Citation Nr: 21015060 Decision Date: 03/16/21 Archive Date: 03/16/21 DOCKET NO. 13-11 043 DATE: March 16, 2021 REMANDED Entitlement to a rating higher than 70 percent for a psychiatric disability is remanded. Entitlement to a rating higher than 40 percent for a thoracic spine disability is remanded. Entitlement to a rating higher than 30 percent for a left knee disability, on the basis of instability, is remanded. Entitlement to a rating higher than 10 percent for a left knee disability, on the basis of limitation of motion, is remanded. REASONS FOR REMAND The Veteran had active service from November 1983 to July 1987. These matters come to the Board of Veterans’ Appeals (Board) on appeal from a January 2011 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Houston, Texas. During the course of the appeal, an April 2018 rating decision established service connection for a left elbow disability, right elbow disability, left wrist disability, left foot disability, and chronic fatigue syndrome. As the benefit sought was service connection for those disabilities, the April 2018 rating decision represents a full grant of the benefits sought, and the issues of entitlement to service connection for a left elbow disability, right elbow disability, left wrist disability, left foot disability, and chronic fatigue syndrome are no longer before the Board. In April 2016, the Veteran had a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. The Veteran has subsequently requested the opportunity to testify at another videoconference hearing with the Board. However, the Veteran testified at the April 2016 Board hearing, and the evidence does not show any pressing reason or change in the facts or circumstances of the case since the April 2016 Board hearing. Cook v. Snyder, 28 Vet. App. 330 (2017). Furthermore, the Veteran has had ample opportunity to submit additional evidence after the last Board hearing and has done so on several occasions since. There is no indication that the decision to not provide an additional Board hearing would prejudice the Veteran in any way. Therefore, the request for another Board hearing is denied. 1. Entitlement to a rating higher than 70 percent for a psychiatric disability is remanded. 2. Entitlement to a rating higher than 40 percent for a thoracic spine disability is remanded. 3. Entitlement to a rating higher than 30 percent for a left knee disability, on the basis of instability is remanded. 4. Entitlement to a rating higher than 10 percent for a left knee disability, on the basis of limitation of motion is remanded. The Veteran last underwent VA psychiatric and orthopedic examination in April 2017. Since that time, he has consistently complained of increased symptoms. Symptoms such as depression, anxiety, and pain come to him through his senses and, therefore, require only personal knowledge rather than medical expertise to competently report. Layno v. Brown, 6 Vet. App. 465 (1994); Buchanan v. Nicholson, 451 F.3d 1331 (Fed. Cir. 2006). Lay testimony is competent to establish the presence of observable symptomatology. Layno v. Brown, 6 Vet. App. 465 (1994). Where the evidence of record does not show the current state of a Veteran’s disability, a more current VA examination must be conducted. Schafrath v. Derwinski, 1 Vet. App. 589 (1991); 38 C.F.R. § 3.327(a). In light of the increased symptomatology reported, remand is required to obtain updated treatment records and provide the Veteran more current VA examinations that indicate the current symptomatology of his disabilities. The matters are REMANDED for the following action: 1. With any necessary authorization from the Veteran, obtain any outstanding VA and private treatment records. All attempts to locate records must be documented in the claims file. 2. Schedule the Veteran for a VA examination to determine the current nature and severity of a psychiatric disability. The examiner should review the claims folder and should note that review in the report. The rationale for all opinions should be explained. All necessary tests and studies, to include psychological testing, if appropriate, should be accomplished and all clinical findings reported in detail. The examiner should identify the existence and severity of all current manifestations of the service-connected psychiatric disorder. The examiner should opine as to the levels of occupational and social impairment caused by a psychiatric disability and should describe the symptoms, to include the frequency and severity of symptoms, resulting in those levels of impairment. 3. Schedule the Veteran for a VA thoracolumbar spine examination conducted by a physician to assist in determining the current severity of the service connected thoracolumbar spine disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Provide ranges of motion for passive and active motion of the lumbosacral spine for weight bearing and non weight bearing. The examiner should specifically state at what degree any observed pain began and whether there is any additional loss of lumbosacral spine function due to painful motion, weakened motion, excess motion, fatigability, or incoordination. (b) Indicate whether, and to what extent, the Veteran experiences functional loss of the lumbosacral spine due to pain or any other symptoms during flare-ups or with repeated use. (c) State whether or not there is any ankylosis of any segment of the spine. (d) Identify the existence, and frequency or extent, as appropriate, of all neurological symptoms associated with the lumbar spine disability, to include radiculopathy. (Continued on the next page)   (e) State whether there have been any incapacitating episodes of intervertebral disc syndrome, periods of acute symptoms requiring bed rest prescribed by a physician and treatment by a physician, and the duration and frequency of any incapacitating episodes. 4. Schedule the Veteran for a VA joints examination to determine the current nature and severity of a service-connected left knee disability. The examiner must review the claims file and should note that review in the report. All appropriate tests and studies must be accomplished, and all clinical findings must be reported in detail. The medical and lay evidence of record should be taken into account and a rationale must be provided for any opinion expressed, to include reference to pertinent evidence where appropriate. For the both knees, the examiner should specifically state ranges of motion for active and passive motion and on weight bearing and non-weight bearing. The examiner should comment on whether there is any additional loss of function due to weakened movement, excess motion, incoordination, fatigability, pain on use, or on flare up for the left knee. The examiner should describe any claimed flare ups, to include the frequency and severity, and opine as to any additional functional loss on flare up. The examiner should describe the severity of any recurrent subluxation or lateral instability of the left knee and should specifically state whether or not recurrent subluxation or lateral instability is shown for the left knee. The examiner is requested to discuss the Veteran’s account of instability of the left knee. The examiner should identify whether the Veteran has had a complete or incomplete ligament tear of the left knee causing persistent instability. The examiner should identify whether the Veteran has been medically prescribed an assistive device or bracing for ambulation due to the left knee disability. The examiner should indicate if replacement of the left knee is medically indicated. The examiner should state whether or not there is any meniscal tear or removal and any symptoms resulting from meniscal pathology. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Layton, 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.