Citation Nr: 21006203 Decision Date: 02/03/21 Archive Date: 02/03/21 DOCKET NO. 05-41 442 DATE: February 3, 2021 REMANDED Service connection for a left knee condition is remanded. An initial compensable rating for status post cholecystectomy is remanded. An initial compensable rating for the right knee disability prior to November 17, 2011, is remanded. A rating higher than 10 percent for the right knee disability from November 17, 2011, is remanded. An initial compensable rating for the left shoulder disability prior to November 17, 2011, is remanded. A rating higher than 10 percent for the left shoulder disability from November 17, 2011 through June 24, 2019, is remanded. A rating higher than 20 percent for the left shoulder disability from June 25, 2019, is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1980 to August 2004. These matters come before the Board of Veterans Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO). The claims were remanded by the Board most recently in December 2017. The Board also remanded a claim for service connection for posttraumatic ulnar neuropraxia. Since service connection was subsequently established for carpal tunnel syndrome of the right and left upper extremities, that issue is no longer before the Board for appellate review. 1. Service connection for a left knee condition is remanded. An opinion is needed to address whether the left knee degenerative arthritis diagnosed during the June 2019 VA examination is related to active duty service. 2. An initial compensable rating for status post cholecystectomy is remanded. The Veteran’s status post cholecystectomy is rated under 38 C.F.R. § 4.114, Diagnostic Code 7318. A VA examination is needed to address the current severity of this disability and whether gastrointestinal complaints reported by the Veteran are residuals of the gallbladder removal surgery. This is important given that 38 C.F.R. § 4.114 provides that a single evaluation will be assigned under the diagnostic code which reflects the predominant disability picture, with elevation to the next higher evaluation where the severity of the overall disability warrants such elevation, under codes 7301 through 7329, 7331, 7342, and 7345 through 7348. 3. An initial compensable rating for the right knee disability prior to November 17, 2011, is remanded. 4. A rating higher than 10 percent for the right knee disability from November 17, 2011, is remanded. 5. An initial compensable rating for the left shoulder disability prior to November 17, 2011, is remanded. 6. A rating higher than 10 percent for the left shoulder disability from November 17, 2011 through June 24, 2019, is remanded. 7. A rating higher than 20 percent for the left shoulder disability from June 25, 2019, is remanded. The Board remanded the increased rating claims involving the right knee and left shoulder for a VA examination that, in part, provided an opinion as to the full range of motion of the Veteran’s left shoulder and right knee since September 2004 in active motion, passive motion, weight-bearing, and nonweight-bearing, and with range of motion of the opposite undamaged joint. It also requested an opinion describing functional impairment of the Veteran’s left shoulder and right knee due to flare-ups since September 2004 that accounted for pain, incoordination, weakened movement, and excess fatigability on use. The examiner was asked to address statements made regarding flare-ups during the examination as well as any such statements made in the 2004 and 2011 examination reports. Since the VA examinations conducted by the same examiner in June 2019 did not provide the requested opinions, remand is needed for an addendum opinion. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to determine the current severity of the status post cholecystectomy. The claims file should be reviewed by the examiner. All necessary tests should be performed, and the results reported. All symptomatology associated with the status post cholecystectomy should be reported. The examiner must address whether gastrointestinal complaints of dyspepsia/indigestion, bloating, stomach cramps, heartburn, and/or diarrhea are residuals of the gallbladder removal surgery. 2. Return the claims file to the VA examiner who conducted the June 2019 VA examinations of the Veteran’s knees and left shoulder. If that examiner is not available, another qualified VA examiner should review the file. Following review of the file, the examiner is asked to provide an opinion as to whether it is at least as likely as not (50 percent probability or greater) that the Veteran’s diagnosed left knee degenerative arthritis manifested in service or is otherwise related to service. The examiner should explain why or why not. The examiner must also provide an opinion as to the full range of motion of the Veteran’s left shoulder and right knee since September 2004 in active motion, passive motion, weight-bearing, and nonweight-bearing, and with range of motion of the opposite undamaged joint; and an opinion describing functional impairment of the Veteran’s left shoulder and right knee due to flare-ups since September 2004 that accounts for pain, incoordination, weakened movement, and excess fatigability on use. The opinion addressing functional impairment should address statements made regarding flare-ups during the June 2019 VA examination as well as any such statements made in the 2004 and 2011 examination reports. If the examiner concludes it is not feasible to provide the opinions requested pertaining to the right knee and left shoulder, or that it is not possible to provide a specific measurement or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state why, to include 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). 3. If the claims remain denied, issue a supplemental statement of the case. K. A. BANFIELD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Van Wambeke, 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.