Citation Nr: 21074414 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 16-45 770 DATE: December 15, 2021 REMANDED Entitlement to service connection for bilateral shoulder impingement syndrome is remanded. Entitlement to service connection for C4-C5 central disc protrusion with spondylosis is remanded. Entitlement to service connection for a kidney disability is remanded. Entitlement to service connection for numbness and paresthesias of the bilateral hands is remanded. Entitlement to an initial compensable rating for left hip painful flexion is remanded. Entitlement to an initial compensable rating for right hip painful extension and flexion is remanded. Entitlement to an initial rating in excess of 10 percent for left hip proximal femur stress fracture is remanded. Entitlement to an initial rating in excess of 10 percent for right hip proximal femur stress fracture is remanded. Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded. Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral pain syndrome is remanded. Entitlement to an initial compensable rating, prior to April 13, 2021, and to a rating in excess of 10 percent beginning April 13, 2021, for left ankle lateral collateral ligament sprain is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had a period of active duty for training (ACDUTRA) from September to May 2002. She also had active military service from June 2002 to September 2002, and from January 2004 to March 2005. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2016 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded the case for further development in August 2018. The case has since been returned to the Board for appellate review. The Board notes that the issues of entitlement to service connection for posttraumatic stress disorder (PTSD), major depressive disorder, and thoracic spondylosis with muscle spasm, lumbar spine, were also remanded for additional development in August 2018. However, in a March 2021 rating decision, the Veteran was granted entitlement to service connection for PTSD. Subsequently, a June 2021 rating code sheet reflects that the Veteran was granted entitlement to service connection for PTSD with major depressive disorder. Similarly, in a June 2021 rating decision, the Veteran was granted entitlement to service connection degenerative disc disease with degenerative arthritis and intervertebral disk syndrome. Those decisions constitute a full grant of the benefits sought on appeal and the Board has limited its consideration accordingly. During the pendency of the appeal, in a June 2021 rating decision, the RO assigned 10 percent rating, effective April 13, 2021, for a left ankle lateral collateral ligament sprain disability. That does not constitute a full grant of the benefit sought on appeal. Therefore, the issue remains on appeal. REASONS FOR REMAND 1. Shoulder, cervical spine, kidney, bilateral hands The Board finds that additional development is warranted before the remaining service connection claims on appeal are decided. VA most recently obtained a VA opinion for the Veteran's shoulder disability in April 2021. At that time, the examiner opined that the Veteran disabilities were less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that there was no evidence to support the Veteran's claim that her shoulder disability began while deployed. Instead, the Veteran's shoulder complaints began remote from her time in active duty. The Board finds that the VA examiner did not fully address the Veteran's lay statements that she injured her shoulder while lifting heavy equipment, reaching for an item under her bed, and while leaning against a wall. Further, the Veteran stated that her symptoms have continued on and off since that time. Moreover, the examiner did not explain the significance of the finding that the Veteran's shoulder complaints began remote from her time in active duty. Thus, a new opinion should be obtained. VA most recently obtained a VA opinion for the Veteran's cervical disability in April 2021, the examiner opined that the Veteran's cervical spine disability was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that the Veteran was not seen or evaluated until years remote from service. However, the examiner did not discuss the significance of the finding that Veteran was not seen for years after service. Additionally, treatment record reflects that the Veteran's cervical disability may be related the Veteran's shoulder disabilities. Thus, a new opinion should be obtained. VA most recently obtained a VA opinion for the Veteran's kidney disability in April 2021, the examiner opined that the Veteran's urinary tract infection (UTI) was less likely than not incurred in or caused by the claimed in-service injury, event, or illness. In so finding, the examiner stated that the Veteran's UTIs occur at a frequency that can be common in women, and do not suggest a chronic condition. Further, that the disability would not be expected to be secondary to remote possible diagnosis of pyelonephritis while deployed. The Board finds that a new opinion should be obtained. In that regard, it appears that the examiner's opinion was limited to the Veteran's UTIs. However, as noted in the August 2018 Board remand, the Veteran's post-service treatment records reflect a diagnosis of pyelonephritis. Based on the evidence of record, it is unclear if the Veteran's pyelonephritis resolved prior to the appeal period. Thus, a new opinion should be obtained. In this decision, the Board remanded entitlement to service connection a cervical spine disability which may impact the Veteran's claimed bilateral hand disabilities. Therefore, entitlement to service connection for bilateral hand disabilities cannot be decided until the other pending claim is decided. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). 2. Bilateral knees, left ankle, and bilateral hips While the record contains a contemporaneous VA examination regarding the Veteran's bilateral knees, bilateral hips, and left ankle disabilties, the examinations do not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). In that regard, the April 2021 VA exmainer noted that the Veteran did not report flare-ups. Therefore, the examiner did not attempt to elicit relevant information regarding the description of the Veteran's flare-ups and any additional functional loss suffered during flare-ups. However, the record reflects that the Veteran has reported flare-ups of her bilateral knees, left ankle, and hip disabilities during the appeal period. Indeed, at the April 2021 VA examination, the Veteran described having chronic intermittent bilateral ankle pain with prolonged walking or running; chronic intermittent bilateral knee pain worse with climbing stairs, kneeling, squatting, prolinged walking, and running; and chronic intermittent bilateral anterior hip pain with squatting, prolonged walking, standing or running. Moreover, at her February 2018 VA examination, the Veteran reported that flare-ups caused increased pain in her knees and left ankle related to prolonged standing and walking. Thus, the Board finds that a new examination should be obtained to adequately address the Veteran's flare-ups. 3. TDIU Finally, the Veteran has raised the issue of entitlement to TDIU in connection with her claims for an increased ratings. See Rice v. Shinseki, 22 Vet. App. 447 (2009). Therefore, the claim for TDIU is inextricably intertwined with the increased rating claims remanded herein. Action on that issue is therefore deferred. The matters are REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of the Veteran's bilateral shoulder impingement syndrome. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. The examiner should be sure to address the Veteran's lay statements that she injured her shoulder while lifting heavy equipment, reaching for an item under her bed, and while leaning against a wall in service. Further, that her symptoms have continued on and off since that time. Based upon the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any bilateral shoulder disability is etiologically related to service. The rationale for all opinions expressed must be provided. 3. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of the Veteran's cervical spine disability. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. Based upon the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any cervical disability is etiologically related to service. The examiner should discuss the significance of the finding that Veteran was not seen for years after service for a cervical spine disability. Further, the examiner should address VA treatment records which discuss a relationship between the Veteran's shoulder disabilities and her cervical spine disabilities. The rationale for all opinions expressed must be provided. 4. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the nature and etiology of the Veteran's kidney disability. The examiner should review the claims file and indicate that review in the report. Any indicated studies should be performed. The examiner should be sure to address any post-service notation of pyelonephritis in the Veteran's treatment records. Specifically, the examiner should discuss if any diagnosis resolved without residuals. Based upon the examination results and a review of the record, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any kidney disability is etiologically related to service. The rationale for all opinions expressed must be provided. 4. Then, schedule the Veteran for a VA examination by an examiner with sufficient expertise to determine the current level of severity of all impairment resulting from her service-connected bilateral knees, left ankle, and bilateral hip disabilities. The examiner must provide all information required for rating purposes, to include findings consistent with Sharp v. Shulkin, 29 Vet. App. 26 (2017). Specifically, the examiner must provide description of additional functional impairment and/or limitation of motion caused by pain, weakness, fatigability, incoordination, or lack of endurance during a flare-up. Additionally, the examiner should provide a retrospective medical opinion regarding the level of severity all impairment resulting from the Veteran's service-connected bilateral knees, left ankle, and bilateral hip disabilities. Specifically, based on the evidence of record, the examiner must opine as to whether the Veteran would have been significantly limited by pain, weakness, fatigability, lack of endurance, or incoordination during a flare-up. 5. Confirm that the VA examination reports and any opinions provided comport with this remand, and undertake any other development found to be warranted. 6. Then, readjudicate the remaining issues on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Sonja A. Mishalanie Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board I. Cannaday, 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.