Citation Nr: 21010225 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 15-27 471 DATE: February 24, 2021 ORDER Entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, left, is denied. Entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, right, is denied. Entitlement to a rating in excess of 30 percent for pes planus is denied. REMANDED The claim of entitlement to ratings in excess of 10 percent prior to November 27, 2019, and 30 percent from November 27, 2019, for residuals of a left knee injury, including degenerative joint disease, is remanded. The claim of entitlement to ratings in excess of 10 percent prior to November 27, 2019, and 30 percent from November 27, 2019, for residuals of a right knee injury, including degenerative joint disease, is remanded. The claim of entitlement to ratings in excess of 10 percent from February 22, 2010 to May 18, 2011, and 30 percent from May 19, 2011, for eczematous dermatitis with tinea versicolor is remanded. FINDINGS OF FACT 1. The Veteran’s May 2011 submission represents new and material evidence submitted within one year of an August 2010 rating decision continuing the 10 percent ratings assigned residuals of the Veteran’s left and right knee injuries and pes planus. 2. The Veteran is right-handed. 3. The Veteran’s left carpal tunnel syndrome causes mild incomplete paralysis of the median nerve. 4. The Veteran’s right carpal tunnel syndrome causes mild incomplete paralysis of the median nerve. 5. The Veteran’s pes planus and related plantar fasciitis are severe, not pronounced, manifesting as accentuated pain on manipulation and use, swelling on weightbearing, and flare-ups of functionally limiting pain. 6. The Veteran also has hallux rigidus and arthritis in his right great toe, which are symptomatic but unrelated to his service-connected pes planus and related plantar fasciitis. CONCLUSIONS OF LAW 1. The August 2010 rating decision, which, in part, continued the 10 percent ratings assigned residuals of the Veteran’s left and right knee injuries and pes planus, remains pending. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.200, 20.302, 20.1103 (2011). 2. The criteria for entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, left, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.27, 4.123, 4.124, 4.124A, DCs 8799-8715. 3. The criteria for entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, right, have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.10, 4.27, 4.123, 4.124, 4.124A, DCs 8799-8715. 4. The criteria for entitlement to a rating in excess of 30 percent for pes planus have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.7, 4.14, 4.71A, DC 5276. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from June 1971 to June 1995. His claims come before the Board of Veterans' Appeals (Board) on appeal of an August 2010 rating decision continuing the 10 percent ratings assigned residuals of his left and right knee injuries and pes planus and a June 2012 rating decision continuing the 10 percent ratings assigned his left and right carpal tunnel syndrome. In a July 2015 Decision Review Officer decision, the Agency of Original Jurisdiction (AOJ) increased the rating assigned the pes planus to 30 percent. In an August 2018 decision, the Board denied increased ratings for all disabilities on appeal. The Veteran then appealed the Board's decision to the United States Court of Appeals for Veterans Claims. In May 2019, based on a Joint Motion For Partial Remand (joint motion), the Court remanded these claims to the Board for action consistent with the terms of the joint motion. The Board in turn remanded these claims to the AOJ in November 2019. In an October 2020 rating decision, the AOJ increased the ratings assigned residuals of the left and right knee injuries to 30 percent, from November 27, 2019, granted the Veteran separate 50 percent ratings for limitation of extension of the left and right knees, and increased the noncompensable ratings assigned the separately service connected laxity of the left and right knees to 10 percent. The Veteran is also claiming entitlement to a total disability rating based on individual unemployability (TDIU) due, in part, to some of the disabilities addressed in this decision. However, this claim is part of another appeal stream, and the Board will be addressing it in a separate decision once it is certified for appellate review. Increased Ratings Procedural Correction In its August 2018 decision, the Board indicated that this appeal originated from a May 2011 claim for increased ratings, which the AOJ decided in a June 2012 rating decision. Once on appeal to the Court, the parties agreed that the Board had failed to provide adequate reasons and bases for finding that the May 2011 submission represented a claim for increased ratings for bilateral knee, bilateral pes planus and bilateral carpal tunnel conditions rather than a notice of disagreement with an August 2010 rating decision or new and material evidence submitted within a year of that rating decision. In the August 2010 rating decision, the AOJ decided multiple claims, including entitlement to ratings in excess of 10 percent for residuals of right and left knee injuries and pes planus. The May 2011 submission to which the parties refer includes a written statement from the Veteran “requesting an increase in [his] disability compensation because [his] disabilities have gotten worse.” The Veteran then referenced a February 2020 notification letter from the AOJ indicating that he was in receipt of payment at the 80 percent rate, and the reason for the increase is because he had a high bilirubin count (probable Gilbert’s syndrome) and a hiatal hernia, both of which VA had never rated, and eczema that required medication, supporting an increase for tinea versicolor. The submission also includes medical records confirming a high bilirubin count and indicating that medication prescribed by a dermatologist was not working, a formal application for a TDIU and a signed request for VA medical records. This submission may not be construed as a notice of disagreement with the August 2010 rating decision continuing the 10 percent ratings assigned residuals of the Veteran’s left and right knee injuries and pes planus. In May 2011, regulations defined a notice of disagreement as a written communication from a claimant or his or her representative expressing dissatisfaction or disagreement with an adjudicative determination by the AOJ and a desire to contest the result. While special wording was not required, the notice of disagreement had to be expressed in terms that could reasonably be construed as disagreement with a determination and a desire for appellate review. In addition, if, like in this case, the AOJ provided notice of a decision on multiple issues, the specific determinations with which the claimant disagreed had to be identified. 38 C.F.R. § 20.201 (2011). Here, none of the evidence submitted in the May 2011 filing, including the Veteran’s written statement, refers to any issue addressed in the August 2010 rating decision or expresses dissatisfaction or disagreement with the decision overall or an intent to appeal it. Herndon v. Principi, 311 F. 3d 1121, 1123 (Fed. Cir. 2002); Gallegos v. Principi, 283 F. 3d 1309, 1314 (Fed. Cir. 2002) (valid notice of disagreement must express desire for appellate review). Although the May 2011 submission may not be construed as a notice of disagreement with the August 2010 rating decision and in part supports new claims, VA must evaluate the submission to determine whether it represents new and material evidence timely submitted after the August 2010 rating decision in support of the claims for increased ratings then decided. 38 C.F.R. § 3.156(b); Bond v. Shinseki, 659 F.3d 1362, 1367-8 (Fed. Cir. 2011); Buie v. Shinseki, 24 Vet. App. 242, 251-52 (2010). Indeed, the Veteran’s May 2011 written statement, which alleges a worsening in disabilities, represents new and material evidence that may be considered as having been filed in connection with the claims decided in August 2010, including those now before the Board. 38 C.F.R. § 3.156(b). Although in his statement, the Veteran doesn’t specifically refer to his knees or feet and later addresses other conditions specifically, his initial statement, when considered in conjunction with the formal TDIU application and 2010 VA treatment records later associated with the record, suggests he was referring to his service-connected disabilities in general and collectively. This statement, not having been of record prior to May 2011 and presumed credible, see Duran v. Brown, 7 Vet. App. 216, 220 (1994), is new and material, indicating a worsening of all of the Veteran’s disabilities, including those affecting his knees and feet. As it was submitted within a year of the August 2010 rating decision, that decision is not final, remains pending and, as noted above, is one of two from which this appeal ensues. 38 U.S.C. § 7105(c); 38 C.F.R. §§ 20.200, 20.302, 20.1103 (2010); Charles v. Shinseki, 587 F.3d 1318, 1323 (Fed. Cir. 2009); Jennings v. Mansfield, 509 F.3d 1362, 1368 (Fed. Cir. 2007). Merits The Veteran seeks increased ratings for his left and right carpal tunnel syndrome and bilateral pes planus. He contends that these disabilities have worsened, interfering with his ability to operate the flea market he owns. This type of work reportedly requires buying and reselling household goods and moving and delivering furniture and appliances, tasks that have become impossible given his unbearable disabilities. In November 2019, the Veteran’s representative argued that a remand was necessary based, in part, on VA’s failure to satisfy its duty to assist. Since the remand, the representative has acknowledged the development that was completed, has not challenged its adequacy, and continues to assert that increased ratings are warranted. Disability ratings are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing his symptomatology with the criteria set forth in the Schedule for Rating Disabilities (rating schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. If two ratings are potentially applicable, the higher rating will be assigned if the disability picture more nearly approximates the criteria required for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. In determining the level of current impairment, it is essential that the disability be considered in the context of the entire recorded history. 38 C.F.R. § 4.1. Entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, left Entitlement to a rating in excess of 10 percent for postoperative carpal tunnel syndrome, right The AOJ has assigned the Veteran’s carpal tunnel syndrome, left and right, 10 percent ratings under 38 C.F.R. § 4.124A, DCs 8799-8715, by analogy to neuralgia of the median nerve, based on mild incomplete paralysis of the median nerve. When, as in this case, an unlisted disease, injury, or residual condition is encountered, requiring rating by analogy, the DC number will be "built-up" by using the first two digits of the DC for the most closely analogous disability, followed by the terminal digits "99", connoting an unlisted condition. 38 C.F.R. § 4.27. Here, neuralgia (DC 8715) and neuritis (DC 8615) of the median nerve are most closely analogous to carpal tunnel syndrome as this syndrome is caused by pressure on the median nerve and produces symptoms secondary to that compression. DCs 8510-8719 address ratings for paralysis, neuritis, and neuralgia of the peripheral nerves affecting the upper extremities and provide different disability ratings for the major (dominant) and minor (non-dominant) sides. 38 C.F.R. § 4.124a. DC 8515, 8615, and 8715 provide ratings for paralysis, neuritis, and neuralgia, respectively, of the median nerve. Under DC 8515, a 60 percent (minor arm) or 70 percent (major arm) rating is assignable for complete paralysis of the median nerve, demonstrated by the hand inclined to the ulnar side, the index and middle fingers more extended than normal, considerable atrophy of the muscles of the thenar eminence, the thumb in the plane of the hand (ape hand); pronation incomplete and defective, absence of flexion of the index finger and feeble flexion of the middle finger, inability to make a fist with index and middle fingers remaining extended; inability to flex the distal phalanx of the thumb, defective opposition and abduction of the thumb; weakened wrist flexion; and pain with trophic disturbances. 38 C.F.R. § 4.124a, DC 8515. Neuritis and neuralgia are to be rated as incomplete paralysis. Neuritis, "characterized by loss of reflexes, muscle atrophy, sensory disturbances, and constant pain, at times excruciating," shall not be rated higher than severe, incomplete paralysis. 38 C.F.R. § 4.123. The maximum rating assignable for "neuritis not characterized by organic changes referred to in this section" is moderate, or with sciatic nerve involvement, moderately severe incomplete paralysis. Id. Neuralgia, "characterized usually by a dull and intermittent pain, of typical distribution so as to identify the nerve," shall not be rated higher than moderate incomplete paralysis. 38 C.F.R. § 4.124. When neural involvement is wholly sensory, it should be rated as mild, or at most, moderate incomplete paralysis. 38 C.F.R. § 4.124A. Ratings ranging from 10 to 50 percent are assignable for incomplete paralysis, defined in the rating schedule as "a degree of lost or impaired function substantially less than the type picture for complete paralysis given." A 50 percent (major arm) or 40 percent (minor arm) rating is assignable for severe incomplete paralysis. A 30 percent (major arm) or 20 percent (minor arm) rating is assignable for moderate incomplete paralysis. A 10 percent (major or minor arm) rating is assignable for mild incomplete paralysis bilaterally. 38 C.F.R. § 4.124a, DC 8515. The Veteran seeks ratings in excess of 10 percent. He contends that he had bilateral wrist surgery in the early 1990s, which initially helped the severe carpal tunnel syndrome symptoms he was having, including constant numbness and tingling and a tendency to drop things, but in the mid-1990s, the symptoms recurred. He asserts they are moderate to severe and include constant pain in his hands that radiate up his forearms, worsening weakness in his wrists, cramping, locking, rigid, stiffening fingers, worse with use, which he has to exercise to move or unlock, episodic paresthesias and difficulty gripping repetitively. He reports that with the exception of frequent locking of the hands and fingers, his symptoms have remained stable. He uses splints or wrist braces at night and takes Motrin for pain. The Veteran contends that his symptoms have interfered with work (previously worked in aircraft structural maintenance), and that, during the last month, he lost between zero and one week of work due to his hands. Although he is retired, he tries to work around his home but has to stop when he has wrist and hand pain and locking hands and fingers. The preponderance of the evidence is against each of these claims. The Veteran is right-hand dominant. See December 2014 VA peripheral nerves examination report. Therefore, according to the above criteria, to be assigned higher ratings for his carpal tunnel syndrome, the evidence must establish that it is causing moderate or more severe incomplete paralysis on the left and right. This, the evidence does not show. The Veteran underwent surgery for carpal tunnel syndrome on the left and right while in service. In September 1995, several months after discharge, he reported that he still had numbness and pain in his wrists, and a VA examiner confirmed residual sensory loss and pain bilaterally. In 1997, the Veteran reported arm pain and swelling, including in “carpal tunnel areas”, but the complaints were attributed to possible rotator cuff tendonitis. Thereafter, for a decade, the Veteran reported a history of carpal tunnel syndrome or indicated he was service connected for that condition, but no medical professional noted any symptoms associated therewith. In May 2007, the Veteran filed a claim for increased ratings for carpal tunnel syndrome, and during the June 2007 VA examination conducted in support of that claim, the VA examiner characterized the condition as mild bilaterally. On that date, the Veteran reported that he had had quite a bit of improvement in his symptoms, but that they had slowly returned, the numbness and pain in his arms, worse on the right, awakening him once or twice weekly. Indeed, this level of severity was noted earlier in the month, when the Veteran underwent a nerve conduction study for bilateral hand numbness. The results showed mild median neuropathy at the wrist, consistent with mild carpal tunnel syndrome, a finding that prompted the issuance of wrist splints. The same month the Veteran filed his claim, he began seeking treatment for carpal tunnel syndrome that “had come back.” A physical evaluation revealed neck problems. Thereafter, during treatment visits from 2008 to 2013, providers noted that the carpal tunnel syndrome was stable, a fact confirmed during June 2010, October 2011, December 2014 and July 2020 VA peripheral nerves and general medical examinations and a July 2012 nerve conduction study. During the first examination, the Veteran reported additional symptoms, including finger stiffness and intermittent tingling of the hands and arms, particularly with activity, and weakness of the hands, but the VA examiner characterized the bilateral carpal tunnel syndrome as mild. During the second examination, the Veteran reported that his condition progressed from “severe” prior to surgery to “zero” after surgery to “mild” many years later, beginning in 1995. The examiner noted that the Veteran was wearing wrist splints, had no swelling or weakness in his hands and had a normal grip. He characterized the bilateral carpal tunnel syndrome as mild, with a 33 percent recurrence beginning in 1995 to the present. Less than a year later, a July 2012 nerve conduction study with EMG of the bilateral upper extremities did not reveal any electrophysiological evidence to suggest nerve entrapment or polyneuropathy. During the third examination, an examiner noted mild intermittent pain bilaterally, mild paresthesias and/or dysesthesias bilaterally and the regular use of a brace. He indicated that the Veteran’s carpal tunnel syndrome was causing mild incomplete paralysis of the median nerve bilaterally, which precluded repetitive gripping. During the fourth examination, when the Veteran reported that, with the exception of rigid and locking fingers/hands, the carpal tunnel syndrome had remained stable, an examiner noted moderate intermittent pain bilaterally, moderate paresthesias and/or dysesthesias bilaterally, moderate numbness bilaterally, moderate to severe rigid and locking fingers and hands, and the occasional use of a wrist brace. Despite these worsening finger symptoms, the examiner concluded that the Veteran’s carpal tunnel syndrome was causing mild incomplete paralysis of the median nerve bilaterally. The Board acknowledges the Veteran’s recent assertion that his carpal tunnel syndrome symptoms are now more than mild. Indeed, the most recent examination report indicates that some of these symptoms have worsened since 2014. However, the crucial question is whether these worsened symptoms cause more than mild incomplete paralysis of the median nerve. Four VA examiners have provided unfavorable opinions on this matter, and the Board finds these opinions highly probative. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). First, they are consistent. Second, they are based on a review of the record, the Veteran’s reported medical history and a thorough physical evaluation. Third, they are supported by treatment records showing years of stable carpal tunnel syndrome, which the Veteran confirmed during his most recent VA examination. The Veteran, who has no medical expertise, is not competent to find that his worsening carpal tunnel syndrome symptoms are causing more than mild incomplete paralysis of the median nerve bilaterally, see Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007), and he has not submitted a medical opinion to this effect. As such, the criteria for entitlement to ratings in excess of 10 percent for postoperative carpal tunnel syndrome, left and right, are not met. Entitlement to a rating in excess of 30 percent for pes planus The AOJ has assigned the Veteran’s pes planus a 30 percent rating pursuant to 38 C.F.R. § 4.71A, DC 5276. There is some confusion of record regarding the effective date of this rating. In an October 2020 supplemental statement of the case, the AOJ phrased this issue as entitlement to a rating in excess of 30 percent for pes planus prior to November 27, 2019. In a July 2015 Decision Review Officer decision, however, the AOJ increased the 10 percent rating assigned the Veteran’s pes planus to 30 percent, from May 19, 2011. The AOJ thus erred, and an October 2020 rating decision code sheet dated the same day as the supplemental statement of the case corrects this error. According to the code sheet, the 30 percent rating now assigned the Veteran’s service-connected bilateral foot disability covers the entire appeal period at issue. The Veteran seeks a rating in excess of 30 percent. He claims that, despite having custom inserts for his shoes, he has daily swelling and constant achy pain in his feet, more on the right, the latter of which requires the use of Motrin. He reports flare-ups of pain after prolonged standing, which is relieved with rest and a two-hour refrain from weight bearing. He asserts that his right great toe hurts all of the time, swells and is stiff, hindering his ability to walk and stand, perform household tasks and engage in activities requiring prolonged walking or standing, and necessitating rest and the use of medications for pain. He further asserts that he was once prescribed braces, but they did not help. He reports moderate to severe flare-ups of right foot pain and swelling, which last several hours, limit his ability to walk, bend and move around and necessitate getting off his feet. Recently, during a July 2000 VA foot conditions examination, an examiner noted that the Veteran has multiple foot disabilities, including the pes planus now at issue, and degenerative joint disease of the right great toe and hallux rigidus, for which he is separately service connected. The examiner diagnosed plantar fasciitis, associated that condition with the pes planus, and also diagnosed hallux rigidus, disassociating that condition from the pes planus and attributing it to the degenerative joint disease of the right toe. Since then, providers and a December 2014 VA examiner have noted that the Veteran also has gout affecting his toes. Based on these findings, the arthritis of the right great toe, hallux rigidus and gout are not considered part of the service-connected bilateral foot disability now on appeal, and in determining the severity of this disability, the Board will, to the extent possible, consider symptoms of the pes planus and plantar fasciitis only. DC 5276, which governs ratings of flatfeet, provides that a 30 percent rating is assignable when the condition is severe with objective evidence of marked deformity, pain on manipulation and use accentuated, indication of swelling on use, characteristic callosities. A maximum 50 percent rating is assignable when the condition is pronounced with marked pronation, extreme tenderness of plantar surfaces of the feet, marked inward displacement and severe spasm of the tendo achilles on manipulation, not improved by orthopedic shoes or appliances. 38 C.F.R. § 4.71a, DC 5276. In this case, even when impossible to distinguish symptoms of the nonservice-connected hallux rigidus and separately service-connected right great toe arthritis from the symptoms of his service-connected bilateral foot disability, there is an absence of findings of record satisfying the criteria for a 50 percent rating under DC 5276. Since 1995, the Veteran has sought treatment for and undergone VA examinations of his feet, but during treatment visits and examinations, no medical professional characterized the Veteran’s bilateral foot disability as pronounced or noted associated marked deformity, to include pronation, characteristic callosities, extreme tenderness of the plantar surfaces of the feet, or marked inward displacement and severe spasm of the tendo achillis on manipulation. Initially, during a September 1995 VA examination, the Veteran complained, in part, of intermittent pain in the arches, and the examiner attributed the arch pain to slight pes planus. In 1998, VA issued him custom molded inserts for pain associated with flat feet. During a June 2007 VA examination, another examiner characterized the Veteran’s pes planus as minimally symptomatic (some pain on palpation of the arch) with some midfoot sag and hindfoot valgus on weightbearing, but no calluses. He attributed a loss of motion and additional pain to the right great toe arthritis. During treatment visits from 2007 to 2013 and June 2010 and October 2011 VA feet examinations, the Veteran sometimes reported that his orthotics were too uncomfortable or ineffective, not alleviating his symptoms; other times he reported they worked. Doctors noted collapsed arches, mild flattening of the calcaneal pitch, associated pain on weight-bearing, pain to palpation on the bottom of the feet and along the medial band of the plantar fascia, and a swollen right foot, including secondary to plantar fasciitis. They characterized the pain as stable. One indicated there was no flat foot pain on manipulation, and the Achilles alignment was straight. The June 2010 VA examiner indicated that the Veteran had never had Achilles issues, corns or calluses and characterized the Veteran’s pes planus as stable. During this time period, when providers and examiners noted painful, limited motion, they attributed it to the arthritis, not the pes planus. In a July 2012 letter, the Veteran’s private podiatrist noted the Veteran’s history of chronic foot pain secondary to rigid pes planus deformities bilaterally and significant degenerative changes through the joints, including great toe joints bilaterally, with degenerative arthritic spurs and significant narrowing of joint space. He opined that these progressive problems would continue to deteriorate over time, leading to increased pain and limitation in the feet. Thereafter, the Veteran’s foot symptoms worsened but not to the extent warranting the assignment of a 50 percent rating for the pes planus and plantar fasciitis. As of December 2014, when he underwent another VA examination, the Veteran had achy pain in the mid plantar aspect of both feet, worse during flare-ups (after prolonged standing for two hours, relieved with rest), and pain accentuated on manipulation and use bilaterally, and his efforts at using orthotics constantly had reportedly failed at alleviating his symptoms. However, he was still able to walk one and a half miles, stand for 30 minutes aided by the orthotics, and work in a position not requiring prolonged standing or walking. The examiner specifically indicated that the Veteran did not have swelling, characteristic callouses, extreme tenderness on the plantar surfaces of his feet, marked deformity, marked pronation, marked inward displacement or severe spasm of the Achilles tendon on manipulation. During the Veteran’s most recent VA examination in July 2020, an examiner noted the same symptoms mentioned in December 2014 except for pain on manipulation of the feet. She also noted swelling on use on the right and limited, but not painful motion, and described these symptoms, including pain on weightbearing, increased during flare-ups, as functionally limiting. She specifically indicated that the Veteran did not have characteristic callouses, extreme tenderness on the plantar surfaces of his feet, marked deformity, marked pronation (characterized pronation as mild bilaterally), marked inward displacement or severe spasm of the Achilles tendon on manipulation. The Veteran’s pes planus and related plantar fasciitis are severe, not pronounced, manifesting as accentuated pain on manipulation and use, swelling on weightbearing, and flare-ups of more severe, functionally limiting pain. As the evidence indicates these conditions have not produced marked pronation, extreme tenderness on the plantar surfaces of his feet, marked inward displacement or severe spasm of the Achilles tendon on manipulation, it does not satisfy the criteria for a rating in excess of 30 percent for bilateral pes planus under DC 5276. The Board has considered whether a separate rating or ratings are assignable for the plantar fasciitis, a condition not listed in the rating schedule, under DC 5284, which governs ratings of other foot injuries. However, over the years, pain has been the only symptom attributed to the plantar fasciitis, and that symptom is contemplated in the 30 percent rating assigned the Veteran’s pes planus. As such, assigning any separate rating(s) for the plantar fasciitis would amount to pyramiding, which is prohibited. 38 C.F.R. § 4.14. The Board has also considered whether a separate rating may be assigned other foot symptoms noted during the course of this appeal. Esteban v. Brown, 6 Vet. App. 259 (1994) (veterans entitled to have all symptoms of their disabilities rated). The Veteran clearly has multiple foot disabilities, the symptoms of which VA examiners have had difficulty distinguishing from those caused by the pes planus and plantar fasciitis. However, these examiners have attributed the limited and sometimes painful motion loss and stiffness shown during examinations to arthritis and/or gout affecting the toes, the former of which is separately service connected, the latter of which has not been associated with the Veteran’s pes planus and/or plantar fasciitis. In August 2016, the Veteran underwent a VA examination of his great right toe exclusively, during which the examiner noted painful motion and stiffness. That disability is rated with hallux rigidus under DC 5003, which contemplates limitation of motion of the affected joint(s), and DC 5281. DC 5276, governing ratings of pes planus, does not contemplate motion loss, and neither the Veteran nor any medical professional has ever attributed motion loss to the pes planus or plantar fasciitis, a finding that might, depending on other facts, warrant a separate rating under a different DC. As the record stands, the 30 percent rating assigned the bilateral pes planus and plantar fasciitis contemplates all symptoms shown to be due to those conditions. REASONS FOR REMAND Entitlement to ratings in excess of 10 percent prior to November 27, 2019, and 30 percent from November 27, 2019, for residuals of a left knee injury, including degenerative joint disease Entitlement to ratings in excess of 10 percent prior to November 27, 2019, and 30 percent from November 27, 2019, for residuals of a right knee injury, including degenerative joint disease In May 2019, the Court remanded these claims to the Board, in part, to consider whether the Veteran was entitled to separate ratings under 38 C.F.R. § 4.71A, DC 5258, for dislocated semilunar cartilage with frequent episodes of locking, pain and effusion into the joint. The Board in turn remanded the claims to the AOJ for a VA examination of the Veteran’s knees, the findings of which resulted in the AOJ increasing the ratings assigned residuals of the Veteran’s left knee injury, including degenerative joint disease, to 30 percent and laxity of the right and left knees to 10 percent, and assigning separate 50 percent ratings for right and left knee limitation of extension and 0 percent ratings for residual surgical scars of the left and right knees, all effective from November 27, 2019, the date of the examination. VA examination reports and treatment records conflict regarding the severity of the Veteran’s knee disabilities prior to November 27, 2019. As such, without additional medical guidance, it is impossible for the Board to determine whether, prior to November 27, 2019, separate ratings are assignable under DC 5258, a determination the Court has requested, or any other pertinent DC. A VA medical opinion reconciling all pertinent information of record is thus needed. In addition, during this appeal, VA amended the criteria for rating musculoskeletal disabilities, effective from February 7, 2021. 85 Fed. Reg. 76464 (Nov. 30, 2020); 86 Fed. Reg. 8142 (Feb. 4, 2021). As the amendments affect DC 5010, one of the DCs pursuant to which the Veteran’s knee disabilities are rated, their applicability must be considered. Entitlement to ratings in excess of 10 percent from February 22, 2010 to May 18, 2011, and 30 percent, from May 19, 2011, for eczematous dermatitis with tinea versicolor In an August 2010 rating decision, the AOJ increased the noncompensable rating assigned the Veteran’s tinea versicolor to 10 percent. As noted above, within a year of that decision, in May 2011, the Veteran submitted new and material evidence that may be considered as having been filed in connection with the claims for increased ratings decided in August 2010, including the claim for a compensable rating for tinea versicolor. Thereafter, in a June 2013 rating decision, the AOJ increased the rating assigned the Veteran’s skin disability to 30 percent, but it did not issue a statement of the case in response to the May 2011 submission, action required under Manlincon v. West, 12 Vet. App. 238 (1999). This matter is remanded for the following action: 1. Transfer this case to a VA examiner for an opinion reconciling the conflicting evidence of record regarding the severity of the Veteran's left and right knee disabilities prior to November 27, 2019. 2. The examiner should review all pertinent documents of record, including: (a) reports of 2008 and 2009 knee surgeries; (b) treatment records dated since 2007, which note post-surgical residual knee symptoms, including pain, locking and effusion, and the continuous use of knee braces and a cane; (c) reports of VA examinations conducted from June 2007, June 2010, October 2011, March 2013, December 2014, November 2016 and November 2019; and (d) the Veteran’s medical histories reported during VA examinations and treatment visits and written statements he submitted in support of this appeal (summarized above). Based on this review, the examiner should describe the severity of the Veteran's left and right knee disabilities prior to November 27, 2019, including since 2009, after his second post-service knee surgery. The examiner should indicate whether, at any point since 2009, the Veteran has experienced knee subluxation, instability, laxity, locking, pain, effusion into the joint and/or limitation of flexion and/or extension. The examiner should explain the purpose for which the Veteran used braces and/or a cane during the course of this appeal, including whether instability, loose ligaments and/or a sliding kneecap played a role. The examiner should describe the severity of each symptom evident during the critical time period. Acknowledging the Veteran’s reports of flare-ups of knee symptoms, the examiner should indicate whether and to what extent (estimate in terms of degrees) such flare-ups produced additional loss of knee flexion and/or extension prior to November 27, 2019. Acknowledging the Veteran’s reports of knee symptoms, which were consistent during the entire appeal period, and contrasting the findings of the November 2016 and November 2019 VA examination reports, the examiner should address whether the Veteran’s knee disabilities worsened as extensively and abruptly as shown in November 2019, or whether they were more than 10 percent disabling prior to that time, as the Veteran alleges and treatment records suggest. The examiner should provide rationale for each opinion. 2. Issue a statement of the case addressing the claim of entitlement to a rating in excess of 10 percent for tinea versicolor. Notify the Veteran that he must perfect his appeal if he wants appellate review of this claim. 3. Readjudicate all claims properly prepared for appellate review. In so doing, determine the applicability of VA’s recently amended criteria for rating disabilities of the musculoskeletal system. 85 Fed. Reg. 76464 (Nov. 30, 2020); 86 Fed. Reg. 8142 (Feb. 4, 2021). Also determine whether, for the period preceding November 27, 2019, separate ratings are assignable under DC 5257, for knee subluxation or instability, DC 5258, for dislocated semilunar cartilage with frequent episodes of locking, pain and effusion into the joint, DC 5259, for symptomatic removal of semilunar cartilage, DC 5261, for limitation of extension, including during flare-ups and/or on repetitive use, and/or DC 7805, for post-surgical scarring on the knees. In issuing a supplemental statement of the case, notify the Veteran of the new criteria for rating disabilities of the musculoskeletal system. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. N. 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.