Citation Nr: 21026562 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 14-35 117 DATE: May 3, 2021 REMANDED Entitlement to a rating in excess of 20 percent for left leg shin splints is remanded. Entitlement to a rating in excess of 20 percent for right leg shin splints is remanded. Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a right wrist disability is remanded. Entitlement to service connection for a left knee disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service in the United States Air Force from January 1993 to December 1995. This matter comes before to Board of Veterans' Appeals (Board) from a July 2013 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously before the Board in May 2018. The Veteran timely appealed to the United States Court of Appeals for Veterans Claims (Court). In February 2019, the Court granted a Joint Motion for Partial Remand (JMPR) of these issues for further development and vacated, in part, the May 2018 Board decision regarding these issues. In July 2019, the Board remanded the claims for additional development. The Veteran also appealed the issue of entitlement to service connection for headaches. In a January 2021 rating decision, the RO granted service connection for headaches, which constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, that matter is no longer in appellate status. Regarding the claims for increased rating for bilateral shin splints, effective February 7, 2021, the Diagnostic Codes applicable to shin splints have changed. As pertinent to this issue, Diagnostic Code 5262 now includes specific rating criteria for medial tibial stress syndrome (MTSS), or shin splints and requires additional evidence, including length and type of treatment and responsiveness to treatment such as orthotics. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 20202) (to be codified at 4.71a, Diagnostic Code 5262). A VA examination regarding the Veteran's shin splints was provided in August 2020. While the examiner noted that the Veteran used compression sleeves for bilateral shin splint, the Board's review indicates that the examination report is silent regarding the duration of any treatment, and whether shin splints were responsive to surgery, orthotics or other conservative treatment. Remand for a new examination is therefore required to provide the necessary findings under the revised Diagnostic Code 5262. Regarding the bilateral wrist disabilities, the Board stated in its July 2019 Remand that the examiner must consider the Veteran's report of wrist pain in service and of being issued braces and pain medication for his wrists during service. The January 2020 examination report does not specifically address the Veteran's service treatment records but instead notes that there is "no mention of wrist pain in the 1628 pages provided." Moreover, the examiner failed to address the Veteran's lay contentions or provide an explanation as to whether the there is any medical reason to accept or reject the Veteran's testimony that his current wrist disability began in service, specifically that he developed carpal tunnel and tendonitis. Consequently, the examination report does not substantially comply with the remand directives, and an addendum opinion must be obtained. Stegall v. West, 11 Vet. App. 268, 271 (1998). Regarding the bilateral knee disabilities, the Board stated in its July 2019 Remand that the examiner must consider both direct and secondary service connection, including whether the claimed knee disabilities were caused or aggravated by the service-connected shin splints. The examiner was requested to provide a complete rationale with reference to clinical data or medical literature, as appropriate. The January 2020 examiner indicated that the bilateral knee disabilities were not caused or aggravated by the service-connected shin splints because the condition is quiescent. However, a review of the August 2020 examination report reflects that the Veteran's bilateral shin splints are symptomatic. Consequently, another remand is required for an addendum opinion. Stegall, 11 Vet. App. at 271. Regarding the claim for a TDIU, the Board notes that the Veteran met the schedular criteria for assignment of a TDIU for only a portion of the time period on appeal. However, resolution of the pending increased rating and service connection claims could impact the outcome of the Veteran's TDIU claim, meaning that the issues are inextricably intertwined. As the claim for a TDIU is intertwined with the other issues on appeal, it is also remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to determine the current nature and severity of his shin splits disability. The claim file should be made available to and reviewed by the examiner and the examination report should state a review of the file was completed. All findings should be reported in detail. The examiner should identify all shin splint pathology found to be present. The examiner should conduct range of motion studies. The joints involved (both ankle and knee) should be tested in both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should also identify the length and type of any treatment required and indicate whether shin splints were responsive to treatment. Findings pertaining to shin splints should comply with the newly enacted Diagnostic Criteria 5262 effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 4.71a, Diagnostic Code 5262) The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. If pain is noted, the point during range of motion at which pain starts must be clearly indicated. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. Submit the Veteran's claims file to the examiner who conducted the January 2020 wrist examination or an examiner with similar expertise. The examiner should review the claims file. The examiner should provide an opinion as to whether it is at least as likely as not (50 percent probability or more) that the Veteran's wrist disability is related to service. In so doing, the examiner must specifically consider the Veteran's report of wrist pain during service and being issued pain mediation and wrist braces. The examiner should discuss whether there is any medical reason to accept or reject the Veteran's testimony that his current wrist disability began in service, specifically that he developed tendonitis and carpal tunnel syndrome. A complete, well-reasoned rationale must be provided for any opinion offered. The examiner should reconcile any opinion with the service treatment and personnel records, any post-service diagnoses, lay statements, and testimony of the Veteran. 4. Submit the Veteran's claims file to the examiner who conducted the January 2020 knee examination or an examiner with similar expertise. The medical professional should consider and discuss the Veteran's lay testimony and assertions regarding any pertinent complaints and symptoms, including his assertion that the knee condition is due to his shin splints. A detailed explanation (rationale) is requested, including citing to supporting clinical data (and/or medical literature), as appropriate. The medical professional should respond to the following: (a) Is it at least as likely as not (a 50 percent or greater probability) that the Veteran's current knee condition began in (or is otherwise related to) service or began within one year of separation from service. (b) The medical professional should also provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current knee condition is proximately due to service connected disabilities, including shin splints. If not, the medical professional should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current knee condition is aggravated (permanently made worse) by one or more service connected disabilities. The examiner should state whether there was an increase in disability regardless of permanence, but medically ascertainable. Any increase in disability should be described in terms of diagnosis, severity, and duration. 5. Confirm that all medical opinions obtained comport with this remand, and undertake any other development determined to be warranted. 6. Then, readjudicate the issues on appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Cryan, 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.