Citation Nr: 21063668 Decision Date: 10/15/21 Archive Date: 10/15/21 DOCKET NO. 17-29 314 DATE: October 15, 2021 ORDER 1. A 40 percent combined (20 percent under Diagnostic Code (Code) 5257, 10 percent under Code 5259, and 10 percent under Code 5260) rating is granted for the Veteran's right knee disability throughout, subject to the regulations governing payment of monetary awards. REMANDED 2. Entitlement to service connection for right foot plantar fasciitis is remanded. 3. Entitlement to service connection for a right shoulder disability is remanded. FINDING OF FACT Throughout, the Veteran's right knee disability is reasonably shown to have been manifested by moderate (but not greater) instability, symptomatic, post-removal of semilunar cartilage, and arthritis with painful motion (or, alternatively, flexion limited to 45 degrees as estimated during flare-ups and repeated use over time); compensable limitation of extension, ankylosis, dislocated semilunar cartilage, nonunion or malunion of the tibia or fibula, genu recurvatum, and instability requiring a prescription from a medical provider for an assistive device (cane, crutch, or walker) are not shown. CONCLUSION OF LAW Throughout, the Veteran's right knee disability warrants a combined 40 percent, but no higher, rating (20 percent under Code 5257, 10 percent under Code 5259, and 10 percent under Code 5260). 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.10, 4.14, 4.21, 4.25, 4.59, 4.71a; Codes 5003, 5010, 5256-5263; 85 Fed. Reg. 76457 (Feb 7, 2021). REASONS AND BASES FOR FINDING AND CONCLUSION The appellant is a Veteran who served on active duty from April 1990 to May 2001. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision which, in relevant part, denied service connection for diabetes mellitus, a left knee disability, a low back disability, a right hip disability, a right shoulder disability, and right foot plantar fasciitis, and continued a 10 percent rating for right knee anterior cruciate ligament (ACL) insufficiency, status post reconstruction with posttraumatic osteoarthritis. An interim (July 2019) rating decision granted service connection for right knee instability, rated 20 percent effective December 30, 2010 (the date of the instant claim for increase), resulting in a combined 30 percent (20 percent under Code 5257 (for instability) and 10 percent under Code 5260 (for posttraumatic osteoarthritis)) rating throughout. In June 2020, a virtual Board hearing was held before the undersigned; a transcript is in the Veteran's record. A March 2021 Board decision remanded the instant matters for additional development. [That decision also denied service connection for type 2 diabetes mellitus, and remanded the matters of service connection for low back, left knee and right hip disabilities. A July 2021 rating decision granted service connection for lumbosacral strain, left knee strain, right thigh impairment, right thigh limitation of flexion (claimed as right side hip complications), and right thigh limitation of extension. Accordingly, those matters are no longer before the Board.] 1. An increased combined (to 40 percent) rating is granted for the Veteran's right knee disability. Legal Criteria Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity caused by the given disability. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). "Staged" ratings may be warranted where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). When a question arises as to which of two ratings applies under a particular code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining, including regarding degree of disability, is resolved in favor of the Veteran. 38 U.S.C. § 5107; 38 C.F.R. §§ 3.102, 4.3. The schedular criteria for evaluating disabilities of the musculoskeletal system, including the knee joint, were revised during the pendency of this appeal. Specifically, and as relevant to this case, revisions to Codes 5003, 5010, and 5257 were made effective February 7, 2021. See 85 Fed. Reg. 76460, 76457 (Feb 7, 2021). Prior to February 7, 2021, Code 5010 provided for rating traumatic arthritis as degenerative arthritis under Code 5003. Under the revised criteria, Code 5010 applies only to post-traumatic arthritis, which is to be rated as limitation of motion, dislocation, or other specified instability under the affected joint. If there are 2 or more joints affected, each rating shall be combined in accordance with § 4.25. Under both the prior and revised rating criteria, degenerative arthritis is rated under Code 5003. Degenerative arthritis established by x-ray findings is rated on the basis of limitation of motion under the appropriate Code(s) for the specific joint(s) involved. When the limitation of motion is noncompensable under the appropriate Code(s), a 10 percent rating is for application for each such major joint affected by limitation of motion, to be combined, not added under Code 5003. Limitation of motion must be objectively confirmed by findings such as swelling, muscle spasm, or satisfactory evidence of painful motion. 38 C.F.R. § 4.71a, Code 5003. The criteria for rating knee disabilities are found at 38 C.F.R. § 4.71a, Codes 5256-5263. Code 5256 applies when the knee is ankylosed. As noted above, revisions to Code 5257 (for recurrent subluxation or instability of the knee) were made effective February 7, 2021. See 85 Fed. Reg. 76457 (Feb 7, 2021). Because these changes took effect during the pendency of the Veteran's appeal, both the former and revised criteria will be considered in evaluating the Veteran's service-connected knee disabilities. However, application of the new criteria prior to the effective date of the amended regulation is not allowed. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003); Green v. Brown, 10 Vet. App. 111, 116-119 (1997); see also 38 U.S.C. § 5110(g). Prior to February 7, 2021, under Code 5257, knee impairment manifested by recurrent subluxation or lateral instability is rated 10 percent when slight, 20 percent when moderate, and 30 percent (the maximum) when severe. Effective February 7, 2021, Code 5257 provides ratings for both recurrent subluxation or instability of the knee and for patellar instability. As it pertains to recurrent subluxation or instability of the knee, Code 5257 provides a 10 percent rating for a sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for either (a) sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device, or (b) unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device or bracing for ambulation. A 30 percent (maximum) rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device and bracing for ambulation. As it pertains to patellar instability of the knee, Code 5257 provides a 10 percent rating for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is assigned for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. [Note (1) explains that for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note (2) explains that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration). See Code 5257 (Effective February 7, 2021).] Under Code 5258, a maximum 20 percent rating is warranted for dislocation of semilunar cartilage with frequent episodes of "locking," pain, and effusion into the joint. Under Code 5259, a 10 percent rating is assigned for symptomatic removal of semilunar cartilage. Under Code 5260, limitation of flexion of the leg warrants a 0 percent rating when flexion is limited to 60 degrees; a 10 percent rating when limited to 45 degrees; a 20 percent rating when limited to 30 degrees; and a (maximum) 30 percent rating when limited to 15 degrees. Under Code 5261, limitation of extension of the leg warrants a 0 percent rating when extension is limited at 5 degrees; a 10 percent rating when limited at 10 degrees; a 20 percent rating when limited at 15 degrees; a 30 percent rating when limited at 20 degrees; a 40 percent rating when limited at 30 degrees; and a (maximum) 50 percent rating when limited at 45 degrees. Code 5262 applies when there is malunion or nonunion of the tibia and fibula. Code 5263 applies when there is acquired, traumatic genua recurvatum. Normal or full range of motion (ROM) of the knee is from 0 degrees of extension to 140 degrees of flexion. Plate II. 38 C.F.R. § 4.71. Separate ratings may be assigned for separate symptoms, including for [compensable] limitations of flexion and extension, instability, and dislocation of semilunar cartilage or symptomatic removal of semilunar cartilage. VAOPGCPREC 9-2004 (September 17, 2004), 69 Fed. Reg. 59990 (2004). In determining the degree of limitation of motion, the provisions of 38 U.S.C. §§ 4.10, 4.40, and 4.45 are for consideration. See DeLuca v. Brown, 8 Vet. App. 202 (1995). The basis of disability evaluation is the ability of the body as a whole, or of the psyche, or of a system or organ of the body to function under the ordinary conditions of daily life including employment. 38 C.F.R. § 4.10. Disability of the musculoskeletal system is primarily the inability, due to damage or infection in parts of the system, to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Functional loss may be due to the absence or deformity of structures or other pathology, or it may be due to pain, supported by adequate pathology and evidenced by the visible behavior in undertaking the motion. Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. 38 C.F.R. § 4.40. With respect to joints, in particular, the factors of disability reside in reductions of normal excursion of movements in different planes. Inquiry will be directed to more or less than normal movement, weakened movement, excess fatigability, incoordination, pain on movement, swelling, deformity or atrophy of disuse. 38 C.F.R. § 4.45. An increased rating may be assigned for up to one year prior to receipt of a formal claim for increase, when it is factually ascertainable that an increase in disability had occurred during that period. 38 C.F.R. § 3.400(o)(2). Consequently, the evaluation period for consideration here is from December 2009 (a year prior to the December 30, 2010 date of claim) to the present. Factual Background A September 2001 VA knee examination report (prior to the period on appeal) notes a history of right knee ACL tear with open joint surgery in 1992 and arthroscopic surgery in 1999. The impression was right knee degenerative joint disease (DJD), status post arthroscopy with meniscectomy, moderately symptomatic. [A November 1999 service treatment record (STR) notes that the arthroscopic surgery included partial chondroplasty and partial meniscectomy.] In a December 30, 2010 VA Form 21-4138, the Veteran reported "limitation of flexion knee." On May 2011 VA joints examination, the Veteran reported left knee soreness, particularly with prolonged standing. He reported that he treats with Aleve; he denied "true flare-ups," use of a brace or cane, and incapacitating events. He also denied that his knee effects his employment; he explained that he "just moves more slowly." Examination of the left knee showed healed arthroscopic holes; there was no tenderness or swelling of the patella or around the medial or lateral aspect of the joint. Flexion was to 140 degrees and extension was full. Repeated testing on active and passive motion showed no indication of pain, weakness, or fatigue. There was no laxity of the lateral or medial ligaments. Anterior and posterior drawer tests were negative, "which indicated intact anterior and posterior cruciate ligaments." McMurray sign was negative. He ambulated without appearance of discomfort. The assessment was post ACL reconstruction of the left knee. The examiner wrote that the Veteran "has minimal to no symptoms of the left knee currently." On September 2011 VA knee examination, a different examiner reviewed the May 2011 examination and wrote that the Veteran's ACL repair was on the right knee and not the left knee. "This is apparently a typographical error both on the C&P examiner's as well as the regional office when they generated the request." The Veteran reported that he underwent right knee ACL reconstruction in 1990 or 1991, and a subsequent arthroscopic surgery in 1997. The Veteran reported that he wears a right knee sports brace occasionally when participating in sports. He reported that standing aggravates the knee, and that "infrequently it does swell on him with no locking but it does pop a lot." He reported that "infrequently" he has a sense of giving way; he treats with Aleve and an occasional Motrin. He denied walking limitations; he reported he can run a half mile and that he bicycles for exercise. On examination, right knee ROM testing showed flexion to 120 degrees and extension to 0 degrees (full). There was no effusion. Repetitive motion testing showed crepitus, but no pain, fatigue, weakness, or incoordination. There was 1+ laxity with varus valgus stress testing. McMurray's test was negative; his gait was normal. The diagnosis was "mild posttraumatic osteoarthritis of the right knee." In a June 2017 VA Form 9, the Veteran reported that due to his right knee disability he cannot stand for more than 10 minutes without pain (which eventually leads to perspiration and nausea). He reported that his most recent surgery in 1997 "resulted in the removal of all remaining cartilage." On June 2017 VA (fee basis) knee examination, the diagnoses were right knee joint arthritis, knee instability, and knee cartilage restoration surgery. The Veteran reported that his knee is "bone on bone" and that he has been told he will require a right knee replacement. He endorsed flare-ups "described as constant pain." He reported that he is unable to stand or walk for 10 minutes before he starts sweating from the pain., and uses a knee brace if he "stands or walks for long periods of time [or] begins to have flare ups." Initial ROM testing showed right knee flexion to 130 degrees and extension to 0 degrees (full). On repetitive use testing, ROM was 0 to 120 degrees due to pain. There was evidence of pain on non-weight-bearing. The examiner indicated the examination was not conducted during a flare-up or immediately after repeated use over a period of time; she indicated that the examination is neither medically consistent or inconsistent with the Veteran's statements describing functional loss during flare-ups and over time due to pain and weakness; she did not provide ROM estimates. Right knee muscle strength was 4/5 in both flexion and extension. There was no muscle atrophy. The knee joint was not ankylosed. Histories of right knee moderate recurrent subluxation and slight lateral instability were noted. A history of right knee recurrent effusion was noted, described as "swells up at times." Joint stability testing showed 1+ anterior instability; posterior, medial, and lateral instability tests were normal. Shin splints were noted bilaterally, but such did not affect ROM of the knees. The examiner noted that the Veteran had an ACL repair, which manifests in current symptoms of knee pain and swelling. She also noted that he had a meniscectomy with residuals of pain and swelling. She noted regular use of a knee brace, which the Veteran uses if standing or walking for long periods, or when he begins to have flare-ups. There was not functional impairment such that no effective function remains other than that which would be equally served by an amputation with prosthesis. The examiner opined that the functional impact of the condition is that the Veteran is unable to stand, walk, squat, or perform other weight-bearing activities for extended periods of time. At the June 2020 Board hearing, the Veteran reported worsening of his right knee disability. He reported pain with "any type of movement, lateral being more painful than say forward." He testified that he avoids lateral force movements, and does not step off a curb using his right leg. He reported that his right knee or hip "will give out at any time. That's happened to me probably 50 to 100 times over the last 20 years." A March 2021 VA treatment record notes the Veteran's report of chronic right knee pain. He denied buckling or giving out. ROM was "intact." On June 2021 VA (fee basis) knee examination, the diagnosis was right knee ACL insufficiency, status post reconstruction with post-traumatic osteoarthritis. He reported right knee flare-ups 1-2 times per month, lasting 30 minutes to four hours, manifested by dull aching pain and fatigue; the flare-ups are precipitated by prolonged walking and squatting, and alleviated by meloxicam. He reported that flare-ups affect the activities of daily living (ADLs) and make it difficult to walk or squat. Initial ROM testing showed right knee flexion to 50 degrees and extension to 0 degrees (full); pain was noted in both motions. Pain was noted on weight-bearing (but not non-weight bearing), and on active and passive motion. There was evidence of localized tenderness or pain on palpation to the anterior knee; the severity was 'mild.' On repetitive use testing, right knee ROM was 0 to 45 degrees due to pain, fatigability, and lack of endurance. Although the examination was not conducted during a flare-up or immediately after repeated use over a period of time, the examiner estimated that ROM is 0 to 45 degrees immediately after repeated use over time and during flare-ups (both due to pain, fatigability, and lack of endurance). Other factors contributing to the Veteran's right knee disability are interference with standing, disturbance of locomotion, and less movement than normal. There was no muscle atrophy or ankylosis. The examiner indicated there was not recurrent subluxation or persistent instability, or patellar instability. He noted that the Veteran previously had a complete ligament tear, and that the tear was successfully repaired. The Veteran does not have a prescription for a cane, walker, crutches, or brace. There was not recurrent patellar dislocation, shin splints, stress fractures, or any other tibial or fibular impairment. The examiner did not diagnose a meniscal condition. He acknowledged a 1992 ACL reconstruction surgery, and noted residual symptoms including painful ROM, decreased ROM, and fatigue. He noted that the Veteran has an antalgic gait favoring his right knee, and that he regularly uses braces on both knees. There was not functional impairment such that no effective function remains other than that which would be equally served by an amputation with prosthesis. The examiner opined that the functional impact of the condition is that the Veteran has difficulty with prolonged walking, prolonged standing, and walking. Analysis The Veteran's right knee disability has been assigned a combined 30 percent rating throughout the appeal period (based on a formulation of 20 percent under Code 5257 (for instability) and 10 percent under Code 5260 (for posttraumatic osteoarthritis)). Upon review of the record, the Board finds that an increased (to 40 percent, combined) rating is warranted throughout for the Veteran's right knee disability, based on a formulation of 20 percent under Code 5257, 10 percent under Code 5259, and 10 percent under Code 5260. Initially, the Board notes the applicability of Codes 5256, 5262, and 5263 has been considered throughout the appeal period. However, as the evidence of record does not show that pathology or separate and distinct symptoms required for ratings under such codes (ankylosis, nonunion or malunion of the tibia or fibula, or genu recurvatum of the knee) were present during the evaluation period, those Codes do not have applicability in this matter (and will not be further discussed). Throughout, the Veteran's right knee disability has been assigned a 20 percent rating under Code 5257; that rating was assigned under the "old" criteria for moderate instability. Considering first the "old" criteria, the Board finds that more than moderate instability is not shown at any time under consideration. On May 2011 examination, instability was not found. On September 2011 examination, there was 1+ laxity (and not 2+ or 3+) with varus valgus stress testing; all other stability tests were negative. On June 2017 examination, anterior stability testing showed 1+ laxity (and not 2+ or 3+); all other stability tests were normal. The examiner noted a history of moderate (but not severe) recurrent subluxation and a history of slight (but not moderate or severe) lateral instability. And on June 2021 examination, recurrent subluxation, persistent instability, and recurrent patellar instability were not diagnosed. The Board also notes that the Veteran described the sensation of his right knee giving out as happening "infrequently" in September 2011; that his knee and hip have given out 50 to 100 times over the past 20 years (so, on average, approximately 5 times per year by his self-report); and, that he denied buckling or giving out on March 2021 treatment. Such objective findings on examinations and such lay reports weigh against a finding of more than moderate instability at any time under consideration. The Board has also considered whether a higher (30 percent) rating is warranted for right knee instability under the "new" criteria under Code 5257 (in place since February 7, 2021), but finds it is not. The Board notes that the Veteran used a brace earlier in the appeal period on an occasional basis during sports, and later in the appeal period on a regular basis. The evidence does not, however, show that the brace was prescribed by a medical provider. Furthermore, the evidence does not show that the Veteran has an unrepaired or failed repair of a complete ligament tear with prescribed cane/crutch/walker for ambulation, or recurrent instability after surgical repair that requires a prescription for a brace and either a cane or walker by a medical provider. Accordingly, a rating in excess of 20 percent for instability is not warranted at any time under either the old, or from February 7, 2021 the new version of the governing regulatory criteria. The Board turns to Codes 5258 and 5259, as the record shows the Veteran underwent a right knee partial chondroplasty and partial meniscectomy during service. The Board finds that a 10 percent (maximum schedular) rating under Code 5259 is warranted throughout for symptomatic removal of semilunar cartilage. At times during the appeal period, the Veteran has reported effusion into the right knee joint and a feeling of popping. In his June 2017 VA Form 9, he reported that a surgery in 1997 "resulted in the removal of all remaining cartilage." He similarly told the June 2017 examiner that his right knee is "bone on bone." Notably, the June 2017 examiner did not diagnose a meniscal tear; however, she checked the box to indicate that the Veteran had a meniscectomy and that residual signs/symptoms include "pain and swelling." Although the June 2021 examiner did not identify symptoms related to the meniscectomy, he did note objective evidence of crepitus. Accordingly, the Board finds the evidence at least in equipoise that the Veteran's right knee disability manifests in symptomatic removal of semilunar cartilage, including effusion into the joint, popping sensation, grinding sensation, pain, and swelling. A separate rating under Code 5258 (for dislocated semilunar cartilage) is not warranted as the evidence has not show a current meniscus tear during the pendency of this claim. Furthermore, separate ratings under Codes 5258 and 5259 are prohibited by the rule against pyramiding, as the two Codes contemplate overlapping cartilage symptoms. See 38 C.F.R. § 4.14. The Veteran's right knee disability has been assigned a 10 percent rating under Code 5260 for painful motion with limitation of flexion. See December 2001 rating decision. At no time under consideration is the Veteran's right knee flexion shown to have been limited to 30 degrees (so as to warrant the next higher, 20 percent rating), or is right knee extension shown to have been limited to 10 degrees (so as to warrant a separate compensable rating for limitation of extension). On May 2011 examination, right knee ROM was 0 to 140 degrees. On September 2011 examination, right knee ROM was 0 to 120 degrees. On June 2017 examination, ROM was 0 to 130 degrees on initial testing (and limited to 120 degrees flexion on repetitive use testing). And on June 2021 examination, ROM was 0 to 50 degrees on initial testing, and estimated as 0 to 45 degrees after repeated use over time and during flare-ups (with consideration of pain, fatigability, and lack of endurance). Accordingly, a rating in excess of 10 percent is not warranted based on limitation of ROM (considering both flexion and extension), including during flare-ups or after repeated use over time. Finally, the matter of entitlement to a total disability rating based on individual unemployability (TDIU) is not raised by the record in the context of the instant claim for increase. The Veteran does not contend, nor has an examiner opined, that his right knee disability renders him unemployable. REASONS FOR REMAND The Board is aware that these matters were remanded before (and regrets the delay inherent with another remand); but because there was not substantial compliance with previous remand instructions, finds that another remand is necessary. See Stegall v. West, 11 Vet. App. 268, 271 (1998). 2. Entitlement to service connection for right foot plantar fasciitis In March 2021, the Board remanded this matter for an examination to identify all right foot disabilities (other than already-service-connected pes planus) and identify the likely etiology of each. The examiner was directed that if right foot plantar fasciitis is not diagnosed, such finding must be reconciled with the diagnosis of such disability on September 2011 VA knee and lower leg conditions examination. On June 2021 VA (fee basis) foot conditions examination, right foot pes planus and right foot degenerative arthritis were diagnosed. Plantar fasciitis was not diagnosed; the examiner did not reconcile such finding with the prior diagnoses in the record, as directed. Stegall v. West, 11 Vet. App. at 271. Remand is required for an addendum opinion to reconcile the evidence of record. [The examiner opined that right foot degenerative arthritis is a progression of the Veteran's service-connected pes planus. A July 2021 rating decision granted service connection for right foot degenerative arthritis and rated such disability with the Veteran's right foot pes planus.] 3. Entitlement to service connection for a right shoulder disability In March 2021, the Board remanded this matter for an examination to ascertain the likely etiology of the Veteran's right shoulder disability. On June 2021 VA (fee basis) shoulder examination, right shoulder impingement syndrome was diagnosed. The examiner provided a negative nexus (to service) opinion. He opined that the right shoulder impingement is due to overuse from normal daily lifting. He cited to a (purported) 2001 service separation examination and wrote that the Veteran "told the examiner that he previously had a right shoulder rotator cuff injury, but the examiner noted there was no documentation to support a right shoulder injury." The Board finds this opinion inadequate for rating purposes as it is based on an incorrect factual premise. The Veteran's December 2000 Medical Evaluation Board (MEB) examination report notes that clinical evaluation of the right shoulder showed weak subscapularis, mildly painful arch, and positive Hawkins test. Under 'summary of defects and diagnoses,' the doctor wrote right shoulder impingement/subscapular weakness, and recommended physical therapy (PT). [The Board notes that the 'physician's summary' in a contemporaneous report of medical history notes the Veteran's report of right shoulder pain, that rotator cuff was "tense" per the Veteran, and there was no documentation in his records.] Accordingly, remand for an addendum advisory medical opinion which reflects consideration of the documented right shoulder complaints/defects noted on December 2000 MEB examination is necessary. The matters are REMANDED for the following: 1. Secure for the record updated (to the present, all not already associated with the record) complete clinical records of all VA evaluations and treatment the Veteran has received for his right foot and right shoulder. 2. After the development requested above is completed, arrange for the Veteran's record to be returned to the June 2021 VA (fee basis) examiner for review and an addendum opinion regarding the nature and likely etiology of the Veteran's claimed right foot plantar fasciitis and right shoulder disabilities. [If that provider is unavailable or unable to provide the addendum opinion sought, arrange for the record to be forwarded to another appropriate clinician for review and the opinions sought. If that occurs, and further examination of the Veteran is deemed necessary, such should be arranged.] The Veteran's entire record (to include this remand, the June 2021 examination report, and any records received pursuant to the request above) must be reviewed by the examiner. Regarding the claim seeking service connection for right foot plantar fasciitis, the examiner should: (a) Reconcile the September 2011 assessment of right foot "minimal tenderness to palpation over the plantar fascia at the insertion on the calcaneus" with the lack of diagnosis on June 2021 examination. If the diagnosis on September 2011 assessment is ultimately determined to not be supported by evidence in the record, explain why that is so. [The rationale for this opinion should include some discussion of the nature of plantar fasciitis, such as its ability to resolve completely, and whether its symptomatology is intermittent or permanent. Merely reiterating that plantar fasciitis was not found on June 2021 examination will not suffice.] (b) If right foot plantar fasciitis is diagnosed upon further review (and examination, if needed), is it at least as likely as not (a 50% or greater probability) that such is etiologically related to the Veteran's service/events therein? [The rationale for this opinion should address the notations in service of such complaints/diagnoses.] (c) If right foot plantar fasciitis is diagnosed but determined to not be directly related to the Veteran's service, is it at least as likely as not that it was caused or aggravated by his service-connected right knee disability? The opinion must address aggravation. (d) If right foot plantar fasciitis is diagnosed but determined to be unrelated to service, and to not have been caused or aggravated by the Veteran's service-connected right knee disability, identify the etiology that is considered to be more likely (and explain why that is so). Regarding the claim of service connection for a right shoulder disability, the examiner should: (e) Identify the likely etiology for each right shoulder disability entity diagnosed. Specifically, is it at least as likely as not (that the disability is etiologically related to the Veteran's service/events therein? [The rationale provided should address the December 2000 MEB examination report notations of positive Hawkins test, right shoulder impingement/subscapular weakness, and recommendation for physical therapy (as discussed above).] (f) For each right shoulder disability entity diagnosed but determined to not be directly related to the Veteran's service, is it at least as likely as not (that it was caused or aggravated by his service-connected right knee disability? The opinion must address aggravation. (g) If a diagnosed right shoulder disability entity is found to be unrelated to service, and to not have been caused or aggravated by the Veteran's service-connected right knee disability, identify the etiology that is considered to be more likely (and explain why that is so). Include rationale with all opinions, citing to supporting factual data and medical principles, as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.