Citation Nr: 21010888 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 16-47 963 DATE: February 26, 2021 ORDER 1. Service connection for left shoulder rotator cuff tendonitis is granted. 2. New and material evidence has been received to reopen a service connection claim for a right knee condition. REMANDED An increased rating in excess of 30 percent for service-connected migraine headaches is remanded. An increased rating in excess of 50 percent for service-connected bilateral plantar fasciitis with pes planus is remanded. A compensable rating for service-connected allergic rhinitis is remanded. Service connection for a right knee condition is remanded. Service connection for a right shoulder condition is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The Veteran has a current diagnosis of left shoulder rotator cuff tendonitis as a result of active service. 2. A May 2012 final rating decision denied the Veteran’s service connection claim for a right knee condition. 3. Evidence associated with the record since the final May 2012 rating decision is not cumulative and redundant of the evidence of record at the time of the decision and does raise a reasonable possibility of substantiating the Veteran’s service connection claim for a right knee condition. CONCLUSIONS OF LAW 1. The criteria for service connection for left shoulder rotator cuff tendonitis have been met. 38 U.S.C. §§ 1131, 1154(a), 5107; 38 C.F.R. § 3.303(a). 2. New and material evidence has been received to reopen the claim of entitlement to service connection for a right knee condition. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 2003 to January 2008. This matter comes before the Board of Veterans’ Appeals (Board) from August 2010 and June 2014 rating decisions issued by Department of Veterans Affairs (VA) Regional Offices (ROs). The Veteran testified at a January 2020 Board video-conference hearing before the undersigned Veterans Law Judge (VLJ). A copy of the hearing transcript is associated with the claims file. This matter has been advanced on the docket pursuant to 38 C.F.R. § 20.902(c). The Board notes that a statement of the case was issued for the Veteran’s service connection claims for the left shoulder and right shoulder in June 2013. Within 60 days of the issuance of the statement of the case, VA received correspondence from the Veteran, which stated that he was unhappy with VA’s decision on his claims and explained that VA examinations were missed through no fault of his own. He noted that the missed VA examinations were partly responsible for the denial of his claims. See July 2013 Correspondence. During the Veteran’s January 2020 Board hearing, he reported that he had been constantly appealing the service connection claims for the left shoulder and right shoulder. See January 2020 Hearing Transcript. The Board also notes that the June 2013 statement of the case suggests that missed VA examinations were partly responsible for the denial of the Veteran’s claims. See June 2013 SOC. Construing the correspondence in a liberal manner, the Board finds that this correspondence was a timely filed substantive appeal, and as such, the issues therein are properly before the Board. See 38 C.F.R. § 20.202 (2018) (a substantive appeal can be achieved through correspondence indicating that an appeal is being perfected for all issues denied in a statement of the case, and the Board should construe such arguments in a liberal manner). Additionally, the Board notes that during the pendency of the appeal, the RO granted a 50 percent disability rating for the Veteran’s service-connected bilateral plantar fasciitis with pes planus and did not include the issue in the most recent supplemental statement of the case. See July 2019 Rating Decision – Narrative; July 2019 SSOC. However, as the evidence suggests that the Veteran may be entitled to a higher benefit, the issue remains on appeal. See AB v. Brown, 6 Vet. App. 35 (1993). Finally, the Board notes that the Veteran filed an informal claim for service connection for a sleeping disorder. See September 2014 NOD; May 2017 Hearing Testimony. It does not appear that any development has taken place since 2017. The matter is referred to the RO. 1. Service connection for left shoulder rotator cuff tendonitis is granted. The Veteran believes that service connection for a left shoulder disability is warranted. See January 2020 Hearing Transcript. Generally, service connection will be granted if the evidence demonstrates that a current disability resulted from a disease or injury incurred in or aggravated by active service, even if the disability was initially diagnosed after service. 38 C.F.R. § 3.303. Direct service connection requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, the veteran will receive the benefit of the doubt. 38 U.S.C. § 5107; 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The first element of service connection is the existence of a current disability. The Veteran has a diagnosis of left rotator cuff tendonitis. See August 2017 C&P Exam. Therefore, the first element of service connection has been met. The second element of service connection is the in-service incurrence or aggravation of a disease of injury. A medical record from August 2017 stated that the Veteran’s service treatment records showed the left shoulder rotator cuff condition. Id. The Veteran reported that during service, he had to carry around heavy bags, which over time caused wear and tear on his left shoulder. During service, it got to the point that he could not lift the shoulder at times. Any time he put weight on his shoulders, it would re-trigger the problem. See January 2020 Hearing Transcript. Service treatment records show numerous entries for problems with the left shoulder. At least one entry showed an assessment of tendonitis rotator cuff. Another entry showed that the Veteran had a chronic illness of left shoulder impingement. See November 2013 STR – Medical – Photocopy; November 2013 STR - Medical. The Board finds the Veteran competent to make the above lay statements. The Board has no reason to doubt the Veteran’s credibility. The Board gives the lay statements great probative weight. See Layno v. Brown, 6 Vet. App. 465, 469-70 (1994). The Board also finds the medical evidence above highly probative. Therefore, the second element of service connection has been met. The third and final element of service connection is a causal relationship between the current disability and the injury incurred or aggravated during service. Evidence in favor of a causal relationship includes an August 2017 examination, which found that the Veteran’s left shoulder rotator cuff tendonitis was likely related to service. The rationale was that service treatment records showed the left shoulder rotator cuff condition. The examination listed numerous supporting entries from the service treatment records. See August 2017 C&P Exam. The Board notes that the examination included a review of the Veteran’s claims file. The Board finds the August 2017 examination highly probative because it reflects full consideration of the pertinent evidence of record and includes adequate rationale. Evidence against a causal relationship includes a February 2015 examination, which found that the left shoulder disability was not related to service. The rationale was that although there was a record of treatment during service, no chronic disability was shown by evidence of treatment since service and because there were no left shoulder complaints during a medical appointment in September 2014. See February 2015 C&P Exam. The Board notes that the examination did not include a review of the Veteran’s claims file; however, the Veteran’s VA treatment records were reviewed. The Board finds the February 2015 examination inadequate because it did not consider/was unable to consider all the relevant evidence of record. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Specifically, among other evidence, the examination did not consider/was unable to consider private treatment records from September 2014 showing significant left shoulder problems. See October 2014 Medical Treatment Record. This is significant because the examination’s opinion was largely based on the absence of left shoulder complaints in September 2014. As such, the Board finds the February 2015 examination inadequate and of low probative value. The Board finds that the evidence is at least in relative equipoise as to whether the Veteran’s left shoulder rotator cuff tendonitis is related to service. Therefore, giving the Veteran the benefit of the doubt, the third and final element of service connection is met. Service connection for left shoulder rotator cuff tendonitis is granted. 2. New and material evidence has been received to reopen a service connection claim for a right knee condition. To reopen a service connection claim, new and material evidence must be presented. See 38 U.S.C. § 5108. The Board determines whether it is proper to reopen a claim. See Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Evidence is new if it was not previously submitted to agency decision makers. Evidence is material if, alone or with previous evidence of record, it (1) relates to an unestablished fact necessary to substantiate the claim, or (2) would at least trigger VA’s duty to assist by providing a medical opinion. See 38 C.F.R. § 3.156(a); Shade v. Shinseki, 24 Vet. App. 110, 118 (2010). New and material evidence cannot be cumulative nor redundant of the evidence of record at the time of the last final denial and must raise a reasonable possibility of substantiating the claim. See 38 C.F.R. § 3.156(a). The Veteran’s service connection claim for a right knee condition was most recently denied in May 2012. See May 2012 Rating Decision – Codesheet. The Veteran was notified of the outcome and did not file a notice of disagreement within one year, nor was any additional evidence pertinent to the claim received within that time. The May 2012 rating decision became final based on the evidence then of record. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. § 20.1103. The Veteran seeks to reopen the service connection claim for a right knee condition. The May 2012 rating decision denied the Veteran’s previous service connection claim, in part, because the Veteran did not have a current diagnosis. See June 2012 Notification Letter. Since that last final rating decision, the evidence pertaining to a right knee condition includes an examination showing that the Veteran has current diagnoses of a right knee meniscal tear, a right knee anterior cruciate ligament tear, and right knee osteoarthritis. See August 2017 C&P Exam. Such evidence was not previously considered and relates to an unestablished fact necessary to prove the claim; namely, whether the Veteran has a current right knee condition. This evidence raises a reasonable possibility of substantiating the claim. As such, the evidence is both new and material, and the Board finds that the reopening of this claim is warranted. REASONS FOR REMAND 1. An increased rating in excess of 30 percent for service-connected migraine headaches is remanded. The Veteran believes that an increased rating for service-connected migraine headaches is warranted. See January 2020 Hearing Transcript. In January 2020, the Veteran reported that his migraine headache disability had worsened during the last couple of years. Specifically, two years ago, the Veteran did not have problems with being in front of a computer screen, but now because of sensitivity to light, it had become a problem for him. Id. The Veteran’s last migraine headache examination took place in August 2017. See August 2017 C&P Exam. Given the amount of time since the last migraine headache examination and the potential worsening of the Veteran’s disability, the current medical evidence of record is insufficient for rating purposes. Therefore, a remand is needed for a contemporaneous examination. See Colvin v. Derwinski, 1 Vet. App. 171, 175 (1991). 2. An increased rating in excess of 50 percent for service-connected bilateral plantar fasciitis with pes planus is remanded. The Veteran believes that an increased rating for service-connected bilateral plantar fasciitis with pes planus is warranted. See January 2020 Hearing Transcript. In January 2020, the Veteran reported that his bilateral plantar fasciitis with pes planus had worsened. Balance was a problem, and he fell often. His feet had become stiffer and tighter. At least a few times each week, he also had something resembling cramps, which prevented him from moving his whole foot and his foot would just lock up. There was a problem with blood flow. His toes ached and were inflamed. The Veteran now had gout. Id. The Veteran’s last bilateral plantar fasciitis with pes planus examination took place in August 2017. See August 2017 C&P Exam. Given the amount of time since the last bilateral plantar fasciitis with pes planus examination and the potential worsening of the Veteran’s disability, the current medical evidence of record is insufficient for rating purposes. Therefore, a remand is needed for a contemporaneous examination. See Colvin, 1 Vet. App. at 175. Additionally, an examination is needed to determine whether any reported injuries to the Veteran’s head, eye, and/or skin, were related to or aggravated by his service-connected bilateral plantar fasciitis with pes planus. The current medical evidence of record is insufficient to decide whether a separate rating is warranted for these problems. Id. 3. A compensable rating for service-connected allergic rhinitis is remanded. The Veteran believes that a compensable rating for service-connected allergic rhinitis is warranted. See January 2020 Hearing Transcript. In January 2020, the Veteran reported that his allergic rhinitis had now gotten to the point where one nostril felt closed off on the left side and it felt like he was only breathing through one nostril. The left nostril may have collapsed because the Veteran was constantly sneezing and inhaling. Id. The Veteran’s last allergic rhinitis examination took place in August 2017. See August 2017 C&P Exam. Given the amount of time since the last allergic rhinitis examination and the potential worsening of the Veteran’s disability, the current medical evidence of record is insufficient for rating purposes. Therefore, a remand is needed for a contemporaneous examination. See Colvin, 1 Vet. App. at 175.   4. Service connection for a right knee condition is remanded. The Veteran believes that service connection for a right knee condition is warranted. See January 2020 Hearing Transcript. Direct service connection requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden, 381 F.3d at 1167. The first element of service connection is the existence of a current disability. The Veteran has current diagnoses of a right knee meniscal tear, a right knee anterior cruciate ligament tear, and right knee osteoarthritis. See August 2017 C&P Exam. Therefore, the first element of service connection has been met. The second element of service connection is the in-service incurrence or aggravation of a disease or injury. The Veteran reported that he injured the right knee during service when he jogged into holes and on unstable surfaces. He received treatment for the right knee from August 2007 on. See February 2010 VA 21-526. Service records show that the Veteran was injured when he stepped into a hole during PT, suffered from knee pain from a series of shipboard accidents, and had an assessment of knee pain. See November 2013 STR – Medical – Photocopy. Therefore, the second element of service connection has been met. However, there currently is no medical opinion concerning a causal relationship. VA must make reasonable efforts to assist a claimant in obtaining a medical opinion when it is necessary to substantiate the claim for a benefit. See De La Rosa v. Peake, 515 F.3d 1319, 1322 (Fed. Cir. 2008); 38 U.S.C. § 5103A. Therefore, a remand for an examination is needed. See McLendon v. Nicholson, 20 Vet. App. 79, 81 (2006). 5. Service connection for a right shoulder condition is remanded. The Veteran believes that service connection for a right shoulder condition is warranted. See January 2020 Hearing Transcript. Direct service connection requires competent evidence showing: (1) the existence of a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the disease or injury incurred or aggravated during service. See Shedden, 381 F.3d at 1167. The first element of service connection is the existence of a current disability. The Veteran has a current diagnosis of right shoulder rotator cuff tendonitis. See August 2017 C&P Exam. Therefore, the first element of service connection has been met. The second element of service connection is the in-service incurrence or aggravation of a disease or injury. The Veteran reported that during service, he had to carry around heavy bags, which over time caused wear and tear on his right shoulder. During service, it got to the point that he could not lift the shoulder at times. Any time he put weight on the shoulders, it would re-trigger the problem. See January 2020 Hearing Transcript. The Veteran also reported that he was treated for the right shoulder from August 2006 on. See February 2010 VA 21-526. Service treatment records show a right shoulder injury and a painful right shoulder rotator cuff. Another entry showed a diagnosis of right shoulder pain from rotator cuff tendonitis. See November 2013 STR – Medical – Photocopy; November 2013 STR - Medical. However, there currently is no medical opinion concerning a causal relationship. VA must make reasonable efforts to assist a claimant in obtaining a medical opinion when it is necessary to substantiate the claim for a benefit. See De La Rosa, 515 F.3d at 322; 38 U.S.C. § 5103A. Therefore, a remand for an examination is needed. See McLendon, 20 Vet. App. at 81. 6. A TDIU is remanded. The Veteran believes that a TDIU is warranted. See January 2020 Hearing Transcript. The Board finds that the TDIU issue is inextricably intertwined with the other issues being remanded herein.  See Parker v. Brown, 7 Vet. App. 116 (1994).  As favorable action on the remanded issues could potentially result in the award of a TDIU, the TDIU issue is deferred until the requested development has been completed.  Id.  Additionally, the most recent written employment documentation provided by the Veteran years ago stated that the Veteran had not worked since 2014 and that the Veteran had not attempted to get a job since that time. See September 2014 VA 21-8940. However, since then, the Veteran has reported that he stopped working sometime in either 2016 or 2017. See January 2020 Hearing Transcript. A remand will allow the Veteran an opportunity to provide updated information on his employment history as well as other relevant information. The matter is REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any relevant outstanding private and/or VA treatment records, including treatment records from Kaiser Permanente and from a private doctor in Lakewood. After obtaining any necessary authorizations from the Veteran, make all reasonable attempts to obtain the outstanding records in accordance with 38 C.F.R. § 3.159. 2. Update VA and private treatment records. VA treatment records appear current up to September 2017. 3. Provide the Veteran with a new VA Form 21-8940 with instructions that updated information should be provided in order to assist with the adjudication of the TDIU issue. Complete any additional development indicated by the information on the returned form. 4. Ask the Veteran to provide IRS tax returns for the years he claims he has been unable to obtain and maintain substantially gainful employment due to service-connected disabilities (from 2010 to the present) and a statement that the copy is an exact duplicate of the return filed with the IRS. Provide the Veteran with an IRS Form 4506-T “Request for Transcript of Tax Return” which may also be found at https://www.irs.gov/pub/irs-pdf/f4506t.pdf so that the Veteran may request tax returns and submit them to VA. Tell the Veteran that if he does not have copies of his tax returns for the requested years, he may use the IRS form cited to above. 5. Schedule one or more appropriate VA examinations to determine the current nature and severity of the Veteran’s service-connected migraine headaches and allergic rhinitis. The examiner should also consider the impact that the Veteran’s migraine headaches and allergic rhinitis may have on the Veteran’s sleep; the impact that the Veteran’s migraine headaches may have on his vision problems, dizziness, and neck pain; and the impact that the Veteran’s allergic rhinitis may have on his hearing/ear problems. The claims file and a copy of this Remand should be made available to and reviewed by the examiner. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s service-connected migraine headaches and allergic rhinitis. This should also include all symptoms and related impairment that would be present without the relief provided by medications used to treat the disabilities. This should also include the impact that the Veteran’s migraine headaches and allergic rhinitis may have on the Veteran’s sleep; the impact that the Veteran’s migraine headaches may have on his vision problems, dizziness, and neck pain; and the impact that the Veteran’s allergic rhinitis may have on his hearing/ear problems. After a review of the record on appeal and an examination of the Veteran, the examiner is asked to provide the following opinions: (A) Identify all disabilities related to the Veteran’s service-connected migraine headaches and allergic rhinitis existing at any point during the pendency of the appeal (i.e. since February 2010) even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) The Veteran is also claiming that his service-connected migraine headaches and allergic rhinitis are interfering with his sleep; that his migraine headaches are impacting his vision problems, dizziness, and neck pain; and that his allergic rhinitis is impacting his hearing/ear problems. Identify all disabilities related to these complaints existing at any point during the pendency of the appeal (i.e. since February 2010) even if they are currently asymptomatic or have resolved during the pendency of the appeal. (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by or aggravated by the Veteran’s service-connected migraine headaches and/or allergic rhinitis? For aggravation, state whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. In addition to the other relevant evidence of record, the examiner is asked to consider the following information with a caution that this list is not a substitute for a review of the record: (1) The Veteran’s 2020 report of the current symptoms of his migraine headaches and allergic rhinitis and his belief that they were affecting his sleep. The Veteran also believed that his migraine headaches affected his dizziness. See January 2020 Hearing Transcript. (2) The Veteran’s 2016 report that there may be a relationship between his allergic rhinitis and ear/hearing problems. See September 2016 Form 9. (3) 2014 medical records showing the Veteran’s report that his migraine headaches were causing neck pain. See October 2014 Medical Treatment Record. (4) The Veteran’s 2014 report that his migraine headaches affected his vision. See September 2014 NOD. (5) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran’s documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community’s knowledge or the limits of the examiner’s medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 6. Schedule one or more appropriate VA examinations to determine the current nature and severity of the Veteran’s service-connected bilateral plantar fasciitis with pes planus. This should include all symptoms and related impairment that would be present without the relief provided by medications used to treat the disabilities. This should also include, but is not limited to, any muscle injuries and any neurological impairments. The examiner should also consider the impact that the Veteran’s bilateral plantar fasciitis with pes planus may have on the Veteran’s head, eyes, skin, blood flow, legs, and gout. The claims file and a copy of this Remand should be made available to and be reviewed by the examiner. Any studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s service-connected bilateral plantar fasciitis with pes planus. This should include, but is not limited to, any muscle injuries and any neurological impairments. The severity of any muscle injuries (i.e. slight, moderate, moderately severe, or severe) and the severity of any neurological impairments (i.e. mild, moderate, severe incomplete paralysis, or complete paralysis of the affected nerves) should be assessed. Identify the specific muscle groups associated with any muscle injuries and identify the specific nerves associated with any neurological impairments. This should also include the impact that the Veteran’s bilateral plantar fasciitis with pes planus may have on the Veteran’s head, eyes, skin, blood flow, legs, and gout. The examiner should also provide range of motion measurements in degrees. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing. If there is evidence of pain on motion, the examiner should indicate the degree of range of motion at which such pain begins. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain why in the report. The examiner must comment on the functional limitations caused by repetitive use over time and flare-ups due to the Veteran’s bilateral plantar fasciitis with pes planus disability. The examiner must indicate whether, and to what extent, the Veteran’s range of motion is additionally limited after repetitive use over time and during flare-ups in terms of degrees, if possible. If it is not possible, the examiner should explain why, making clear that all procurable and assembled data (i.e., the information regarding frequency, duration, characteristics, severity, and/or functional loss related to repetitive use over time and flare-ups elicited from the Veteran) was considered, and that the medical community at large could not provide such an opinion without resorting to speculation. If it is not possible due to a deficiency in the record or a lack of personal medical knowledge, the examiner should state so. Any additional impairment on use or in connection with repetitive use over time and flare-ups should be described in terms of the degree of additional range of motion loss. If the Veteran states that the limitation on range of motion is variable, provide the range of variableness in terms of degrees. The examiner should specifically describe the severity, frequency, and duration of impairment after repetitive use over time and during flare-ups; name the precipitating and alleviating factors; and estimate, per the Veteran, to what extent, if any, such repetitive use over time and flare-ups affect functional impairment. This testing should be done regardless of whether the Veteran is tested after repetitive use over time or during a flare-up or not. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). After a review of the record on appeal and an examination of the Veteran, the examiner is asked to provide the following opinions: (A) Identify all disabilities related to the Veteran’s service-connected bilateral plantar fasciitis with pes planus existing at any point during the pendency of the appeal (i.e. since February 2010) even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) The Veteran is also claiming that his service-connected bilateral plantar fasciitis with pes planus is related to injuries to his head, eyes, and skin, as well as problems with blood flow, his legs, and gout. Identify all disabilities related to these complaints existing at any point during the pendency of the appeal (i.e. since February 2010) even if they are currently asymptomatic or have resolved during the pendency of the appeal. (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by or aggravated by the Veteran’s service-connected bilateral plantar fasciitis with pes planus? For aggravation, state whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. The examiner should also report whether any identified disabilities are a progression/worsening of the Veteran’s service-connected bilateral plantar fasciitis with pes planus. In addition to the other relevant evidence of record, the examiner is asked to consider the following information with a caution that this list is not a substitute for a review of the record: (1) The Veteran’s 2020 report that due to his service-connected bilateral plantar fasciitis with pes planus, he has a balance problem and falls often. In October 2019, he lost his balance and fell. The falls caused him to bang his head, bruise his eye, and have eye swelling. He also received some scars, scraped his knee, and had a gash under his nose. His feet are stiff and tight. He gets something like cramps where he can’t move his whole foot and it will just lock up. This happens often and varies with weather and movements. It happens at least a few times per week. His feet hurt and are tender. He cannot stand for long periods of time. His blood flow is messed up and causes pain. His toes generally ache. There is toe inflammation and gout. He is forced to shift his weight, which causes his leg to support him. The Veteran feels the strain from that over time. See January 2020 Hearing Transcript. (2) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran’s documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community’s knowledge or the limits of the examiner’s medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 7. Schedule one or more appropriate VA examinations for the Veteran’s right knee and right shoulder conditions. The need for an in-person examination of the Veteran is left to the discretion of the examiner. Following a review of the claims file and a copy of this Remand, the reviewing examiner is requested to furnish an opinion with respect to the following: (A) Identify all disabilities related to the Veteran’s right knee and right shoulder existing at any point during the pendency of the appeal (i.e. since February 2010 for the right shoulder and since July 2013 for the right knee), even if they are currently asymptomatic or have resolved during the pendency of the appeal. (B) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is related to the Veteran’s service? (C) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was caused by any or all of the Veteran’s service-connected disabilities (including any medications taken for the service-connected disabilities)? (D) For each identified disability, is it at least as likely as not (a 50 percent or greater probability) that the disability is/was aggravated beyond its natural progression by any or all of the Veteran’s service-connected disabilities (including any medications taken for the service-connected disabilities)? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (E) Is it at least as likely as not (a 50 percent or greater probability) that any or all of the Veteran’s service-connected disabilities (including any medications taken for the service-connected disabilities) caused or aggravated the Veteran’s obesity/being overweight including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (F) If yes, is it at least as likely as not (a 50 percent or greater probability) that the obesity/being overweight caused or aggravated any or all of the Veteran’s right knee and/or right shoulder disabilities including whether there is/was any incremental increase in disability or aggravation as a result of service? State whether there is/was a medically ascertainable increase in disability regardless of permanence. Any increase in disability should be described in terms of diagnosis, severity, and duration. The permanence of the aggravation is not at issue. (G) Is it at least as likely as not (a 50 percent or greater probability) that any right knee and/or right shoulder arthritis manifested to a compensable degree within one year following the Veteran’s separation from service? If so, which ones? In addition to the other relevant evidence of record, the examiner is asked to consider the following information with a caution that this list is not a substitute for a review of the record: Right knee (1) A list of the Veteran’s service-connected disabilities. Additionally, as stated above, the Veteran is now service connected for left shoulder rotator cuff tendonitis. See July 2019 Rating Decision – Codesheet. (2) The Veteran’s 2020 report that the right knee was first injured during service, that there were additional injuries to the right knee during service, and that the right knee had been a problem ever since service. Further information is contained in this record. See January 2020 Hearing Transcript. (3) 2017 medical records showing the Veteran’s report of multiple right knee issues since service. See November 2017 CAPRI. (4) A 2017 medical record showing diagnoses of a right knee meniscal tear, a right knee anterior cruciate ligament tear, and right knee osteoarthritis. See August 2017 C&P Exam. (5) The Veteran’s 2017 report that his service-connected feet disabilities impact his right knee. During service, the Veteran started to feel the impact of the feet on his right knee, which eventually required right knee surgery. See May 2017 VA 21-4138. (6) 2014 medical records showing the Veteran’s report that during service he passed out and fell. See February 2017 CAPRI. (7) The Veteran’s 2016 report that the right knee was treated during service and continued to be treated. There was medical documentation of treatment during service and during the transition out of service. People in service saw the right knee problem. Many doctors have stated that the right knee disability is due to his service-connected plantar fasciitis because of how the Veteran had to shift his weight on his feet, which created and added additional strain on his right knee. See September 2016 Form 9. (8) 2013 medical records showing that the Veteran first injured his right knee around 2007 when he was playing basketball and stepped on another player’s foot. See April 2015 Medical Treatment Record. (9) 2008 medical records showing right knee problems for months from multiple events. The Veteran had a diagnosis of a right knee sprain, probable internal derangement. One of the contributing factors was stepping on someone’s foot while playing basketball. Further information is contained in this record. See December 2014 Medical Treatment Record. (10) The Veteran’s 2014 report that since injuring the right knee during service, he had two surgeries and lots of physical therapy. See September 2014 NOD. (11) Service records showing a body mass index of 25.68, knee pain from a series of shipboard accidents, and an assessment of knee pain. See November 2013 STR – Medical; November 2013 STR – Medical - Photocopy. (12) The Veteran’s 2011 report that most of his medical information during service was not properly documented. There was also a problem with his separation examination. The military medical examiner seemed to disregard his statements about pain from injuries during service. See August 2011 Correspondence. (13) The Veteran’s 2010 report that the right knee was treated from August 2007 to the present and that the right knee was injured by combat exercises, jogging into holes, and from unstable surfaces during PT. See February 2010 VA 21-526. (14) All other relevant lay and medical evidence. Right shoulder (1) A list of the Veteran’s service-connected disabilities. Additionally, as stated above, the Veteran is now service connected for left shoulder rotator cuff tendonitis. See July 2019 Rating Decision – Codesheet. (2) The Veteran’s 2020 report about the situations that caused and then aggravated the right shoulder problems during service and that the right shoulder had been a problem ever since service. Further information is contained in this record. See January 2020 Hearing Transcript. (3) A 2017 medical record showing a diagnosis of right shoulder rotator cuff tendonitis. See August 2017 C&P Exam. (4) The Veteran’s 2016 report of right shoulder problems during service, the reasons for those problems, and certain treatments which were provided. The right shoulder was diagnosed with nerve pinching due to all the strenuous heavy lifting and carrying of various objects during service. See September 2016 Form 9. (5) 2015 medical records showing a history of right shoulder injuries in 2005. See July 2016 CAPRI. (6) A 2015 medical record showing the Veteran’s report of what caused his right shoulder problems during service, what he was told about the injury, and treatment that was given. See February 2015 C&P Exam. (7) Service records showing a painful right shoulder rotator cuff, a right shoulder injury, that the Veteran had or once had shoulder problems, a past medical history of right shoulder pain diagnosed as rotator cuff tendonitis, and a body mass index of 25.68. See November 2013 STR – Medical. (8) The Veteran’s 2011 report of right shoulder pain from service. Most of his medical information during service was not properly documented. He went to physical therapy from 2005 to 2008. He also had cortisone shots during service. There was also a problem with his separation examination. The military medical examiner seemed to disregard his statements about pain from injuries during service. See August 2011 Correspondence. (9) The Veteran’s 2010 report that the right shoulder rotator cuff was treated from August 2006 to the present. See February 2010 VA 21-526. (10) All other relevant lay and medical evidence. A complete rationale for all opinions offered should be provided. Address the Veteran’s documented history and assertions. All necessary tests and studies should be conducted. If the examiner cannot provide an opinion without resorting to mere speculation, the examiner should provide an explanation stating why. In so doing, the examiner should explain whether the inability to provide a more definitive opinion is due to the limits of the medical community’s knowledge or due to the limits of the examiner’s medical knowledge. The Veteran is competent to attest to factual matters of which the Veteran has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. 8. Readjudicate the issues on appeal. The AOJ should consider separate ratings, if warranted by the evidence of record, including but not limited to the Veteran’s sinusitis which was previous found to be caused by the Veteran’s service-connected allergic rhinitis. See February 2017 CAPRI. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Dougan, Associate 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.