Citation Nr: 21070434 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-15 517 DATE: November 24, 2021 ORDER Entitlement to an initial evaluation in excess of 10 percent for left elbow strain has been withdrawn. Entitlement to an initial evaluation in excess of 10 percent for impairment of supination and/or pronation, left elbow has been withdrawn. Entitlement to an initial evaluation in excess of 10 percent for degenerative disc and joint disease, lumbosacral spine has been withdrawn. Entitlement to an initial evaluation in excess of 10 percent for service connection for degenerative joint disease, right knee has been withdrawn. Entitlement to an initial compensable evaluation for left index finger strain has been withdrawn. Entitlement to an initial compensable evaluation for bilateral hearing loss has been withdrawn. Entitlement to service connection for toenail onychomycosis has been withdrawn. Entitlement to service connection for tinea pedis has been withdrawn. Entitlement to service connection for contusion to ribs has been withdrawn. Entitlement to an initial 10 percent evaluation, but no greater, for right elbow strain prior to June 17, 2015, and as of August 1, 2015 and a 100 percent rating from June 17, 2015 to August 1, 2015 is granted. Service connection for obstructive sleep apnea is granted. Service connection for restless legs syndrome is granted. REMANDED Entitlement to service connection for left leg sciatic pain is remanded. Entitlement to service connection for bilateral hand condition is remanded. Entitlement to an initial compensable evaluation for left knee strain is remanded. Entitlement to an initial compensable evaluation for left shoulder strain is remanded. Entitlement to an initial evaluation in excess of 10 percent for right shoulder strain with humeral cyst and history of degenerative joint disease is remanded. Entitlement to an initial compensable evaluation for dermatitis is remanded. FINDINGS OF FACT 1. At his May 2021 Board hearing, prior to the promulgation of a decision in the matter, the Veteran submitted a request to withdraw his appeal on the issue of entitlement to a higher initial rating for left elbow strain, left elbow disability, lumbosacral spine degenerative disc and joint disease, right knee degenerative joint disease, left index finger strain, an bilateral hearing loss and entitlement to service connection for toenail onychomycosis, tinea pedis, and contusion to ribs; there are no questions of fact or law in this matter remaining for the Board to consider. 2. Prior to June 17, 2015 and as of August 1, 2015, the Veteran has had painful motion of his right elbow but has not had flexion limited to 90 degrees or less or extension limited to 45 degrees or greater. 3. On June 17, 2015, the Veteran had right elbow surgery requiring one month of convalescence. 4. The Veteran's obstructive sleep apnea onset in service. 5. The Veteran's restless leg syndrome onset in service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the issue of entitlement to rating in excess of 10 percent for left elbow strain by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 2. The criteria for withdrawal of the issue of entitlement to a rating in excess of 10 percent for left elbow impairment of supination and/or pronation by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 3. The criteria for withdrawal of the issue of entitlement to a rating in excess of 10 percent for lumbosacral spine degenerative disc and joint disease by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 4. The criteria for withdrawal of the issue of entitlement to a rating in excess of 10 percent for right knee degenerative joint disease by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 5. The criteria for withdrawal of the issue of entitlement to a compensable evaluation for left index finger strain by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 6. The criteria for withdrawal of the issue of entitlement to a compensable evaluation for bilateral hearing loss by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 7. The criteria for withdrawal of the issue of entitlement to service connection for toenail onychomycosis by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 8. The criteria for withdrawal of the issue of entitlement to service connection for tinea pedis by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 9. The criteria for withdrawal of the issue of entitlement to service connection for contusion to ribs by the appellant have been met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. 10. The criteria for an evaluation of 10 percent, but no greater, for right elbow strain prior to June 17, 2015 and as of August 1, 2015 have been met. 38 U.S.C. § 1155, 5107; 38 C.F.R. §§ 3.321, 4.1, 4.40, 4.45, 4.71a, Diagnostic Code 5206. 11. The criteria for a temporary total rating pursuant to 38 C.F.R. § 4.30 due to right elbow surgery requiring convalesce have been met from June 17, 2015 to August 1, 2015. 38 C.F.R. § 4.30. 12. The criteria for service connection for obstructive sleep apnea have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304. 13. The criteria for service connection for restless leg syndrome have been met. 38 U.S.C. §§ 1110, 1131, 5103A, 5107; 38 C.F.R. §§ 3.159, 3.303, 3.304. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from September 1982 to September 2012. This appeal comes to the Board of Veterans' Appeals (Board) from a February 2014 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran provided sworn testimony in support of his appeal during a hearing before the undersigned Veterans Law Judge in May 2021. Withdrawal 1. Entitlement to an initial evaluation in excess of 10 percent for left elbow strain 2. Entitlement to an initial evaluation in excess of 10 percent for left elbow impairment of supination and/or pronation 3. Entitlement to an initial evaluation in excess of 10 percent for lumbosacral spine degenerative disc and joint disease 4. Entitlement to an initial evaluation in excess of 10 percent for right knee degenerative joint disease 5. Entitlement to an initial compensable evaluation for left index finger strain 6. Entitlement to an initial compensable evaluation for bilateral hearing loss 7. Entitlement to service connection for toenail onychomycosis 8. Entitlement to service connection for tinea pedis 9. Entitlement to service connection for contusion to ribs The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the appellant or by his or her authorized representative. Id. In the present case, the appellant has withdrawn his appeal as to the issues of entitlement to a higher initial rating for left elbow strain, left elbow disability, lumbosacral spine degenerative disc and joint disease, right knee degenerative joint disease, left index finger strain, an bilateral hearing loss and entitlement to service connection for toenail onychomycosis, tinea pedis, and contusion to ribs and, hence, there remain no allegations of errors of fact or law for appellate consideration. The Veteran requested the withdrawal at his May 2021 hearing. The Board finds that the withdrawal was (1) explicit, (2) unambiguous, and (3) done with a full understanding of the consequences of such action on the part of the claimant. DeLisio v. Shinseki, 25 Vet. App. 45, 57 (2011); see Acree v. O'Rourke, 891 F.3d 1009, 1014 (Fed. Cir. 2018). Accordingly, the Board does not have jurisdiction to review the appeal as to the listed issues and it is dismissed. Increased Rating Disability evaluations are determined by evaluating the extent to which a Veteran's service-connected disability adversely affects his or her ability to function under the ordinary conditions of daily life, including employment, by comparing his or her symptomatology with the criteria set forth in the Schedule for Rating Disabilities. The percentage ratings represent as far as can practicably be determined the average impairment in earning capacity resulting from such diseases and injuries and the residual conditions in civilian occupations. Generally, the degree of disabilities specified are considered adequate to compensate for considerable loss of working time from exacerbation or illness proportionate to the severity of the several grades of disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities and the criteria for specific ratings. If two disability evaluations are potentially applicable, the higher evaluation will be assigned to the disability picture that more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Any reasonable doubt regarding the degree of disability will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. However, the evaluation of the same disability under various diagnoses, known as pyramiding, is to be avoided. 38 C.F.R. § 4.14. If there is disagreement with the initial rating assigned following a grant of service connection, separate ratings can be assigned for separate periods of time, based on the facts found. Fenderson v. West, 12 Vet. App. 119, 126 (1999). 10. Entitlement to an initial compensable evaluation for right elbow strain prior to April 22, 2021 and a rating in excess of 10 percent thereafter The Veteran has appealed the initial noncompensable rating assigned in the February 2014 rating decision that granted service connection for right elbow strain effective October 1, 2012. A May 2021 rating decision granted a 10 percent rating effective April 22, 2021. Thus, the Board will consider whether a compensable rating is warranted from October 1, 2012 to April 22, 2021 and whether a rating in excess of 10 percent is warranted as of April 22, 2021. The Board notes that the period on appeal encompasses a 2015 right elbow surgery. The Veteran is presumed to be seeking the maximum benefit allowed by law and regulation. Ab v. Brown, 6 Vet. App. 35, 38 (1993). When deciding an appeal, the Board is required to consider all issues raised by the Veteran or by the evidence of record. Robinson v. Mansfield, 21 Vet. App. 545, 552 (2008). In keeping with that rule of law, the United States Court of Appeals for Veterans Claims held in a memorandum decision that if the record evidence reasonably raised the issue of entitlement to a temporary total disability rating for a period of convalescence during the pendency of the claim, the Board is required to consider it. Minor v. Gibson, No. 12-2879 (Vet. App. June 11, 2014) (BARTLEY, Judge); Bethea v. Derwinski, 2 Vet. App. 252, 254 (1992). Therefore, entitlement to a temporary total disability rating under 38 C.F.R. § 4.30 is a part of the Veteran's appeal. Under 38 C.F.R. § 4.30, a temporary total (100 percent) rating for convalescence will be assigned effective from the date of hospital admission and continue for 1, 2, or 3 months from the first day of the month following hospital discharge when treatment of a service-connected disability results in: (1) surgery necessitating at least one month of convalescence; (2) surgery with severe postoperative residuals such as incompletely healed surgical wounds, stumps of recent amputations, therapeutic immobilization of one major joint or more, application of a body cast, or the necessity for house confinement, or the necessity for continued use of a wheelchair or crutches (regular weight-bearing prohibited); or (3) immobilization by cast, without surgery, of one major joint or more. The total rating will be followed by a rating reflecting the appropriate schedular evaluation; where the evidence is inadequate to assign the schedular evaluation, a physical examination will be scheduled prior to the end of the total rating period. See 38 C.F.R. § 4.30. Diagnostic Code 5206 applies to limitation of flexion of the forearm. For the major arm, a noncompensable rating is warranted for flexion limited to 110 degrees, a 10 percent rating for flexion limited to 100 degrees, a 20 percent rating for flexion limited to 90 degrees, a 30 percent rating for flexion limited to 70 degrees, a 40 percent rating for flexion limited to 55 degrees, and a 50 percent rating for flexion limited to 45 degrees. 38 C.F.R. § 4.71a. Under Diagnostic Code 5207 for limitation of extension of the forearm, a 10 percent rating is assigned when extension of the major forearm is limited to 45 or 60 degrees; a 20 percent rating is warranted for extension of the major forearm limited to 75 degrees; a 30 percent rating is warranted for extension of the major forearm limited to 90 degrees; a 40 percent rating is warranted for extension of the major forearm limited to 100 degrees; and a 50 percent rating is warranted for extension of the major forearm limited to 110 degrees. Id. Diagnostic Code 5208 provides for a 20 percent evaluation where flexion of the forearm is limited to 100 degrees and extension to 45 degrees. Id. For disabilities of the musculoskeletal system, the Board also considers whether a higher disability evaluation is warranted on the basis of functional loss due to pain or due to weakness, fatigability, incoordination, or pain on movement of a joint under 38 C.F.R. §§ 4.40 and 4.45. See DeLuca v. Brown, 8 Vet. App. 202, 204-07 (1995). Weakness is as important as limitation of motion, and a part that becomes painful on use must be regarded as seriously disabled. Id. Functional loss contemplates the inability of the body to perform the normal working movements of the body with normal excursion, strength, speed, coordination and endurance, and must be manifested by adequate evidence of disabling pathology, especially when it is due to pain. 38 C.F.R. § 4.40. The factors of disability affecting joints are reduction of normal excursion of movements in different planes, weakened movement, excess fatigability, swelling and pain on movement. 38 C.F.R. § 4.45. Additionally, painful motion is an important factor of disability; and joints that are actually painful, unstable, or malaligned, due to healed injury, should be entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. Although pain may cause a functional loss, pain itself does not constitute functional loss. Pain must affect some aspect of "the normal working movements of the body" such as "excursion, strength, speed, coordination, and endurance," in order to constitute functional loss. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011). An April 2013 private treatment record noted the Veteran's report of right elbow pain that is constant and fluctuating, aggravated by lifting and holding. On VA examination in December 2013, the range of motion in the Veteran's right elbow was tested to 145 degrees or greater flexion with no objective evidence of painful motion. There was no limitation of extension or objective evidence of painful motion on extension. There was no additional functional loss after three repetitions. A February 2015 private treatment record states that the Veteran reported an increase in right elbow pain aggravated by bending and movement. A March 2015 orthopedic record notes the Veteran's report of four to five years of lateral right elbow pain. He was noted to deny loss of motion or hand symptoms. In May 2015, range of motion testing showed flexion to 150 degrees and extension lacking five degrees, with objective evidence of pain. On June 17, 2015, the Veteran underwent surgery on his right elbow. The surgery report states that the Veteran reported he is unable to use his right arm, including to eat, write, and type, due to pain. The record reflects the Veteran was scheduled to have sutures removed three weeks after surgery and that the Veteran began physical therapy three weeks following the surgery as scheduled. A July 8, 2015 physical therapy note indicates that the Veteran has significant activity restrictions that will not be lifted for several more weeks. A July 24, 2015 physical therapy record indicates that the Veteran is able to use his right arm for much more activity during the day and his range of motion is nearly fully restored actively. An August 4, 2015 private treatment record notes the Veteran's report that he is able to write and hold a coffee cup and his right elbow has a full range of motion. Physical therapy records from the end of August and early September note right elbow flexion to 155 degrees and extension to 0 degrees with good quality active arc of motion. A November 2017 private treatment record notes diffuse right elbow pain on a chronic basis. In early May 2021, the Veteran underwent a VA examination of his right elbow. The examination report indicates no functional loss or functional impairment of the right elbow, including after repeated use over time. Range of motion testing was normal with no complaints of painful motion noted. The report indicates that the Veteran denied flare-ups. Later in May 2021, the Veteran testified at a Board hearing. At that time, he reported he has a constant ache in his right elbow with an increase in sharpness of pain with rotation. The Board finds that a temporary total rating is warranted under 38 C.F.R. § 4.30 from June 17, 2015, the date of the Veteran's right elbow surgery, to August 1, 2015, one month from the first day of the month following the surgery. The Board finds that although the Veteran continued physical therapy after August 1, 2015, his condition had improved such that it no longer constituted a period of convalescence under 38 C.F.R. § 4.30. The Board further finds that a 10 percent rating is warranted prior to June 17, 2015. The evidence reflects that throughout the period on appeal the Veteran has experienced painful motion of his right elbow, which warrants a 10 percent rating. The Board finds that a rating in excess of 10 percent is not warranted prior to June 17, 2015 or after August 1, 2015. There is no evidence that the Veteran's right elbow flexion has been limited to 90 degrees or less prior to June 17, 2015 or after August 1, 2015. Rather, as outlined above, the Veteran has consistently had motion to at least 145 degrees. The evidence further does not support that a compensable rating is warranted for limitation of extension or that Diagnostic Code 5208 applies. As noted above, at worst extension was lacking 5 degrees of full motion. The Board has considered whether a disability rating higher than 10 percent or a separate rating is warranted based on functional loss due to pain or weakness, fatigability, incoordination, or pain on movement of a joint and finds that it is not. Although the Veteran's symptoms included pain on movement and flare-ups the loss in range of motion even after three repetitions of testing do not more closely approximate flexion limited to 90 degrees or extension limited to 45 degrees. In other words, any additional limitation due to pain does not more nearly approximate the criteria for a higher rating and the 10 percent rating contemplates the functional loss due to pain and less movement. There is no basis for the assignment of additional disability due to pain, weakness, fatigability, weakness or incoordination for this period of the appeal. See 38 C.F.R. §§ 4.40, 4.45; DeLuca, 8 Vet. App. at 206-07. Based on the forgoing, the Board finds that a 10 percent rating, but no greater, is warranted prior to June 17, 2015 and after August 1, 2015 and that a temporary total rating is warranted from June 17, 2015 to August 1, 2015. Service Connection Service connection will be granted if it is shown that the veteran suffers from a disability resulting from personal injury suffered or disease contracted in the line of duty, or for aggravation of a preexisting injury suffered or disease contracted in the line of duty, during active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303. Disorders diagnosed after discharge will still be service connected if all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d); see also Combee v. Brown, 34 F.3d 1039, 1043 (Fed. Cir. 1994). 11. Entitlement to service connection for obstructive sleep apnea The Veteran contends that his sleep apnea onset in service. The Veteran separated from service in September 2012 and was diagnosed with obstructive sleep apnea in May 2013 after a private sleep study. At his May 2021 Board hearing, the Veteran testified that in the late 1990s and early 2000s his spouse complained that he would kick her and snore while he was sleeping. He reported that he sought treatment and was prescribed medication to relax his muscles while sleeping but was told that he could not get a sleep study overseas where he was stationed. He stated that he waited until after service to request a sleep study from his private doctor. In a May 2021 statement, his spouse recalled that when they lived overseas from the early 1990s to 1998, the Veteran began to snore. She stated that when they returned to the United States between 1998 and 2004 the Veteran continued to snore, kick his legs in his sleep, toss and turn, and moan and groan. She stated that they returned overseas from 2007 to 2012 and the Veteran continued to have more problems sleeping. She reported the same problems continued and he eventually sought a sleep study after service when they returned to the United States upon his separation from service. In a November 2021 letter, the Veteran's private primary care doctor opined in a letter than it is more likely than not that the Veteran's sleep apnea began prior to his separation from service and was undiagnosed and untreated during active duty. The doctor noted review of the Veteran's medical record showed notations regarding sleep issues including chronic insomnia, excessive snoring, and nocturnal leg movements between 2011 and 2012. Sleep apnea was diagnosed in May 2013 after a sleep study, less than a year after the Veteran's September 2012 separation from service. A November 2013 VA opinion is also of record. The VA reviewer opined that the Veteran's sleep apnea was less likely than not incurred in or caused by service. The Board acknowledges the VA reviewer's opinion but finds that the evidence is at least in equipoise as to whether service connection is warranted. The Board finds the statements of the Veteran and the Veteran's spouse as to the onset of his sleep symptoms in service to be competent and credible and the November 2021 private opinion as to an onset in service to be highly probative. Therefore, the Board finds that service connection for sleep apnea is warranted. 12. Entitlement to service connection for restless legs syndrome The Veteran contends he has restless leg syndrome that onset in service. At his May 2021 Board hearing, the Veteran testified that he began experiencing restless legs at night while in service. In a May 2021 letter, the Veteran's spouse recalled that he began kicking his legs in his sleep during service and has continued to do so several times a week while sleeping. Service treatment records include the Veteran's report of restless leg in September 2011, which he reported has been present for two to three years. His April 2012 examination notes a diagnosis of restless leg syndrome in 2009 for which he is prescribed valium. An April 2013 private treatment record notes an assessment of restless leg syndrome with a referral for a sleep study. A June 2013 record notes that restless leg syndrome was not confirmed by the sleep study but that the Veteran reported symptom relief with gabapentin, which would be continued. A July 2013 treatment record notes the Veteran's report of jerking movements during sleep and a creeping, restless, crawling feeling in his extremities that began during adulthood. In an August 2014 letter the Veteran's private doctor stated that since April 2013 the Veteran has expressed concerns regarding restless legs. The Board finds the statements of the Veteran and his spouse as to the onset and continuation of his restless legs during the night to be competent and credible and supported by the evidence of record. Therefore, giving the Veteran the benefit of the doubt, the Board finds that service connection for restless leg syndrome is warranted. REASONS FOR REMAND Although the Board regrets the additional delay, a remand is needed as to the following issues to further develop the record. 1. Entitlement to service connection for left leg sciatic pain Service treatment records include a May 2007 note in which the Veteran reported back pain and periodic tinging in the left leg and foot. The Veteran last had a VA spine examination in December 2013 that noted no signs or symptoms of radiculopathy. An April 2014 private treatment record notes the Veteran's report of tingling in the legs and pain radiating from the back to the left foot. At his May 2021 Board hearing, the Veteran reported continuing leg pain and tinging that is predominating episodic, especially with extended standing and bending at the waist. The Board finds that the Veteran should be afforded a VA examination and an opinion obtained as to whether the Veteran has a condition manifest with left leg symptoms, and if so, whether that condition onset in or is causally related to the Veteran's service or any of his service-connected disabilities, to include lumbosacral spine degenerative disc and joint disease and right and left hip strain. 2. Entitlement to service connection for bilateral hand condition The Veteran contends that he has a bilateral hand disability that is causally related to his service. A VA examiner who examined Veteran in December 2013 stated that there was no pathology to render a diagnosis of a right or left hand condition. At his May 2021 Board hearing, the Veteran testified that he had several injuries to his hands in service, including sports-related injuries and repetitive stress and fatigue. He reported that in the last year he began noticing his hands are swollen every morning. He stated that a doctor suggested to him it could be rheumatoid arthritis. A June 2021 private treatment record notes the Veteran's complaint of pain in his hands and wrists, worse in the morning. The Board finds that the Veteran should be afforded a new VA examination. The examiner should consider the Veteran's lay statements and perform any necessary tests. For any hand condition diagnosed, the examiner should opine whether it is at least as likely as not that it onset in or is causally related to the Veteran's service. 3. Entitlement to an initial compensable evaluation for left knee strain The Veteran was most recently afforded a VA knee examination in May 2019. At his May 2021 Board hearing the Veteran testified that his left knee condition had worsened. Thus, on remand, the Board finds that he should be afforded a new VA examination to assess the current nature and severity of his left knee disability. 4. Entitlement to an initial compensable evaluation for left shoulder strain 5. Entitlement to an initial evaluation in excess of 10 percent for right shoulder strain with humeral cyst and history of degenerative joint disease The Veteran most recently underwent a VA examination of his shoulders in December 2013. His testimony at his May 2021 Board hearing with respect to his right and left shoulder pain and range of motion suggests that his right and left shoulder disability has worsened. Thus, on remand, the Board finds that he should be afforded a new VA examination to assess the current nature and severity of his right and left shoulder disability. 6. Entitlement to an initial compensable evaluation for dermatitis The Veteran most recently underwent a VA examination of his dermatitis in December 2013. At his May 2021 Board hearing, the Veteran testified that the condition has spread over the years. He indicated that sometimes, such as in the heat or when the air is dry, the condition, especially on his face, is exacerbated. The Board notes that he submitted an April 2021 private dermatology record, which notes various areas of skin conditions, but does not include an estimate of total exposed area or total body area affected. The Board finds that the Veteran should be afforded a new VA examination to assess the current nature and severity of the Veteran's service-connected dermatitis. If the examination is not scheduled during a flare-up of the condition, the examiner should solicit from the Veteran a description of the condition during a flare-up. The matters are REMANDED for the following action: 1. Arrange for the Veteran to undergo a VA examination of his claimed left leg pain. For any left leg condition diagnosed, the examiner should opine whether it is at least as likely as not that the condition onset in or is causally related to the Veteran's service or any of his service-connected disabilities, to include lumbosacral spine degenerative disc and joint disease and right and left hip strain. 2. Arrange for the Veteran to undergo a VA examination of his claimed bilateral hand condition. For each hand condition diagnosed, the examiner should opine whether it is at least as likely as not that the condition onset in or is causally related to the Veteran's service. 3. Arrange for the Veteran to undergo a VA examination to assess the nature and severity of his service-connected left knee strain. 4. Arrange for the Veteran to undergo a VA examination to assess the nature and severity of his service-connected left shoulder strain and right shoulder strain with humeral cyst and history of degenerative joint disease. (Continued on the next page) 5. Arrange for the Veteran to undergo a VA examination to assess the nature and severity of his service-connected dermatitis. H. SEESEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Christensen 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.