Citation Nr: 21076586 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 15-16 201 DATE: December 27, 2021 ORDER The application to reopen a claim of service connection for bilateral foot disability is granted. The application to reopen a claim of service connection for right shoulder disability is granted. Entitlement to service connection for right shoulder labral tear is granted. REMANDED Entitlement to service connection for back disability is remanded. Entitlement to service connection for paraplegia and sensory loss at T4 level is remanded. Entitlement to service connection for disability manifested by chest pain, to include pleurisy, is remanded. Entitlement to service connection for bilateral foot disability is remanded. Entitlement to service connection for bilateral leg disability (other than left knee patellofemoral syndrome), to include shin splints, is remanded. Entitlement to an initial rating higher than 10 percent for traumatic brain injury (TBI) with memory loss and dizziness is remanded. Entitlement to an initial compensable rating for surgical scars of the left knee, left hip, and right hip is remanded. Entitlement to a rating in excess of 10 percent for left hip strain with bursitis is remanded. Entitlement to a rating in excess of 10 percent for right hip strain is remanded. Entitlement to a rating in excess of 10 percent for post-operative repair of the right ankle is remanded. Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome is remanded. Entitlement to an increased rating for obstructed lung disease (claimed as bronchitis), rated 60 percent disabling prior to October 19, 2012 and 10 percent disabling since that date, is remanded. Entitlement to an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts, rated 10 percent disabling prior to December 27, 2012, 30 percent disabling from December 27, 2012 through April 30, 2013, and 10 percent disabling from May 1, 2013, is remanded. Entitlement to an effective date earlier than May 4, 2011 for the award of service connection for migraines is remanded. Entitlement to an effective date earlier than May 4, 2011 for the award of service connection for loss of smell is remanded. Entitlement to an effective date earlier than May 4, 2011 for the award of service connection for loss of taste is remanded. Entitlement to an effective date earlier than May 4, 2011 for the award of service connection for tinnitus is remanded. Entitlement to an effective date earlier than April 9, 2012 for the award of an increased (10 percent) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts is remanded. Entitlement to an effective date earlier than April 16, 2013 for the award of special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114(k) due to loss use of a creative organ is remanded. FINDINGS OF FACT 1. The Veteran's claim of service connection for bilateral foot disability (characterized as bilateral heel condition) was originally denied in a February 2007 rating decision on the basis that there was no medical evidence of any such disability that was related to service; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 2. The Veteran's claim of service connection for right shoulder disability was originally denied in an April 2010 rating decision on the basis that there was no medical evidence of any such disability that was related to service; the Veteran did not appeal this decision within one year of its issuance and new and material evidence was not received within that year. 3. Evidence received since the February 2007 and April 2010 agency of original jurisdiction (AOJ) decisions includes information that was not previously considered and which relates to unestablished facts necessary to substantiate the claims of service connection for bilateral foot disability and right shoulder disability, the absence of which was the basis of the previous denials. 4. The evidence is at least evenly balanced as to whether the Veteran's right shoulder labral tear began during active service. CONCLUSIONS OF LAW 1. The AOJ's February 2007 and April 2010 decisions that denied the claims of service connection for bilateral foot disability and right shoulder disability are final. 38 U.S.C. § 7105 ; 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. 2. The evidence received since the February 2007 and April 2010 AOJ decisions is new and material and reopening of the claims of service connection for bilateral foot disability and right shoulder disability is therefore warranted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for right shoulder labral tear are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2004 to October 2005. These matters come before the Board of Veterans' Appeals (Board) from January 2013 and two March 2015 decisions. The Veteran requested a Board hearing before a Veterans Law Judge (VLJ) on his May 2015 and October 2019 substantive appeals (VA Form 9). He was notified that a Board hearing was scheduled for a date in October 2021 by way of a July 2021 letter. This letter was sent to his address of record and was not returned as undeliverable. A copy of the letter was also sent to the Veteran's representative. The Veteran failed to appear for the scheduled Board hearing. To the Board's knowledge, he has not requested that the requested hearing be rescheduled. The Veteran's Board hearing request is therefore considered withdrawn. See 38 C.F.R. § 20.704 (d). As for characterization of the issues on appeal, claims of service connection for bilateral foot disability and right shoulder disability were initially denied by way of final rating decisions dated in February 2007 and April 2010, respectively. Where the claim in question has been finally adjudicated, the Board must initially determine whether new and material evidence has been submitted with regard to the claims of service connection for bilateral foot disability and right shoulder disability. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Only where the Board concludes that new and material evidence has been received does it have jurisdiction to consider the merits of these claims. Hickson v. West, 11 Vet. App. 374, 377 (1998). Therefore, the Board has included the issues of whether new and material evidence has been received to reopen the claims of service connection for bilateral foot disability and right shoulder disability. Moreover, in light of the Veteran's reported symptoms and contentions, to encompass all disorders that are reasonably raised by the record, and in light of the fact that the Veteran has already been awarded service connection for left knee patellofemoral syndrome, the Board has re-characterized the claims of service connection for degenerative disc disease of the thoracolumbar spine, pleurisy, left and right foot bursitis, and left and right leg shin splints as claims of service connection for back disability, disability manifested by chest pain (to include pleurisy), bilateral foot disability, and bilateral leg disability (other than left knee patellofemoral syndrome). See Clemons v. Shinseki, 23 Vet. App. 1, 4-5 (2009) (a claim should not be limited to the disorder as characterized by the Veteran but must be characterized based on the reasonable expectations of the non-expert claimant and the evidence in processing the claim). Lastly, the Veteran submitted a claim for an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts which was received on May 6, 2012. In the January 2013 rating decision, the AOJ denied entitlement to an increased (compensable) rating for this disability. In the second March 2015 decision, the AOJ awarded an increased (10 percent) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts, from April 9, 2012 through December 26, 2012, a 30 percent rating, from December 27, 2012 through April 30, 2013, and a 10 percent rating, from May 1, 2013. In a March 2015 statement of the case (SOC), the AOJ included the issue of entitlement to an increased (compensable) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts. In an August 2019 SOC, the AOJ included the separate issues of entitlement to an effective date earlier than April 9, 2012 for the award of an increased (10 percent) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts, entitlement to an effective date earlier than December 27, 2012 for the award of an increased (30 percent) rating for this disability, and whether the effective date for the reduction to a 10 percent rating, from May 1, 2013, for this disability was proper. The Board points out that the grant of any compensation benefit necessarily includes implementation of an award and the selection of an effective date, since no award is granted in a legal vacuum. As explained above, the Veteran submitted a claim for an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts which was received on May 6, 2012. Therefore, the AOJ essentially awarded staged ratings for this disability by way of the March 2015 rating decision. See Hart v. Mansfield, 21 Vet. App. 505, 510 (2007) (staged ratings are appropriate for any rating claim when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings). The Board's adjudication of the issue of entitlement to an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts will include consideration of, among other things, whether a higher rating for this disability is warranted at any time since May 6, 2011 (one year prior to receipt of the Veteran's increased rating claim). Thus, the Board has characterized the Veteran's claim as only the two separate issues of entitlement to an effective date earlier than April 9, 2012 for the award of an increased (10 percent) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts and entitlement to an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts, rated 10 percent disabling prior to December 27, 2012, 30 percent disabling from December 27, 2012 through April 30, 2013, and 10 percent disabling from May 1, 2013. I. Applications to Reopen Generally, an AOJ decision denying a claim which has become final may not thereafter be reopened and allowed. 38 U.S.C. § 7105 (d)(3). The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to VA, and material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The newly presented evidence is presumed to be credible for purposes of determining whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For the purpose of determining whether new and material evidence has been presented to reopen a claim, the evidence for consideration is that which has been presented or secured since the last time the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The applications to reopen claims of service connection for bilateral foot disability and right shoulder disability The Veteran's claim of service connection for bilateral foot disability (characterized as bilateral heel condition) was originally denied in a February 2007 rating decision on the basis that there was no medical evidence of any such disability that was related to service. The Veteran was notified of the February 2007 decision, he did not appeal the decision within one year of its issuance, and new and material evidence was not received within that year. Therefore, the February 2007 decision became final. See 38 U.S.C. § 7105 (d)(3); Bond v. Shinseki, 659 F.3d 1362 (Fed. Cir. 2011); 38 C.F.R. §§ 3.104, 3.156(a)-(b), 19.52(a), 20.1103. The Veteran's claim of service connection for right shoulder disability was originally denied in an April 2010 rating decision on the basis that there was no medical evidence of any such disability that was related to service. The Veteran was notified of the April 2010 decision, he did not appeal the decision within one year of its issuance, and new and material evidence was not received within that year. Therefore, the April 2010 decision became final. See Id. The pertinent new evidence received since the February 2007 and April 2010 denials of service connection for bilateral foot disability and right shoulder disability includes the report of an October 2012 VA foot examination and an April 2013 VA physical therapy consultation note. This additional evidence reflects that the Veteran was diagnosed as having multiple bony fractures in the feet, lower extremity paraplegia, and right shoulder labral tear. Therefore, the additional evidence pertains to an element of the claims of service connection for bilateral foot disability and right shoulder disability that was previously found to be lacking and raises a reasonable possibility of substantiating the claims by indicating that the Veteran has current bilateral foot disability and right shoulder disability. The evidence is, therefore, new and material, and the claims of service connection for bilateral foot disability and right shoulder disability are reopened. II. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, air, or space service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Entitlement to service connection for right shoulder labral tear The Veteran contends that he has current right shoulder disability which had its onset in service. The Board finds, for the following reasons, that the Veteran has a current diagnosis of right shoulder labral tear, and that the evidence is at least evenly balanced as to whether this disability began during active service. Medical records, including the April 2013 VA physical therapy consultation note and an April 2013 shoulder CT report, indicate that the Veteran has been diagnosed as having right shoulder labral tear. Therefore, current right shoulder disability has been demonstrated. There is also evidence of right shoulder symptoms in service and evidence of continuous symptoms in the years since service. In this regard, the Veteran's service treatment records reveal that he reported on a June 2005 report of medical history form completed for purposes of separation from service that he had been experiencing right shoulder pain ever since a fall in 2004. Moreover, the Veteran's post-service medical records and lay statements indicate that his right shoulder symptoms have continued in the years since service. The Veteran is competent to report continuous right shoulder symptoms in the years since service. Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). Also, there no evidence that explicitly contradicts the Veteran's reports and his reports are generally consistent with the evidence of record. Therefore, the Board concludes that his reports of continuous right shoulder symptoms in the years since service are credible. In March 2015 a VA nurse practitioner reviewed the Veteran's claims file and opined that his claimed right shoulder disability was not likely ("less likely than not"/"less than 50 percent probability") incurred in or caused by service. The nurse practitioner reasoned that although the Veteran reported a right shoulder injury at the time of separation from service and later underwent right shoulder surgery, there were no service treatment records of any evaluation, diagnosis, or surgery for a right shoulder injury during service. A right shoulder MRI in 2013 noted a right labral tear and it appeared that the Veteran sustained significant trauma on several different occasions following his separation from service in 2005 and prior to the 2013 MRI. Therefore, it was not likely ("less likely than not") that the Veteran's right labral tear was incurred in or caused by the right shoulder pain during service. The March 2015 opinion is of little probative value because it is solely based on the absence of clinical evidence of treatment for right shoulder problems during service. The nurse practitioner did not take into account the Veteran's competent and credible reports of continuous right shoulder symptoms in the years since service. In this regard, a medical opinion is inadequate if it is based solely on the absence of documentation in the record and does not take into account the Veteran's reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). In sum, the evidence reflects that the Veteran experienced right shoulder symptoms in service and that there have been continuous symptoms in the years since service. He has also been diagnosed as having right shoulder labral tear. There is no adequate medical opinion that is contrary to a conclusion that the current right shoulder labral tear had its onset in service. Thus, the evidence is at least evenly balanced as to whether this disability had its onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for right shoulder labral tear is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. See also Buchanan, 451 F.3d at 1335 ("[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself"). REASONS FOR REMAND As an initial matter, following a March 2015 supplemental statement of the case (SSOC), additional evidence has been associated with the Veteran's claims file by the AOJ that is relevant to the remaining service connection and higher rating issues listed below. This relevant evidence has not been considered by the AOJ and no waiver of initial AOJ consideration of this evidence has been received. See 38 C.F.R. § 20.1305 (c). Hence, the Board is required to remand the service connection and higher rating issues for issuance of the necessary SSOC. 1. Entitlement to service connection for back disability, paraplegia and sensory loss at T4 level, and disability manifested by chest pain (to include pleurisy) are remanded. The Veteran contends that he has current back disability and paraplegia and sensory loss at T4 level that are related to his physical activities in service (to include heavy lifting, performing sit ups on uneven surfaces, and performing other strenuous physical exercises) and a fall that he experienced in service. His treatment records also reflect that he sustained significant injuries following service when he was involved in a skateboarding accident in 2008 and fell backwards in his wheelchair while participating in wheelchair games in 2011. The Veteran also contends that he began to experience pleurisy (characterized by chest pain) during service, and he reported a history of pleurisy (characterized by intermittent burning pain) on the June 2005 report of medical history form completed for purposes of separation from service. He has suggested that such symptoms have continued in the years since service. In the alternative, he contends that he has current pleurisy which is associated with his service-connected obstructed lung disease. The Veteran was afforded a VA central nervous system and neuromuscular diseases examination in January 2015 and was diagnosed as having trauma to the spinal cord causing neurogenic bladder/bowel and paraplegia. The physician who conducted the examination noted that the Veteran's spinal cord injury with paraplegia and neurogenic bowel and bladder "appear service-connected." The examiner did not provide any further explanation or rationale for this conclusion. The January 2015 opinion is inadequate because it is not accompanied by any explanation or rationale. Also, a review of the examination report appears to suggest that the examiner believed that the Veteran's significant injuries sustained following his separation from service, as noted above, actually occurred during service. Therefore, a remand is necessary to afford the Veteran a new examination to determine the nature of his claimed paraplegia and sensory loss and to obtain an adequate medical opinion as to whether the disability is related to service. Also, there is evidence that the Veteran has persistent or recurrent symptoms of back disability and disability manifested by chest pain and that any such disabilities may be related to service, and the record does not contain sufficient information to make a decision on the claims. Therefore, the Veteran should be afforded appropriate examinations upon remand to assess the nature of his claimed back disability and disability manifested by chest pain, and to obtain medical opinions as to whether any such disabilities are related to service and/or are caused or aggravated by service-connected respiratory disability. See 38 U.S.C. § 5103A (d); McLendon v. Nicholson, 20 Vet. App. 79 (2006). Moreover, evidence associated with the claims file, including a January 2010 VA SSA Inquiry, indicates that the Veteran was awarded Social Security Administration (SSA) disability benefits for unspecified disability. Any outstanding records pertaining to the Veteran's claim(s) for SSA benefits may be relevant to the issues on appeal. Hence, the AOJ should attempt to obtain any such relevant records upon remand. Additionally, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the Indianapolis Vista electronic records system (dated to December 2017), the VA Eastern Colorado Health Care System (dated to August 2015), the VA Pittsburgh Healthcare System (dated to August 2011), the VA Richmond Healthcare System (dated to July 2019), the Hines Vista electronic records system (dated to January 2016), the VA Louisville Healthcare System (dated to June 2016), and the VA Martinsburg Healthcare System (dated to August 2019). Any VA treatment records are within VA's constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. Lastly, the Board notes that the Veteran's representative has made multiple requests for copies of the curriculum vitae (CVs) and other credentials of the VA examiners who conducted all pertinent VA examinations relevant to each issue on appeal. Upon remand, the AOJ should, to the extent possible, provide the Veteran's representative with the requested information. See Francway v. Wilkie, 940 F.3d 1304, 1308 (Fed. Cir. 2019) ("Once the request is made for information as to the competency of the examiner, the veteran has the right, absent unusual circumstances, to the curriculum vitae and other information about qualifications of a medical examiner. This is mandated by the VA's duty to assist"). 2. Entitlement to service connection for bilateral foot disability and bilateral leg disability (other than left knee patellofemoral syndrome) are remanded. The Veteran contends that he has bilateral foot disability (claimed as bursitis) and bilateral leg disability other than left knee patellofemoral syndrome (claimed as shin splints) that are related to service. He was afforded VA foot and knee examinations in October 2012 and was diagnosed as having multiple bony fractures in the feet. He was not diagnosed as having any shin splints at the time of the examination. The examiner who conducted the October 2012 examinations opined that the Veteran's claimed foot and leg disabilities were not likely incurred in or caused by service. These opinions are inadequate because the only rationale provided was that the Veteran did not have shin splints or foot bursitis at the time of the examinations. However, the Veteran's medical records reflect that he has experienced non service-connected leg and foot disabilities other than shin splints and bursitis. For example, the report of a November 2014 VA knee examination indicates that the Veteran was diagnosed as having left knee disabilities other than the service-connected patellofemoral syndrome. As explained above, the Veteran has experienced lower extremity paraplegia. Also, he underwent a left leg above the knee amputation in June 2018. Therefore, the Veteran should be afforded new examinations upon remand to determine the nature of his claimed foot and leg disabilities and to obtain medical opinions as to whether any such disabilities are related to service or are caused or aggravated by service-connected disability. Also, all outstanding SSA records and VA treatment records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. 3. Entitlement to an initial rating higher than 10 percent for TBI with memory loss and dizziness is remanded. The Veteran was most recently afforded a VA examination to assess the severity of his service-connected TBI in April 2018. The examiner noted, in pertinent part, that the Veteran experienced visual impairment associated with his TBI. However, the examiner did not otherwise address the nature or the severity of the Veteran's visual impairment so as to determine whether any separate rating for visual impairment associated with his TBI is warranted. In light of this fact, the fact that the issue of entitlement to a higher initial rating for TBI must otherwise be remanded to obtain outstanding SSA records and VA treatment records, to provide the Veteran's representative with the requested information pertaining to VA examiners, and to issue an SSOC, the Veteran should be provided an opportunity to report for new VA examinations to ascertain the current severity and manifestations of his service-connected TBI. Also, all outstanding SSA records and VA treatment records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. 4. Entitlement to an increased rating for obstructed lung disease (claimed as bronchitis), rated 60 percent disabling prior to October 19, 2012 and 10 percent disabling since that date, is remanded. The evidence reflects that the Veteran's service-connected obstructed lung disease may have worsened since he was last examined by VA in November 2014. For instance, the November 2014 examination report indicates that the Veteran was diagnosed as having mild obstructive lung disease and that pulmonary function testing revealed only mild impairment. However, a July 2019 VA respiratory therapy note reflects that the Veteran had moderate obstructive ventilatory defect based on spirometry. In light of this information and the fact that the issue of entitlement to an increased rating for obstructed lung disease must otherwise be remanded to obtain outstanding SSA records and VA treatment records, to provide the Veteran's representative with the requested information pertaining to VA examiners, and to issue an SSOC, the Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of his service-connected obstructed lung disease. Also, all outstanding VA treatment records should be secured upon remand. Specifically, the July 2019 VA respiratory therapy note indicates that pulmonary function testing was performed and that the report of the testing is available in VISTA imaging. The report of the July 2019 pulmonary function testing has not been obtained and associated with the claims file. Lastly, all outstanding SSA records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. 5. Entitlement to a rating in excess of 10 percent for left hip strain with bursitis, entitlement to a rating in excess of 10 percent for right hip strain, and entitlement to a rating in excess of 10 percent for post-operative repair of the right ankle are remanded. While the Veteran was most recently afforded VA examinations regarding his service-connected bilateral hip and right ankle disabilities in November 2014, the examinations do not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). Specifically, the Veteran reported that he experienced flare ups of hip and ankle symptoms and the examinations were not being conducted during a flare up, but the examiner was unable to determine whether pain, weakness, fatigability, or incoordination significantly limited functional ability during flare ups without resort to mere speculation. The examiner did not provide any explanation for these opinions, other than to note that functional ability of the right ankle was not being evaluated during a flare up. Moreover, although the examiner noted that the examinations were not being conducted immediately after repetitive use over time, the examiner was unable to determine whether pain, weakness, fatigability, or incoordination significantly limited functional ability with repeated use over time without resort to mere speculation. The only explanation was that functional ability was not being examined over a period of time. In light of the above inadequacies of the November 2014 examinations, the Veteran should be afforded new examinations upon remand to determine the current severity and manifestations of his service-connected bilateral hip and right ankle disabilities. Also, all outstanding SSA records and VA treatment records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. 6. Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome and entitlement to an increased (compensable) rating for surgical scars of the left knee, left hip, and right hip are remanded. Additional information will be obtained during the requested VA leg and hip examinations which is pertinent to the issues of entitlement to increased ratings for left knee patellofemoral syndrome and surgical scars of the left knee, left hip, and right hip. Also, the Veteran has never been afforded a VA scars examination to fully assess the severity of his service-connected scars. Therefore, an appropriate examination should be conducted upon remand. Moreover, all outstanding SSA records and VA treatment records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. 7. Entitlement to an increased rating for HPV with genital warts, dysmenorrhea, and ovarian cysts (rated 10 percent disabling prior to December 27, 2012, 30 percent disabling from December 27, 2012 through April 30, 2013, and 10 percent disabling from May 1, 2013), entitlement to an effective date earlier than May 4, 2011 for the award of service connection for migraines, entitlement to an effective date earlier than May 4, 2011 for the award of service connection for loss of smell, entitlement to an effective date earlier than May 4, 2011 for the award of service connection for loss of taste, entitlement to an effective date earlier than May 4, 2011 for the award of service connection for tinnitus, entitlement to an effective date earlier than April 9, 2012 for the award of an increased (10 percent) rating for HPV with genital warts, dysmenorrhea, and ovarian cysts, and entitlement to an effective date earlier than April 16, 2013 for the award of SMC pursuant to 38 U.S.C. § 1114(k) due to loss use of a creative organ are remanded. All outstanding SSA records and VA treatment records should be secured upon remand and the Veteran's representative should be provided, to the extent possible, with the requested information pertaining to the relevant VA examiners. The matters are REMANDED for the following action: 1. Ask the Veteran and his representative to identify the specific VA medical professionals whose CVs they wish to obtain. Then, to the extent possible, provide the Veteran and his representative with copies of the requested CVs and other pertinent information. If the information requested is not available, then the AOJ should advise the Veteran and his representative of such and note the reasons for such in the record. 2. Obtain the Veteran's outstanding VA treatment records, to include (a) the specific results of the pulmonary function testing conducted during a July 24, 2019 VA respiratory evaluation (i.e., the specific test results from this date which are available in VISTA imaging, as noted by the July 2019 VA respiratory therapy note, NOT merely the July 2019 VA respiratory therapy note itself); (b) all records from the Indianapolis Vista electronic records system for the period since December 2017; (c) all records from the VA Eastern Colorado Health Care System for the period since August 2015; (d) all records from the VA Pittsburgh Healthcare System for the period since August 2011; (e) all records from the VA Richmond Healthcare System for the period since July 2019; (f) all records from the Hines Vista electronic records system for the period since January 2016; (g) all records from the VA Louisville Healthcare System for the period since June 2016; (h) all records from the VA Martinsburg Healthcare System for the period since August 2019; and (i) all such relevant records from any other sufficiently identified VA facility. 3. Contact the SSA and request a copy of that agency's decision(s) for disability and/or supplemental security income benefits and all relevant records pertaining to the Veteran's claim(s). Document all requests for information as well as all responses in the claims file. 4. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination with an appropriate clinician to determine the nature of any current back disability, and whether any such disability is related to service. The examiner must opine whether any back disability experienced by the Veteran since approximately September 2011 at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service (in the case of any currently diagnosed arthritis); OR (3) is related to an injury or disease during service, including his fall in service and his various physical activities in service The examiner must provide reasons for each opinion given. 5. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination with an appropriate clinician to determine the nature of any current paraplegia and sensory loss, and whether any such disability is related to service. The examiner must opine whether any paraplegia and sensory loss experienced by the Veteran since approximately September 2011 at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service; OR (3) is related to an injury or disease during service, including his fall in service and his various physical activities in service. The examiner must provide reasons for each opinion given. 6. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination with an appropriate clinician to determine the nature of any current disability manifested by chest pain, and whether any such disability is related to service. The examiner must opine whether any disability manifested by chest pain experienced by the Veteran since approximately May 2012 (including, but not limited to, pleurisy) at least as likely as not (1) began during active service; (2) is related to an injury or disease during service, including his pleurisy in service; (3) is caused by service-connected obstructed lung disease; OR (4) is aggravated by service-connected obstructed lung disease. The examiner must provide reasons for each opinion given. 7. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination with an appropriate clinician to determine the nature of any current foot disability, and whether any such disability is related to service. The examiner must opine whether any foot disability experienced by the Veteran since approximately May 2012 at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service (in the case of any currently diagnosed arthritis); OR (3) is related to an injury or disease during service, including the foot problems documented in his service treatment records. The examiner must provide reasons for each opinion given. 8. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination with an appropriate clinician to determine the nature of any current leg disability other than left knee patellofemoral syndrome, and whether any such disability is related to service. The examiner must opine whether any leg disability other than left knee patellofemoral syndrome experienced by the Veteran since approximately May 2012 (including, but not limited to, any shin splints and his left leg above the knee amputation) at least as likely as not (1) began during active service; (2) manifested within one year after discharge from service (in the case of any currently diagnosed arthritis); (3) is related to an injury or disease during service, including the leg problems documented in his service treatment records; (4) is caused by service-connected left knee patellofemoral syndrome; OR (5) is aggravated by service-connected left knee patellofemoral syndrome. The examiner must provide reasons for each opinion given. 9. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for all appropriate examinations to determine the current severity of his service-connected TBI and its residuals. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. Specifically, the examiner should provide an assessment of the current nature and severity of all residuals of the Veteran's service-connected TBI consistent with the schedular criteria for evaluating the residuals of TBI under 38 C.F.R. § 4.124a, Diagnostic Code 8045. The examiner should specifically address the degree to which the service-connected disability is manifested by facets of cognitive impairment including memory, attention, concentration, and executive functions; judgment; social interaction; orientation; motor activity; visual spatial orientation; subjective symptoms; neurobehavioral effects; communication; and consciousness. For each such area of impairment identified, the examiner should opine whether it is at least as likely as not a symptom associated (in whole or in part) with the Veteran's service-connected TBI. The examiner should also identify all comorbid physical, neurological, or mental disorder(s) and state whether each is shown to be caused by the Veteran's TBI. If not, then, with respect to each comorbid disorder identified, the clinician should attempt to distinguish any symptoms and impairment attributable to such disability from the symptoms and impairment attributable to the identified TBI. If the manifestations cannot clearly be distinguished, the clinician should clearly so state. The examiner must provide reasons for any opinion given. 10. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left and right hip disabilities. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing of both the left and right hip. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and with repeated use over time. 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 and with repeated use over time 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 may not rely solely upon his or her inability to personally observe the Veteran during a period of flare-up or following repeated use over time. The examiner must provide reasons for any opinion given. 11. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right ankle disability. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing of the right ankle. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and with repeated use over time. 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 and with repeated use over time 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 may not rely solely upon his or her inability to personally observe the Veteran during a period of flare-up or following repeated use over time. The examiner must provide reasons for any opinion given. 12. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected surgical scars of the left knee, left hip, and right hip. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must provide reasons for any opinion given. 13. After all efforts have been exhausted to obtain and associate with the claims file any SSA records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected obstructed lung disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. The examiner must provide reasons for any opinion given. 14. After the above development, and any additionally indicated development, has been completed, readjudicate the remaining issues on appeal. If any benefit sought is not granted to the Veteran's satisfaction, send the Veteran and his representative a supplemental statement of the case that considers all additional relevant evidence received since the March 2015 SSOC and August 2019 SOCs, and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.