Citation Nr: 21021385 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 17-10 755A DATE: April 12, 2021 REMANDED Entitlement to a rating in excess of 10 percent prior to October 1, 2014, and in excess of 0 percent from that date, to include the propriety of a reduction in rating from 10 percent to 0 percent effective October 1, 2014, for left knee impairment rated pursuant to Diagnostic Code 5257 is remanded. Entitlement to a rating in excess of 10 percent prior to October 1, 2014, and in excess of 0 percent from that date, to include the propriety of a reduction in rating from 10 percent to 0 percent effective October 1, 2014, for right knee impairment rated pursuant to Diagnostic Code 5257 is remanded. Entitlement to a compensable rating for left distal tibia, status post fracture is remanded. Entitlement to service connection for an abdominal aorta suprarenal aneurysm is remanded. REASONS FOR REMAND The Veteran served in the United States Army from October 1972 to October 1975, and from January 1976 to January 1997. This appeal comes to the Board of Veterans’ Appeals (Board) from Department of Veterans Affairs (VA) rating decisions of the Agency of Original Jurisdiction (AOJ). The Veteran appeared before the undersigned Veterans Law Judge at a January 2021 teleconference Board hearing. A transcript of the hearing has been reviewed by the Board, and has been associated with the claims file. 1. Entitlement to a rating in excess of 10 percent prior to October 1, 2014, and in excess of 0 percent from that date, to include the propriety of a reduction in rating from 10 percent to 0 percent effective October 1, 2014, for left knee impairment rated pursuant to Diagnostic Code 5257 is remanded. 2. Entitlement to a rating in excess of 10 percent prior to October 1, 2014, and in excess of 0 percent from that date, to include the propriety of a reduction in rating from 10 percent to 0 percent effective October 1, 2014, for right knee impairment rated pursuant to Diagnostic Code 5257 is remanded. 3. Entitlement to an initial compensable rating for a left-tibia disability is remanded. At his January 2021 Board hearing, the Veteran claimed that his bilateral knee disabilities along with his left tibia disability have worsened. The Board notes that the Veteran’s medical record, in conjunction with his hearing testimony, suggests some worsening has occurred. A VA examination in December 2013 showed that, at the time, the Veteran only needed knee braces to assist in movement. A year later, in December 2014, a VA examination found that in addition to knee braces, the Veteran also utilized a cane as well as a shin guard for his left-tibia disability. At his January 2021 hearing, the Veteran stated that he now has to utilize a walker with a built-in seat, as his leg disabilities prevent him from walking for prolonged periods of time. The Veteran’s last VA examination regarding his bilateral knee and left tibia disabilities was in December 2014. Given the Veteran’s testimony, and the fact that it has been over 6 years since the last VA examination, a new examination is in order to assist the Veteran in developing his claim by obtaining more up-to-date and contemporary medical evidence. Green v. Derwinski, 1 Vet. App. 121 (1991); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 4. Entitlement to service connection for an abdominal aortal aneurysm is remanded. The Veteran asserts that his abdominal aortal aneurysm is due to his military service. Currently, there is no objective medical evidence that provides a link, or nexus, between the Veteran’s active duty service and his abdominal aortal aneurysm. However, in his March 2016 Notice of Disagreement (NOD), the Veteran reported that he was told by Dr. F., a non-VA vascular surgeon, that based on the rate of growth of the aneurysm the onset would have been in or around 1994, when the Veteran was on active duty. At his January 2021 Board hearing, the Veteran testified to the same. However, the etiology of a condition as medically complex as an abdominal aortal aneurysm can only be determined by a medical professional. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). As such, a remand is necessary to allow the Veteran additional opportunity to develop his claim. The matters are REMANDED for the following action: 1. The AOJ shall schedule the Veteran for a VA examination to determine the current severity of his bilateral knee and left tibia disabilities. All indicated tests should be conducted, including any diagnostic testing, and the reports of any such studies incorporated into the examination reports to be associated with the claims file. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disability under the applicable rating criteria. In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. The AOJ shall provide the Veteran with the opportunity to obtain, and submit, medical evidence from Dr. F. regarding the onset and/or growth of his abdominal aortic aneurysm. If necessary, the AOJ shall provide the Veteran with the necessary medical releases authorizing VA to obtain treatment records from any private physicians. 3. If the Veteran, or the AOJ, is unable to obtain the above-requested information from Dr. F., the AOJ shall schedule the Veteran for an examination to determine the etiology of the Veteran’s abdominal aortic aneurysm. The examiner shall be provided with a copy of the Veteran’s claims file, as well as a copy of these remand directives. The examiner shall provide the following opinion: (a.) Whether it is as least as likely as not the Veteran’s abdominal aortic aneurysm had its onset in or was otherwise due to his active duty military service. The examiner shall address the Veteran’s contentions regarding the rate of growth of the aneurysm and the purported onset date. The examiner must provide a complete rationale for all expressed medical opinions. If the examiner is unable to provide the required opinions without resorting to mere speculation, the examiner must explain why that is the case. S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Neville, 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.