Citation Nr: A21016293 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 200129-64523 DATE: October 4, 2021 REMANDED The issue of a compensable rating for bilateral hearing loss is remanded. The issue of a compensable rating for status post left-hand ring finger extensor tendon laceration and repair is remanded. The issue of a compensable rating for status post left-hand little finger extensor tendon laceration and repair is remanded. The issue of a compensable rating for a laceration, dorsum of left hand is remanded. The issue of a compensable rating for removal of toenails, bilaterally (claimed as ingrown toenails) is remanded. The issue of a compensable rating for hypertension is remanded. The issue of service connection for a right knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty from 1962 to 1994. This matter comes before the Board of Veterans' Appeals (Board) from a March 2019 rating decision from a Department of Veterans Affairs (VA) regional office (RO). The Veteran originally filed his claim under the legacy appeals system in January 2018. After rating decisions in March 2018 and July 2018, the Veteran opted into the rapid appeals modernization program (RAMP) in December 2018. The Veteran's claims remained denied in the March 2019 appeals modernization rating decision and the Veteran requested the Board review the claims on the hearing docket. The Veteran was afforded a hearing in May 2021 and submitted evidence for review within the 90-day evidence window. 1. The issue of a compensable rating for bilateral hearing loss is remanded. 2. The issue of a compensable rating for status post left-hand ring finger extensor tendon laceration and repair is remanded. 3. The issue of a compensable rating for status post left-hand little finger extensor tendon laceration and repair is remanded. 4. The issue of a compensable rating for a laceration, dorsum of left hand is remanded. 5. The issue of a compensable rating for removal of toenails, bilaterally (claimed as ingrown toenails) is remanded. 6. The issue of a compensable rating for hypertension is remanded. 7. The issue of service connection for a right knee disability is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE ADJUDICATOR: VA has not obtained relevant VA records identified by the Veteran before the March 2019 rating decision. In the Veteran's January 2019 filing, the Veteran identified treatment at the VA Medical Center in Clarksville, TN. Additionally, a private treatment record from April 2018 also indicates the Veteran had recently received treatment at a VA facility. No attempt has been made to associate these records with the claims folder. A remand is necessary to fulfill VA's duty to assist in obtaining relevant federal records. Additionally, VA did not obtain an examination for the Veteran's claimed right knee disability. The Veteran has indicated he has pain in his right knee in the same location where he had cellulitis while on active duty. The Veteran is competent to identify his subjective pain. Service treatment records confirm in-service treatment for cellulitis in the right knee. A VA medical examination is required to determine if the Veteran's current right knee pain is related to his in-service cellulitis VA provided inadequate examinations to the Veteran regarding his left-hand disabilities. The February 2018 examination report for hand conditions does not provide an opinion as to the nature and severity of the Veteran's flare-ups in the left-hand that the Veteran describes as causing his hand to tighten up and his ring- and little-fingers to curl. The examiner states he cannot provide an assessment of the severity of a flare-up without resulting in speculation because a flare-up was not observed. However, the examiner did not elicit information that would allow for an estimate of the severity of the condition during flare-ups. Therefore, a new examination is required for the ring- and little-fingers of the left hand to assess the severity of flare-ups. The February 2018 examination report for hand conditions also noted evidence of a scar that is either painful or unstable on the left hand. However, the February 2018 examination report for scars stated there was no scar to measure on the left hand. These two examination reports are contradictory and require resolution of the issue of whether there is a scar on the left hand. Therefore, a new examination of the left-hand scar of the dorsum is required to resolve the contradiction between the two February 2018 examination reports. 2. Obtain the Veteran's VA treatment records for the period on appeal. Note that the Veteran identified treatment at the Clarksville, TN VA Medical Center. 3. Schedule the Veteran for a VA examination for his right-knee pain by an appropriately-qualified examiner. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner must provide a response to the following: (a.) Identify all disabilities of the Veteran's right knee that manifest with pain and/or swelling. (b.) For each disability identified state whether it is related to the inservice occurrence and treatment of right-knee cellulitis. THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION, INCLUDING: SERVICE TREATMENT RECORD INDICATING TREATMENT FOR CELLULITIS OF THE RIGHT KNEE IN AUGUST 1963. A FEBRUARY 2010 STATEMENT BY THE VETERAN DESCRIBING SWELLING OF THE RIGHT KNEE. A DECEMBER 2017 PRIVATE TREATMENT RECORD NOTING THE VETERAN HURT HIS RIGHT KNEE INSTALLING A HARDWOOD FLOOR. A JANUARY 2019 CORRESPONDENCE DESCRIBING THE RIGHT KNEE PAIN. MAY 2021 HEARING TESTIMONY WHERE THE VETERAN DESCRIBES THE TREATMENT OF HIS RIGHT KNEE IN SERVICE WITH SURGERY AND THE LOCATION OF THE CURRENT PAIN. 4. Obtain a new examination by an appropriately-qualified VA examiner to provide an assessment of the nature and severity of the Veteran's disabilities of the ring- and little-fingers. All appropriate tests, studies and consultations should be accomplished, and all clinical findings should be reported in detail in the narrative portion of the examination report. The examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION, INCLUDING: A SEPTEMBER 2017 PRIVATE TREATMENT RECORD NOTING THE VETERAN IS UNABLE TO STRAIGHTEN HIS FINGERS. OCTOBER 2017 PRIVATE TREATMENT RECORDS FOR OCCUPATIONAL THERAPY FOR THE LEFT HAND. THE FEBRUARY 2018 EXAMINATION REPORT FOR HAND CONDITIONS NOTING DECREASED STRENGTH IN THE LEFT AND FINGERS TIGHTENING UP. MAY 2021 HEARING TESTIMONY DESCRIBING LIMITED MOBILITY IN THE LEFT HAND, FLARE-UPS OF HIS FINGERS CLOSING UP, AND TINGLING IN THE LEFT HAND AND FINGERS. 5. Obtain a new examination by an appropriately-qualified VA examiner to provide an assessment of the nature and severity of the Veteran's scar of the left dorsum. All appropriate tests, studies and consultations should be accomplished, and all clinical findings should be reported in detail in the narrative portion of the examination report. The examiner should specifically address whether there is a scar of the left-hand dorsum and resolve the apparent contradiction between the February 2018 examination report for hand conditions and the February 2018 examination report for scars. THE EXAMINER MUST REVIEW THE ENTIRE RECORD IN CONJUNCTION WITH RENDERING THE REQUESTED OPINION, INCLUDING: THE FEBRUARY 2018 EXAMINATION REPORT FOR HAND CONDITIONS NOTING EVIDENCE OF A SCAR THAT IS EITHER PAINFUL OR UNSTABLE. (CONTINUED ON NEXT PAGE) THE FEBRUARY 2018 EXAMINATION REPORT FOR SCARS NOTHING THERE IS NO SCAR ON THE LEFT HAND TO MEASURE. Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Reed, 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.