflect that recent VA treatment records from these facilities have been associated with the claims file. A review of the Veteran's VA treatment records reveals that the most recent VA treatment records associated with the Veteran's claims file are from December 2014; more recent VA treatment records have not been associated with the Veteran's claims file. Furthermore, there is no documentation of record regarding any attempt to obtain these outstanding VA treatment records. Thus, a remand is still needed to obtain these records. Accordingly, to ensure compliance with the directives of the March 2016 remand, the above outstanding records should be obtained, or documentation of the AOJ's attempts to obtain these records should be provided. See Stegall, 11 Vet. App. at 271. 1. Entitlement to service connection for a left leg disorder is remanded. See Argument in Section 2 2. Entitlement to service connection for a right leg disorder is remanded. Beyond the development discussed above, a new VA examination is warranted to determine the nature and etiology of the Veteran's claimed bilateral leg disorder. In the March 2016 remand, the Board directed the AOJ to afford the Veteran a VA examination to determine the nature and etiology of this claimed disability. The record does not reflect that the Veteran was afforded a new VA examination as directed by the March 2016 remand. Thus, in light of the above, to ensure compliance with the March 2016 remand directives, a remand is required for a new VA examination of the claimed bilateral leg disorder. See id. 3. Entitlement to service connection for a left hand disorder is remanded. See Argument in Section 6 4. Entitlement to service connection for a right hand disorder is remanded. See Argument in Section 6 5. Entitlement to service connection for migraines is remanded. See Argument in Section 6 6. Entitlement to service connection for frequent urination is remanded. Beyond the development discussed above, new VA opinions are warranted to determine the nature and etiology of the Veteran's claimed bilateral hand disorder, migraines, and frequent urination. In the March 2016 remand, the Board directed the AOJ to afford the Veteran VA examinations to determine the nature and etiology of these claimed disabilities. The examiner was directed to identify all current disorders related to the Veteran's claimed disabilities. With regard to the claimed bilateral hand disorder and migraines, the examiner was further directed to address the Veteran's prior diagnoses of gout and ocular migraines. Additionally, as regards to all of these claimed disabilities, the examiner was directed that, if the Veteran has any symptomatology that is not attributable to a known clinical diagnosis, the examiner should address whether the reported symptomatology could be attributed to an undiagnosed illness or a medically unexplained chronic multi-symptom illness, resultant of the Veteran's Gulf War service. Accordingly, the Veteran was afforded separate VA examinations for his claimed bilateral hand disorder, migraines, and frequent urination in October 2019. He was also afforded a Gulf War examination at that time. With regard to the Veteran's hands, the examiner concluded that there is no diagnosis of a hand condition. Thus, the examiner provided an opinion against the claim. Similarly, as regards to the Veteran's migraines, the examiner indicated that this condition had resolved, and thus, provided an opinion against the claim. The examiner failed to address the prior diagnoses of gout and ocular migraines. Finally, as regards to the Veteran's claimed frequent urination, the examiner simply noted that the Veteran denied any symptom of frequent urination. The Board finds the October 2019 VA opinions to be inadequate. The March 2016 remand directives instructed the examiner to address the Veteran's prior diagnoses of gout and ocular migraines. However, the examiner failed to do so. The Board further notes that, despite the lack of finding of issues related to the Veteran's bilateral hands and migraines during the October 2019 VA examinations, there were diagnoses related to each claimed disability during the claims period. See McLain v. Nicholson, 21 Vet. App. 319 (2007) (holding that the "current disability" requirement for service connection is met if disability is shown at any time during the claims period). Furthermore, the Board finds that the examinations are also inadequate on the basis that the examination reports do not address whether symptomatology reported by the Veteran in relation to issues with his bilateral hands, migraines, or frequent urination could be attributed to an undiagnosed illness or a medically unexplained chronic multi-symptom illness. Thus, based on the above, and to ensure compliance with the March 2016 remand directives, a remand is required for new VA examinations of the claimed bilateral hand disorder, migraines, and frequent urination. See Stegall, 11 Vet. App. at 271. 7. Entitlement to an initial disability rating in excess of 20 percent for low back disability is remanded. Beyond the development discussed above, a new VA examination is warranted for the Veteran's service-connected back disability. In the March 2016 remand, the Board directed the AOJ to afford the Veteran a new VA examination for the Veteran's back to assess the severity of the disability. During the appeal period, the Veteran was afforded a VA examination for his back in May 2010, January 2013, July 2017, and October 2019. The Board notes that, in 2016 and 2017, two precedential opinions were issued by the United States Court of Appeals for Veterans Claims (Court). These opinions necessitate retroactive opinions in this case. On July 5, 2016, the Court, in Correia v. McDonald, 28 Vet. App. 158 (2016), held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. Thus, the Court's holding in Correia interprets 38 C.F.R. § 4.59 to establish additional requirements that must be met prior to finding that a VA examination is adequate. None of the previous examiners provided range of motion measurements in passive motion, weight-bearing, or non-weight-bearing. Moreover, as regards to the July 2017 and October 2019 examinations, while the examinations reported pain on motion, the point during range of motion where pain started was not noted on the examination reports. None of the examiners provided an explanation as to why such testing was unnecessary. Thus, the Board finds that the previous VA examinations are inadequate. As the previous examination reports do not fully satisfy the requirements of Correia and 38 C.F.R. § 4.59, a retroactive opinion is warranted. Furthermore, the Court issued another decision in Sharp v. Shulkin, 29 Vet. App. 26 (2017) concerning the adequacy of VA orthopedic examinations. In Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the Court held that when a VA examiner is asked to opine as to additional functional loss during flare-ups of a musculoskeletal disability, such opinion must be based on all procurable and assembled medical evidence, to include eliciting relevant information from the veteran as to the flare (i.e., the frequency, duration, characteristics, severity, or functional loss), and such opinion cannot be based on the insufficient knowledge of the specific examiner. In this case, during the May 2010, January 2013, July 2017, and October 2019 VA examinations of the back, the Veteran reported experiencing flare-ups. However, none of the examination reports provide an opinion as to whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups. Therefore, a retroactive opinion to address limitation of motion during flare-ups is warranted in light of Sharp. Furthermore, in the March 2016 remand, the Board directed that the examiner state the total duration of incapacitating episodes over the past 12 months. Neither the July 2017 nor the October 2019 addressed this matter. Thus, based on the above, and to ensure compliance with the March 2016 remand directives, a remand is required to assess the current severity of the Veteran's back to include retroactive opinions in light of Correia and Sharp. See Stegall, 11 Vet. App. at 271. 8. Entitlement to an initial disability rating in excess of 10 percent for right lower extremity radiculopathy is remanded. As additional information will be obtained during the requested VA back examination, which is pertinent to the issue of entitlement to a higher initial rating for right lower extremity radiculopathy, Board action on this matter at this time would be premature. Hence, this matter is being remanded as well. 9. Entitlement to an initial disability rating in excess of 10 percent for right elbow bursitis is remanded. Beyond the development discussed above, a new VA examination is warranted for the Veteran's service-connected right elbow disability. In the March 2016 remand, the Board directed the AOJ to afford the Veteran a new VA examination for the Veteran's right elbow to assess the severity of the disability. During the appeal period, the Veteran was afforded a VA examination for his elbows in May 2010, January 2013, and October 2019. The May 2010 and July 2013 VA examiners failed to provide range of motion measurements in passive motion, weight-bearing, or non-weight-bearing for either elbow. The October 2019 VA examiner failed to provide range of motion measurements in weight-bearing, or non-weight-bearing for either elbow. Furthermore, while the October 2019 examination report noted pain on motion for the right elbow, the point during range of motion where pain started was not noted. None of the examiners provided an explanation as to why such testing was unnecessary. Therefore, the examinations did not comply with the requirements in Correia, 28 Vet. App. at 168. The Board finds that a new VA examination of the elbows is necessary. Furthermore, during the May 2010 and January 2013 VA examinations, the Veteran reported experiencing flare-ups of the right elbow. However, neither of the examination reports provides an opinion as to whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups. Therefore, a retroactive opinion to address limitation of motion during flare-ups is warranted in light of Sharp. Thus, based on the above, a remand is required to assess the current severity of the Veteran's right elbow to include retroactive opinions in light of Correia and Sharp. See Stegall, 11 Vet. App. at 271. 10. Entitlement to an initial disability rating in excess of 10 percent for right hip strain with limitation of extension is remanded. See Argument in Section 14 11. Entitlement to an initial compensable rating for right hip strain with limitation of flexion is remanded. See Argument in Section 14 12. Entitlement to an initial disability rating in excess of 10 percent for right hip strain with limitation of adduction is remanded. See Argument in Section 14 13. Entitlement to an initial disability rating in excess of 10 percent for left hip strain with limitation of extension is remanded. See Argument in Section 14 14. Entitlement to an initial compensable rating for left hip strain with limitation of flexion is remanded. Beyond the development discussed above, a new VA examination is warranted to assess the severity of the Veteran's service-connected bilateral hip disabilities. A review of the record shows that the Veteran most recently underwent a VA examination for his hips in January 2013, over eight years ago. Throughout the appeal period, the Veteran has asserted that the current severity of his bilateral hips is worse than what is contemplated by the current ratings. Therefore, in light of the foregoing, a more contemporaneous examination is warranted for the Veteran's service-connected bilateral hips in order to ensure that the record reflects the current severity of the disabilities. Furthermore, during the appeal period, the Veteran was afforded a VA examination for his hips in May 2010 and January 2013. The May 2010 and July 2013 VA examiners failed to provide range of motion measurements in passive motion, weight-bearing, or non-weight-bearing for either hip. Neither examiner provided an explanation as to why such testing was unnecessary. Therefore, the examinations did not comply with the requirements in Correia, 28 Vet. App. at 168. The Board finds that a new VA examination of the hips is necessary. Furthermore, during the May 2010 and January 2013 VA examinations, the Veteran reported experiencing flare-ups of the bilateral hips. However, neither of the examination reports provides an opinion as to whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups. Therefore, a retroactive opinion to address limitation of motion during flare-ups is warranted in light of Sharp. Thus, based on the above, a remand is required to assess the current severity of the Veteran's bilateral hips to include retroactive opinions in light of Correia and Sharp. See Stegall, 11 Vet. App. at 271. 15. Entitlement to an initial disability rating in excess of 10 percent for right knee patellofemoral syndrome is remanded. See Argument in Section 16 16. Entitlement to an initial disability rating in excess of 10 percent for left knee patellofemoral syndrome is remanded. Beyond the development discussed above, a new VA examination is warranted to assess the severity of the Veteran's service-connected bilateral knee disabilities. In the March 2016 remand, the Board directed the AOJ to afford the Veteran a new VA examination for the Veteran's knees to assess the severity of the disabilities. During the appeal period, the Veteran was afforded a VA examination for his knees in May 2010, January 2013, and October 2019. The May 2010 and July 2013 VA examiners failed to provide range of motion measurements in passive motion, weight-bearing, or non-weight-bearing for either knee. The October 2019 VA examiner failed to provide range of motion measurements in weight-bearing, or non-weight-bearing for either knee. None of the examiners provided an explanation as to why such testing was unnecessary. Therefore, the examinations did not comply with the requirements in Correia, 28 Vet. App. at 168. The Board finds that a new VA examination of the knees is necessary. Furthermore, during the May 2010 and January 2013 VA examinations, the Veteran reported experiencing flare-ups of the bilateral knees. However, neither of the examination reports provides an opinion as to whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups. Therefore, a retroactive opinion to address limitation of motion during flare-ups is warranted in light of Sharp. Thus, based on the above, a remand is required to assess the current severity of the Veteran's bilateral knees to include retroactive opinions in light of Correia and Sharp. See Stegall, 11 Vet. App. at 271. With further regard to Section 7 and Sections 9-16, the Board also notes that, during the course of this appeal, the criteria for rating musculoskeletal disabilities changed effective February 7, 2021. Claims pending prior to the effective date will be considered under both old and new rating criteria, and whatever criteria is more favorable to the Veteran will be applied. The Board may not apply a current regulation prior to its effective date, unless the regulation explicitly provides otherwise. Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). However, the Board is not precluded from applying prior versions of the applicable regulation to the period on or after the effective dates of the new regulation if the prior version was in effect during the pendency of the appeal. Although it is unclear whether any of the changes in this case would impact the Veteran's ratings for his back, right elbow, bilateral hips, and bilateral knees, the Board finds that new comprehensive VA examinations of these service-connected disabilities are warranted in light of the regulatory changes. Thus, in addition to the previously stated reasons, remand is required to afford the Veteran with new full back, elbow, hip, and knee examinations so that the Board may properly rate the Veteran's service-connected disabilities under the applicable diagnostic code(s). 17. Entitlement to an initial disability rating in excess of 20 percent for left foot plantar fasciitis is remanded. Beyond the development discussed above, a new VA examination is warranted for the Veteran's service-connected left foot plantar fasciitis. In the March 2016 remand, the Board directed the AOJ to afford the Veteran a new VA examination for the Veteran's left foot to assess the severity of the disability. The examiner was directed to address whether the Veteran's left foot plantar fasciitis is best characterized as moderate, moderately severe, or severe. Pursuant to the March 2016 remand directives, the Veteran was afforded a VA examination for his left foot in October 2019. The examiner failed to address whether the Veteran's left foot plantar fasciitis is best characterized as moderate, moderately severe, or severe. Thus, in light of the above, to ensure compliance with the March 2016 remand directives, a remand is required for a new VA examination of the Veteran's left foot plantar fasciitis. See Stegall, 11 Vet. App. at 271. 18. Entitlement to an initial compensable rating for bilateral hearing loss is remanded. See Argument in Section 24 19. Entitlement to an initial compensable rating for hypertension is remanded. See Argument in Section 24 20. Entitlement to an initial compensable rating for left testicle vasocongestion is remanded. See Argument in Section 24 21. Entitlement to an initial disability rating in excess of 10 percent for status post head concussion is remanded. See Argument in Section 24 22. Entitlement to an initial disability rating in excess of 10 percent for head scar status post head concussion, prior to April 20, 2017, and in excess of 30 percent thereafter is remanded. See Argument in Section 24 23. Entitlement to an initial compensable rating for a lumbar scar status post discectomy is remanded. See Argument in Section 24 24. Entitlement to an initial compensable rating for an umbilicus scar status post hernia repair surgery is remanded. As noted above, to ensure compliance with the March 2016 remand directives, the matter must be remanded to obtain outstanding VA treatment records. See id. As previously indicated, a review of the Veteran's medical records shows that the most recent VA treatment records associated with the Veteran's claims file are dated from December 2014. After obtaining any outstanding records, the AOJ should review the record and conduct any additional development deemed necessary, to include obtaining any VA examinations and/or opinions, for the adjudication of these claims. 25. Entitlement to a higher level of SMC is remanded. As development of the Veteran's previously discussed claims may have an impact on the Veteran's claim for entitlement to a higher level of SMC, the Board finds these issues are inextricably intertwined. See Henderson v. West, 12 Vet. App. 11, 20 (1998) (matters are "inextricably intertwined" where action on one matter could have a "significant impact" on the other). Accordingly, the Board will defer adjudication of the inextricably intertwined SMC claim at this time. The matters are REMANDED for the following action: 1. Identify and obtain any outstanding VA and private treatment records that are not already associated with the claims file. The most recent VA treatment records included in the claims file are from December 2014. If any record identified cannot be obtained, the Veteran and his representative should be notified of this in writing, to include all efforts taken by VA to attempt to obtain any such record. The Veteran should also be offered the option to provide any such record himself. 2. After obtaining any outstanding records, the Veteran should be scheduled for VA examination(s) before an appropriate clinician to determine the nature and etiology of his claimed disabilities of a bilateral leg disorder, a bilateral hand disorder, migraines, and frequent urination. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. If an examination cannot be scheduled at a location to which the Veteran can safely travel, or if health considerations make the scheduling of an in-person examination not possible, the AOJ should consider whether other virtual options, to include telehealth interviews or examinations are possible. If virtual alternatives are not feasible or possible, the AOJ should indicate as much, and medical opinions based on review of the Veteran's claims file should be obtained, in lieu of an in-person or virtual examination, addressing the etiology of the Veteran's claimed disabilities. For each claimed disability, the examiner must opine whether it is at least as likely as not that any diagnosed disability manifested during, or as a result of, active military service, to include as due to in-service environmental hazards from his service in Southwest Asia. The examiner must address all diagnosed conditions related to the bilateral legs, bilateral hands, migraines, and frequent urination during the claims period. With regard to the claimed bilateral hand disability and migraines, the examiner must address the prior diagnoses of gout and ocular migraines. For any of the claimed disabilities, if no diagnosis can be made, then the examiner shall provide an opinion regarding whether it is at least as likely as not that the Veteran manifests signs and symptoms of any undiagnosed illness. All lay statements describing the Veteran's symptoms, manifestations, and onset must be fully considered and discussed. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 3. Then, schedule the Veteran for an examination by an appropriate clinician to determine the current level of severity of his service-connected back (to include his right lower extremity radiculopathy), right elbow, bilateral hip, and bilateral knee disabilities. A separate examination for the Veteran's radiculopathy need not be conducted unless deemed necessary by the examiner assigned to this case. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. If an examination cannot be scheduled at a location to which the Veteran can safely travel, or if health considerations make the scheduling of an in-person examination not possible, the AOJ should consider whether other virtual options, to include telehealth interviews or examinations are possible. If virtual alternatives are not feasible or possible, the AOJ should indicate as much, and medical opinions based on review of the Veteran's claims file should be obtained, in lieu of an in-person or virtual examination, addressing the severity of the Veteran's service-connected disabilities. The examiner should provide all information required for rating purposes, to specifically include range of motion of the back, each elbow, each hip, and each knee in active motion, passive motion, weight-bearing, and non-weight-bearing. Further, the examiner must indicate if movement is limited by pain, and if so, at what point. The examiner is requested, to the extent possible, to provide estimates of range of motion if the Veteran asserts he is unable to perform range of motion testing due to pain. 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 must report whether there is a lack of normal endurance or functional loss due to pain and pain on use, including that experienced during flare ups; whether there is weakened movement, excess fatigability, incoordination; and the effects of the service-connected disabilities on the Veteran's ordinary activity, including his ability to work. The examiner should also review the VA examinations containing range of motion findings pertinent to the Veteran's back, right elbow, bilateral hips, and bilateral knees conducted during the course of the appeal. If the examiner is unable to provide the requested opinion in this case, he or she should clearly explain the basis for this decision. The examiner should also ask the Veteran to identify the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups. The examiner should identify the extent of the Veteran's functional loss during flare-ups and offer range of motion estimates based on that information. If the examiner cannot provide the above-requested opinion without resorting to speculation, he or she should state whether all procurable medical evidence had been considered, to specifically include the Veteran's description as to the severity, frequency, duration of the flare-ups and his description as to the extent of functional loss during a flare-up and after repetitive use over time; whether the inability is due to the limits of medical community or the limits of the examiner's medical knowledge; and whether there is additional evidence, which if obtained, would permit the opinion to be provided. The examiner should also specifically interview the Veteran about the nature of the flare-ups that he reported in the May 2010, January 2013, July 2017, and October 2019 VA examinations; assess this impairment during flare-ups, and provide a retrospective opinion as to any additional functional loss during flare-ups at that time, and provide an estimate of that loss in terms of degrees reduction in range of motion. With specific regard to the back disability, the examiner should state the total duration of incapacitating episodes over the past 12 months. The examiner is requested to comment on the severity of the Veteran's service-connected back, right lower extremity radiculopathy, right elbow, bilateral hips, and bilateral knees throughout the rating period. The examiner should also discuss the effect of the service-connected disabilities on his occupational functioning and daily activities. The VA examiner should present findings necessary to consider the claim pursuant to the new musculoskeletal regulations. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the severity of his service-connected left foot plantar fasciitis. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. If an examination cannot be scheduled at a location to which the Veteran can safely travel, or if health considerations make the scheduling of an in-person examination not possible, the AOJ should consider whether other virtual options, to include telehealth interviews or examinations are possible. If virtual alternatives are not feasible or possible, the AOJ should indicate as much, and medical opinions based on review of the Veteran's claims file should be obtained, in lieu of an in-person or virtual examination, addressing the current severity of the Veteran's service-connected disability. The examiner is requested to comment on the severity of the Veteran's service-connected left foot plantar fasciitis throughout the rating period. The examiner should discuss the effect of the disability on his occupational functioning and daily activities. The examiner is also requested to indicate whether the Veteran's service-connected left foot plantar fasciitis is best characterized as moderate, moderately severe, or severe. A complete rationale must be provided for all opinions offered. If an opinion cannot be offered without resort to mere speculation, the examiner must fully explain why this is the case and identify what additional evidence, if any, would allow for a more definitive opinion. 5. The AOJ should conduct any additional development it deems necessary based upon a review of the complete file, to include arranging for any additional VA examinations or opinions related to the matters on appeal it determines are warranted. (Continued on next page) 6. After completing all indicated development, the Veteran's claims should be readjudicated based on the entirety of the evidence. If any benefit sought on appeal is not granted, the Veteran and his representative should be provided a Supplemental Statement of the Case (SSOC) and afforded the requisite opportunity to respond before the case is remanded to the Board. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. MacDonald, 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.