Citation Nr: 21072016 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-14 587 DATE: December 2, 2021 ORDER Entitlement to an increased rating of 30 percent, but no higher, since April 15, 2014, for fractures of first left metatarsal with malunion and healed fractures of second, third, and fourth metatarsal bones is granted. REMANDED Entitlement to an initial increased rating above 10 percent prior to August 31, 2021, for left knee osteoarthritis limitation of flexion with IT band syndrome, including on an extraschedular basis, is remanded. Entitlement to an increased rating above 40 percent since August 31, 2021, for left knee osteoarthritis limitation of flexion with IT band syndrome, including on an extraschedular basis, is remanded. Entitlement to an initial increased rating above 10 percent prior to November 7, 2016, for left ankle osteoarthritis, including on an extraschedular basis, is remanded. Entitlement to an increased rating above 20 percent since November 7, 2016, for left ankle osteoarthritis, including on an extraschedular basis, is remanded. Entitlement to an initial increased rating above 10 percent prior to November 7, 2016, for right ankle osteoarthritis, including on an extraschedular basis, is remanded. Entitlement to an increased rating above 20 percent since November 7, 2016, for right ankle osteoarthritis, including on an extraschedular basis, is remanded. FINDING OF FACT Throughout the appeal period, the probative evidence weighs in favor of finding that the left metatarsal disability has most closely approximated the severe level of impairment; however, the probative evidence has not indicated, nor has the Veteran contended, that the left metatarsal disability results in loss of use or produces such diminished functioning that amputation with prosthesis would equally serve him. CONCLUSION OF LAW The criteria for entitlement to an increased rating of 30 percent, but no higher, since April 15, 2014, for fractures of first left metatarsal with malunion and healed fractures of second, third, and fourth metatarsal bones have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1, 4.2, 4.3, 4.7, 4.10, 4.63, 4.71a, Diagnostic Code (DC) 5283, 3.321(b)(1) (2018); Johnson v. McDonald, 762 F.3d 1362 (Fed. Cir. 2014). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had qualifying service from March 1966 to February 1968. In a May 1968 Rating Decision, the Agency of Original Jurisdiction (AOJ), granted service connection for fractures of first left metatarsal with malunion and healed fractures of second, third, and fourth metatarsal bones at 10 percent effective February 28, 1968. In a November 1969 Rating Decision, the AOJ denied an increased rating above 10 percent for the left metatarsal disability; VA mailed a November 1969 Notification Letter containing appeal rights, but the Veteran did not timely appeal and the November 1969 Rating Decision became final. On April 15, 2014, VA received a Statement from the Veteran requesting an increased rating for the left metatarsal disability. In a September 2014 Rating Decision, the AOJ, in pertinent part: granted an increased rating from 10 percent to 20 percent effective April 15, 2014, for the left metatarsal disability; and denied service connection for a left hip disability. In a June 2015 Rating Decision, the AOJ, in pertinent part, granted service connection for the left knee disability at 0 percent effective April 15, 2014. In a July 2015 Rating Decision, the AOJ, in pertinent part: granted service connection for the left ankle disability at 0 percent effective June 16, 2015; and denied service connection for a right foot disability. In an August 2016 Rating Decision, the AOJ, in pertinent part: granted an increased rating from 0 percent to 10 percent effective May 17, 2016, for the left knee disability; granted an increased rating from 0 percent to 10 percent effective May 17, 2016, for the left ankle disability; granted service connection for the right ankle disability at 10 percent effective May 17, 2016; denied an increased rating above 20 percent for the left metatarsal disability; denied service connection for a left hip disability; denied service connection for a right hip disability; and denied service connection for a right foot disability. In a January 2017 Rating Decision, the AOJ, in pertinent part: granted an increased rating from 10 percent to 20 percent effective November 7, 2016, for the left ankle disability; granted an increased rating from 10 percent to 20 percent effective November 7, 2016, for the right ankle disability; denied an increased rating above 20 percent for the left metatarsal disability; and denied an increased rating above 10 percent for the left knee disability. In a February 2018 Rating Decision, the AOJ, in pertinent part: granted an earlier effective date of the 10 percent rating for the left ankle disability (awarding 10 percent from June 16, 2015, and 20 percent from November 7, 2016); and granted an earlier effective date of the 10 percent rating for the left knee disability (awarding 10 percent since April 15, 2014). In February 2020, the Veteran testified at a Board Videoconference Hearing before the undersigned Veterans Law Judge. In a July 2021 Decision, the Board, in pertinent part, remanded: service connection for a right foot disability; service connection for a left hip disability; service connection for a right hip disability; an increased rating above 10 percent prior to November 7, 2016, for the right ankle disability; an increased rating above 20 percent since November 7, 2016, for the right ankle disability; an increased rating above 10 percent prior to November 7, 2016, for the left ankle disability; an increased rating above 20 percent since November 7, 2016, for the left ankle disability; an increased rating above 10 percent for the left knee disability; and an increased rating above 20 percent for the left metatarsal disability. In a September 2021 Rating Decision, the AOJ: granted an increased rating from 10 percent to 40 percent effective August 31, 2021, for the left knee disability; granted service connection for a left hip disability; granted service connection for a right foot disability; and granted service connection for a right hip disability. As the service connection claims previously before the Board were resolved in full by the AOJ upon remand, they are no longer before the Board; however, the increased rating claims herein remain properly before the Board because, despite the AOJ's increased ratings, the maximum available benefits have not yet been awarded. AB v. Brown, 6 Vet. App. 35, 38-39 (1993). 1. Entitlement to an increased rating above 20 percent since April 15, 2014, for fractures of first left metatarsal with malunion and healed fractures of second, third, and fourth metatarsal bones, including on an extraschedular basis In general, disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentages are based on the average impairment of earning capacity as a result of service-connected disability, with different diagnostic codes identifying the criteria for specific ratings for various disabilities. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability ratings are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. Where entitlement to compensation has already been established and an increase in the disability rating is at issue, the primary concern is the present level of disability. Francisco v. Brown, 7 Vet. App. 55, 58 (1994). However, the Board must also consider staged ratings. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). All reasonable doubt, including the degree of disability, will be resolved in favor of the claimant. 38 C.F.R. § 4.3. The Veteran generally contends that his left metatarsal disability is more severe than contemplated by the 20 percent rating under DC 5283. See 38 C.F.R. § 4.71a, DC 5283; April 2014 Statement; August 2014 VA foot conditions examination; April 2015 Third Party Correspondence by the Veteran; April 2015 Third Party Correspondence by former employer SE; April 2015 Correspondence by the Veteran; June 2015 Correspondence; July 2015 VA foot conditions examination; June 2016 VA foot conditions examination; June 2016 Correspondences; September 2016 VA Form 21-526EZ; December 2016 VA Form 21-4192; November 2016 VA foot conditions examination; August 2017 Notice of Disagreement (NOD); March 2018 Correspondence; March 2019 Correspondence; February 2020 Board Hearing transcript; August 2021 VA foot conditions examination; September 2021 Codesheet; November 2021 Brief. Under DC 5283: a 10 percent rating is warranted for "moderate" malunion or nonunion of the tarsal or metatarsal bones; a 20 percent rating is warranted for "moderately severe" malunion or nonunion of the tarsal or metatarsal bones; a 30 percent rating is warranted for "severe" malunion or nonunion of the tarsal or metatarsal bones; and a 40 percent rating is warranted for actual loss of use of the foot. 38 C.F.R. § 4.71a, DC 5283. Additionally, DC 5284 is alternatively available for non-specified foot disabilities, similarly providing: a 10 percent rating for a "moderate" injury; a 20 percent rating for a "moderately severe" injury; a 30 percent rating for a "severe" injury; and a 40 percent rating for actual loss of use of the foot. 38 C.F.R. § 4.71a, DC 5284. However, because the left metatarsal disability herein has been specified with a diagnosis that fits the scope of DC 5283, and because rating that disability under DC 5284 would not result in a higher rating, the Board continues to apply DC 5283 instead of DC 5284. During the August 2014 VA foot conditions examination, the Veteran reported, in pertinent part: baseline, aching pain (3 out of 10 on the pain scale); flare-ups (aching and throbbing pain, three to four times per month, 8 out of 10 on the pain scale, lasting for one hour each, caused by prolonged standing and walking, relieved by rest and elevation of feet); use of non-prescription insoles; functional loss (able to stand for only 30 minutes, able to walk only a mile at a slow pace, must avoid putting his full weight on his left foot during flare-ups); and occupational impact (during his last job, he had to elevate his feet during his lunch hour). The examiner indicated that: the Veteran had normal gait; functioning was not so diminished such that amputation with prosthesis would equally serve him; there was pain on weightbearing and nonweight-bearing along with swelling; and the disability was "moderately severe" overall. An April 2015 Third Party Correspondence from former employer SE indicated that the Veteran had a work accomodation so that he could elevate his left foot/leg during his shift. In a June 2015 Correspondence, the Veteran's spouse BB reported that the Veteran's left foot disability had affected every aspect of his life, including missing out on many family activities because he could not do the walking or standing involved. During the July 2015 VA foot conditions examination, the Veteran reported, in pertinent part: constant, aching, baseline pain (4 out of 10 on the pain scale); flare-ups (three to four times per month, 6 out of 10 on the pain scale, lasting for one hour each, caused by prolonged standing and walking, relieved by rest and elevation of feet); functional loss (able to stand for only 30 minutes, able to walk only a quarter of a mile at a slow pace, must avoid putting his full weight on his left foot during flare-ups); and occupational impact (during his last job, he had to elevate his feet during his lunch hour). The examiner indicated that: the Veteran had normal gait; functioning was not so diminished such that amputation with prosthesis would equally serve him; there was pain on weightbearing, deformity, and lack of endurance (reduced periods of standing and walking requiring breaks); and the disability was "moderate" overall. During the June 2016 VA foot conditions examination, the Veteran reported, in pertinent part: that he had trouble finding comfortable orthotics; walking about 40 feet before requiring rest; using a cane for balance; constant pain in several places; flare-ups (caused by weightbearing more than 40 feet); and functional loss (cannot walk 40 feet or stand for less than 10 minutes). The examiner indicated that: functioning was not so diminished such that amputation with prosthesis would equally serve him; there was pain on weightbearing, pain on movement, excess fatigability, and interference with standing (required use of a cane regularly, ability to walk only 40 feet, ability to stand less than 10 minutes); and the disability was "moderate" overall. In a June 2016 Correspondence, the Veteran's spouse BB reported that the Veteran's left foot disability: prevented him from attending school functions for his children because he would be home resting his feet; prevented him from helping around the house, shopping, running errands, and other household tasks because it involves too much walking and standing; prevented him from driving because he never knows when he is going to have a cramp; and had worsened in the last two years because he must take prescription pain medicine and sit in a chair with his feet propped up just to get through the day after only a little time on his feet. In a September 2016 VA Form 21-526EZ, the Veteran requested that his increased rating claim be considered on an extraschedular basis. In a September 2016 VA Form 21-8940, the Veteran contended occupational limitations due, in part, to his left foot disability. A December 2016 VA Form 21-4192 by former employer SE indicated that the Veteran had a work accomodation so he could elevate his left foot/leg during his shift and that he left the job because his left foot/leg was aggravating him more. During the November 2016 VA foot conditions examination, the examiner indicated that the left foot disability: caused less movement than normal; caused weakened movement; caused excess fatigability; caused pain on movement; caused pain on weightbearing; caused pain on nonweight-bearing; caused swelling; caused deformity; caused disturbance of locomotion; caused interference with standing; caused lack of endurance; caused difficulty walking (restricted ambulation); had flare-ups with activity; required regular use of a cane; had less than 50 percent relief with orthotics; did not have such diminished functioning that amputation with prosthesis would equally serve him; and was "moderately severe" overall. In the August 2017 NOD, the Veteran requested a 30 percent rating for the left metatarsal disability. In a March 2019 Correspondence, the Veteran reported that VA prescribed a cane and cane training in September 2015 to prevent fatigue and future falls after he fell earlier in September 2015 when his left foot cramped/spasmed, resulting in injury to his shoulders and lower back. During the February 2020 Board Hearing, the Veteran testified that his left metatarsal disability including pain and swelling and that the resulting deformity was "severe." During the August 2021 VA foot conditions examination, the Veteran reported, in pertinent part: constant, achy pain; severe flare-ups (three to four times per day, lasting an hour to an hour and a half, resulting in swelling and increased pain, caused by extended standing and walking, relieved by ice, rest, and Vicodin, and so painful that it requires the Veteran to stop the activity and rest until the pain subsides). The examiner indicated that the left foot resulted in: pain on physical examination; weakened movement; deformity; disturbance of locomotion; interference with standing; pain; fatigability; lack of endurance; interference with standing for extended periods; constant pain that increased with activity; weakened movement; and functional impact (foot pain can be very severe at times and he has to limit all physical activity due to the pain). The examiner also found that the left metatarsal disability: did not have such diminished functioning that amputation with prosthesis would equally serve him; and was "moderately severe" overall. In the November 2021 Brief, the representative argued that the Veteran: continues to experience intractable pain or refractory pain, which has led to functional loss that has impacted his ability to sit and stand for more than a certain period of time on a regular basis; continues to exude incapacitating attacks of pain, limited range of motion, and functional loss due to weakness, fatigability, incoordination, and pain; has limitation of motion due to pain on use, especially during flare-ups; and presents significant deficits with activities of daily living. Based on the evidence above, the Board finds that, throughout the appeal period, the probative evidence weighs in favor of finding that the left metatarsal disability has most closely approximated the severe level of impairment; however, the probative evidence has not indicated, nor has the Veteran contended, that the left metatarsal disability results in loss of use or produces such diminished functioning that amputation with prosthesis would equally serve him. Specifically, although the examiners have approximated the disability as "moderately severe," the Board finds that it is "severe" because it has, throughout the appeal period: manifested in severe flare-ups that severely restrict mobility (including standing for short periods and walking for short distances), required frequent periods of rest with elevation of feet until pain subsides, required use of assistive devices for ambulation and stability, required use of prescribed narcotic pain medication, and impacted various activities of daily living (including working, driving, errands, household tasks, and family activities). Accordingly, a 30 percent rating is appropriate for these "severe" manifestations throughout the appeal period and the Board grants an increased rating from 20 percent to 30 percent throughout the appeal period (since April 15, 2014). However, a higher rating of 40 percent is not available because the probative evidence has not indicated, nor has the Veteran contended, that the left metatarsal disability results in loss of use or produces such diminished functioning that amputation with prosthesis would equally serve him. Specifically, all the examiners and lay contentions have indicated that amputation with prosthesis would not equally serve the Veteran and that, although motion and functioning is restricted, it is not lost or so diminished as to functionally equate to loss of use, as the Veteran still retains the ability to walk/stand, even if for reduced periods/lengths. Notably, 38 C.F.R. § 4.63 states that loss of use, for the purpose of special monthly compensation, will be held to exist when no effective function remains other than that which would be equally well served by an amputation with prosthesis, with the determination being made based on factors including the actual remaining function of the foot, the balance and propulsion of the foot, and whether the foot would be equally well served by an amputation stump with prosthesis. As discussed above, the Veteran retains some functioning in the left foot such that he is still able to walk and stand for some periods/lengths without needing rest and the evidence does not indicate that amputation with prosthesis would equally serve him; thus, a higher rating of 40 percent is not warranted and denied herein. Lastly, a higher rating on an extraschedular basis is also not warranted. If a case presents such an exceptional or unusual disability picture with such related factors as marked interference with employment or frequent periods of hospitalization as to render impractical the application of the regular schedular standards, a Veteran may be awarded an extraschedular rating to fill any gap between the Rating Schedule and a TDIU. 38 C.F.R. § 3.321(b)(1); Johnson, 762 F.3d 1362. There is a three-step inquiry for determining whether a veteran is entitled to an extraschedular rating. First, the Board must determine whether the evidence presents such an exceptional disability picture that the available schedular ratings for the service-connected disability are inadequate. Doucette v. Shulkin, No. 15-2818 (Vet. App. March 6, 2017). Second, if the schedular rating does not contemplate the Veteran's level of disability and symptomatology and is found inadequate, the Board must determine whether the Veteran's disability picture exhibits other related factors such as those provided by the regulation as "governing norms." Third, if the rating schedule is inadequate to evaluate a Veteran's disability picture and that picture has factors such as marked interference with employment or frequent periods of hospitalization, then the case must be referred to the Under Secretary for Benefits or the Director of the Compensation and Pension Service to determine whether the Veteran's disability picture requires the assignment of an extraschedular rating. Thun v. Peake, 22 Vet. App. 111 (2008). Crucially, however, turning to the first step of the extraschedular analysis, the Board finds that all the symptomatology and impairment caused by the Veteran's left metatarsal disability is specifically contemplated by the schedular rating criteria. Specifically, the schedular criteria not only encompass the Veteran's symptoms and functional limitations (through the 30 percent rating granted herein) but exceed them (by providing for an even higher rating of 40 percent, should the disability worsen to the point of actual loss of use). Thus, a higher rating on an extraschedular basis is also not warranted and denied herein. REASONS FOR REMAND 1. Entitlement to an initial increased rating above 10 percent prior to August 31, 2021, for left knee osteoarthritis limitation of flexion with IT band syndrome, including on an extraschedular basis The Veteran's left knee disability is currently rated at: 10 percent from April 15, 2014; and 40 percent since August 31, 2021. 38 C.F.R. § 4.71a, DC 5261; September 2021 Codesheet. The Veteran generally contends that the severity of this disability warrants higher ratings throughout the appeal period. In the July 2021 Decision, the Board remanded the increased rating claims for the AOJ to obtain new examinations to assess the severity of the left knee, left ankle, and right ankle disabilities after contentions of worsening since the November 2016 VA examinations. In August 2021, the AOJ afforded the Veteran a VA knee and lower leg examination. During that examination, the Veteran reported, in pertinent part, severe flare-ups (every night, lasting hours, increased pain with swelling and cramping, caused by laying on side and standing/walking too long, relieved by pain medication, massage, and stretching) that are so painful he has to rest. Initial range of motion (ROM) testing revealed flexion to 100 degrees and extension to 20 degrees. Observed repetitive use testing revealed flexion to 95 degrees and extension to 25 degrees, with pain causing the additional functional loss. Repetitive use over time testing revealed flexion to 85 degrees and extension to 35 degrees, with the examiner stating that pain significantly limits functional ability with repeated use over time. Flare-ups testing revealed estimated flexion to 85 degrees and estimated extension to 35 degrees, with the examiner stating that pain and fatigability significantly limit functional ability during flare-ups. Crucially, these August 2021 findings are inadequate because they are inconsistent with the holding in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017) (the examiner must attempt to elicit information regarding the severity, frequency, duration, and functional loss during flare-ups before determining that additional range of motion loss due to flare-ups cannot be estimated). Specifically, the August 2021 examiner documented the Veteran's reports of flare-ups (described above), stated that pain and fatiguability significantly limit functional ability during flare-ups, and indicated that the functional loss due to flare-ups was able to be estimated in terms of range of motion loss. However, the examiner documented the same estimated measurements for range of motion loss during flare-ups as he did for estimated range of motion loss during repetitive use over time, despite the contradictory finding that the loss during flare-ups would be greater because fatigability would further restrict functional ability during flare-ups. Barr v. Nicholson, 21 Vet. App. 303 (2007); Sharp, supra. As such, this August 2021 examination is inadequate in that regard and the Board must remand for further medical development. 2. Entitlement to an increased rating above 40 percent since August 31, 2021, for left knee osteoarthritis limitation of flexion with IT band syndrome, including on an extraschedular basis This issue is remanded for the reasons and bases discussed above. 3. Entitlement to an initial increased rating above 10 percent prior to November 7, 2016, for left ankle osteoarthritis, including on an extraschedular basis The Veteran's left ankle disability is currently rated at: 10 percent from June 16, 2015; and 20 percent since November 7, 2016. 38 C.F.R. § 4.71a, DC 5271; September 2021 Codesheet. The Veteran generally contends that the severity of this disability warrants higher ratings throughout the appeal period. In the July 2021 Decision, the Board remanded the increased rating claims for the AOJ to obtain new examinations to assess the severity of the left knee, left ankle, and right ankle disabilities after contentions of worsening since the November 2016 VA examinations. In August 2021, the AOJ afforded the Veteran a VA ankle conditions examination. During that examination, the Veteran reported, in pertinent part, moderate flare-ups (daily, lasting several hours, increased pain with instability, swelling, and cramping, caused by over activity, relieved by rest) that are so painful he has to limit physical tasks. Initial ROM testing revealed plantar flexion to 10 degrees and dorsiflexion to 5 degrees. Observed repetitive use testing revealed no additional functional or ROM loss after three repetitions. Regarding repetitive use over time, the examiner indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with repeated use over time; as such, the examiner did not estimate ROM loss. Regarding flare-ups, the examiner indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability during flare-ups; as such, the examiner did not estimate ROM loss. Crucially, these August 2021 findings are inadequate because they are inconsistent with the holding in Sharp. Sharp, supra. Specifically, the August 2021 examiner documented the Veteran's reports of flare-ups resulting in functional loss (described above), but then contradictorily indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability during flare-ups; further, because of this contradictory indication, the examiner did not even attempt to estimate additional ROM loss during flare-ups. Barr, supra; Sharp, supra. As such, this August 2021 examination is inadequate in that regard and the Board must remand for further medical development. 4. Entitlement to an increased rating above 20 percent since November 7, 2016, for left ankle osteoarthritis, including on an extraschedular basis This issue is remanded for the reasons and bases discussed above. 5. Entitlement to an initial increased rating above 10 percent prior to November 7, 2016, for right ankle osteoarthritis, including on an extraschedular basis The Veteran's right ankle disability is currently rated at: 10 percent from May 17, 2016; and 20 percent since November 7, 2016. 38 C.F.R. § 4.71a, DC 5271; September 2021 Codesheet. The Veteran generally contends that the severity of this disability warrants higher ratings throughout the appeal period. In the July 2021 Decision, the Board remanded the increased rating claims for the AOJ to obtain new examinations to assess the severity of the left knee, left ankle, and right ankle disabilities after contentions of worsening since the November 2016 VA examinations. In August 2021, the AOJ afforded the Veteran a VA ankle conditions examination. During that examination, the Veteran reported, in pertinent part, moderate flare-ups (daily, lasting several hours, increased pain with instability, swelling, and cramping, caused by over activity, relieved by rest) that are so painful he has to limit physical tasks. Initial ROM testing revealed plantar flexion to 20 degrees and dorsiflexion to 10 degrees. Observed repetitive use testing revealed no additional functional or ROM loss after three repetitions. Regarding repetitive use over time, the examiner indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with repeated use over time; as such, the examiner did not estimate ROM loss. Regarding flare-ups, the examiner indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability during flare-ups; as such, the examiner did not estimate ROM loss. Crucially, these August 2021 findings are inadequate because they are inconsistent with the holding in Sharp. Sharp, supra. Specifically, the August 2021 examiner documented the Veteran's reports of flare-ups resulting in functional loss (described above), but then contradictorily indicated that the Veteran's statements do not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability during flare-ups; further, because of this contradictory indication, the examiner did not even attempt to estimate additional ROM loss during flare-ups. Barr, supra; Sharp, supra. As such, this August 2021 examination is inadequate in that regard and the Board must remand for further medical development. 6. Entitlement to an increased rating above 20 percent since November 7, 2016, for right ankle osteoarthritis, including on an extraschedular basis This issue is remanded for the reasons and bases discussed above. The matters are REMANDED for the following action: 1. Obtain new examinations to assess the current severities of the Veteran's left knee, left ankle, and right ankle disabilities. The findings must be consistent with the holding in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). R. FEINBERG Veterans Law Judge Board of Veterans' Appeals Attorney for the Board H. Daus, 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.