Citation Nr: 21028421 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 13-21 780 DATE: May 11, 2021 ORDER Entitlement to service connection for depressive disorder as secondary to service-connected degenerative arthritis of the lumbar spine is granted. Entitlement to service connection for a left shoulder disorder, including osteoarthritis, is denied. Entitlement to service connection for a bilateral foot disability, to include pes planus with arthritis and as secondary to the right knee disability, is denied. Entitlement to an initial rating in excess of 10 percent prior to January 11, 2016 for chondromalacia patella of the right knee and in excess of 30 percent for a total right knee arthroplasty since March 1, 2017 is denied. Entitlement to a separate 20 percent rating for right knee semilunar cartilage, dislocated, with frequent episodes of locking, pain, and effusion in the right knee joint is granted effective May 31, 2011, subject to the regulations governing the award of monetary benefits. Entitlement to an initial 10 percent rating for bruxing habit/attrition with history of temporomandibular joint disorder (TMD) symptoms is granted effective October 31, 2011, subject to the regulations governing the award of monetary benefits. Entitlement to a 30 percent rating for bruxing habit/attrition with history of TMD symptoms is granted effective November 12, 2013, subject to the regulations governing the award of monetary benefits. Entitlement to special monthly compensation (SMC), based on the need for regular aid and attendance or at the housebound rate, is denied. REMANDED Entitlement to compensation under 38 U.S.C. § 1151 for left lower extremity deep vein thrombosis is remanded. Entitlement to compensation under 38 U.S.C. § 1151 for right lower extremity deep vein thrombosis is remanded. FINDINGS OF FACT 1. The Veteran's depressive disorder is proximately due to his service-connected degenerative arthritis of the lumbar spine. 2. The Veteran's left shoulder condition was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is attributable to intercurrent causes; and the disability is not otherwise etiologically related to an in-service injury or disease. 3. The Veteran's pes planus is not secondary to a service-connected right knee disability and is not otherwise related to an in-service injury or disease. 4. Prior to January 11, 2016, the service-connected right knee disability manifested at worst by flexion to 90 degrees and extension to 5 degrees. 5. From January 11, 2016 to February 28, 2017, the Veteran's right knee disability was totally disabling, and a 100 percent evaluation is already in effect. 6. Beginning March 1, 2017, the Veteran's service-connected right knee disability was manifested by intermediate degrees of residual weakness, pain, and limitation of motion with flexion to 125 degrees and normal extension. 7. The service-connected right knee disability manifested with a tear of the medial meniscus with frequent episodes of "locking," pain, and effusion throughout the period on appeal. 8. Prior to November 12, 2013, the service-connected bruxing habit/attrition with history of TMD symptoms resulted in an interincisal range from 30 to 34mm without dietary restrictions to mechanically altered foods. 9. Beginning November 12, 2013, the service-connected bruxing habit/attrition with history of TMD symptoms resulted in an interincisal range from 11 to 20mm without dietary restrictions to mechanically altered foods. 10. The Veteran was not, as the result of service-connected disabilities, with such significant disabilities as to be in need of regular aid and attendance and was not, by reason of service-connected disabilities, permanently housebound. CONCLUSIONS OF LAW 1. The criteria for service connection for depressive disorder as secondary to degenerative arthritis of the lumbar spine are met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 2. The criteria for service connection for a left shoulder disorder, including osteoarthritis, are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309 (2020). 3. The criteria for service connection for a bilateral foot disability, to include pes planus, are not met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.310 (2020). 4. Prior to January 11, 2016 the criteria for a rating in excess of 10 percent for right knee chondromalacia patella have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Code 5261 (2020). 5. The criteria for a separate 20 percent rating for right knee cartilage, semilunar, dislocated have been met beginning May 21, 2011. 38 U.S.C. §§ 1155, 5103, 5107 (2012); 38 C.F.R. § 3.159, 3.321, 4.3, 4.7, 4.10, 4.71a, Diagnostic Code 5258 (2020). 6. Beginning March 1, 2017, the criteria for a rating in excess of 30 percent for the right knee total arthroplasty have not been met. 38 U.S.C. §§ 1155, 5107(b) (2012); 38 C.F.R. §§ 4.7, 4.10, 4.71a, Diagnostic Code 5055 (2020). 7. Prior to November 12, 2013, the criteria for an initial 10 percent disability rating for bruxing habit/attrition with history of TMD symptoms have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.7, 4.150, Diagnostic Code 9905 (2020). 8. Beginning November 12, 2013, the criteria for an initial 30 percent disability rating for bruxing habit/attrition with history of TMD symptoms have been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.1-4.14, 4.40, 4.45, 4.59, 4.7, 4.150, Diagnostic Code 9905 (2020). 9. The criteria for special monthly compensation (SMC) based on the need for aid & attendance or housebound status have not been met. 38 U.S.C. §§ 1114 (l), (s) (2012), 5121; 38 C.F.R. §§ 3.350, 3.352 (2020). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served honorably in the United States Air Force from December 1981 to February 1986. In December 2015, the Veteran offered testimony as to the pending psychiatric, left shoulder, bilateral feet, TMD, and right knee appeals. A transcript of this proceeding has been associated with the record. In February 2021, the Veteran was informed that the Veterans Law Judge (VLJ) who presided over the December 2015 hearing was no longer with the Board, and offered a hearing before a different VLJ. On his August 2019 VA Form 9s, the Veteran also requested the opportunity to testify at an additional hearing for the pending SMC and § 1151 appeals. In March 2021, the Veteran provided a written statement withdrawing his request for a hearing in this case. This sentiment was reiterated during a March 2021 call with VA. Upon these representations, it is found that the Veteran has not requested that a new hearing be held on the matters previously addressed in December 2015, and withdrawn his request for a hearing as to the SMC and § 1151 appeals. Accordingly, there are no outstanding hearing requests to be satisfied and the Board may proceed with its review of the matters on appeal. 38 U.S.C. § 7107(c); 38 C.F.R. § 20.707. Of note, the psychiatric, left shoulder, bilateral feet, TMD, and right knee appeals were previously remanded by the Board in June 2016 and October 2017 for additional development, which has since been completed. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Also in October 2017, the Board remanded a service connection claim for a left knee disability. Service connection for such a disability was subsequently awarded in an October 2020 rating decision. This award constitutes a complete grant of the service connection claim, such that this matter is no longer for the Board's consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997) (noting that a grant of service connection extinguishes appeals before the Board). Of final note, the Veteran is in receipt of a total disability rating based on individual employability (TDIU) from June 19, 2017. Thus, any future awards of service connection or increased ratings will bear no impact on his compensation payments. Service Connection Under the relevant laws and regulations, service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110. Generally, the evidence must show: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1166-67 (Fed. Cir. 2004); Caluza v. Brown, 7 Vet. App. 498, 505 (1995); see Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013) (noting that nexus may be demonstrated by a showing of continuity of symptomatology where the disability claimed qualifies as a chronic disease listed in 38 C.F.R. § 3.309(a)). Service connection may also be established on a secondary basis for a disability which is proximately due to, or the result of, a service-connected disability. 38 C.F.R. § 3.310(a). Secondary service connection may also be established for a disorder which is aggravated by a service-connected disability; compensation may be provided for the degree of disability (but only that degree) over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); Allen v. Brown, 8 Vet. App. 374 (1995). In order to prevail on the issue of secondary service connection, the record must show: (1) evidence of a current disability; (2) evidence of a service-connected disability; and (3) medical nexus evidence establishing a connection between the service-connected disability and the current disability. See Wallin v. West, 11 Vet. App. 509, 512 (1998); see also Allen, supra. 1. Entitlement to service connection for depressive disorder as secondary to the service-connected degenerative arthritis of the lumbar spine The Veteran contends that his acquired psychiatric disorder is related to service or alternatively related to his service-connected lumbar spine condition and right knee disability. The Board notes that this claim has been pending for 10 years and has been sent for numerous VA examinations. The Board apologizes for the prolonged process of deciding this claim. For the reasons set forth below, the Board finds that the evidence is at least in equipoise that the Veteran's diagnosis of a depressive disorder is secondary to his service-connected lumbar spine condition. With regard to a current disability, the evidence is conflicted. The October 2011 and July 2016 VA examiners opined the Veteran did not have a mental diagnosis. However, the private January 2016 examiner, and VA examinations in July 2016, February 2018, and September 2020, all found the Veteran had a diagnosis of a depressive disorder (some examiners noted major depressive disorder while others found unspecified depressive disorder). Further, the VAMC treatment records showed ongoing medication management and psychological services for the treatment of depression. Therefore, the Board finds that the first element of service connection has been established. The in-service element of service connection has also been met. At the December 2015 Board hearing, the Veteran testified that he began having mental health problems as a result of problems with his first sergeant. He stated he had to get a mental evaluation during service based on his alcohol abuse and fighting. He stated he had trouble meeting the weight standards due to his depression during service. The service treatment records (STRs) show the Veteran was sent for a psychological evaluation and weight management treatment during service. While the record does not establish that the Veteran received a mental diagnosis in service, nor does the Veteran allege he received a mental diagnosis in service, the Board finds that the preponderance of the evidence establishes that the second element of service connection has also been met. With regard to a direct nexus, the preponderance of the evidence is against the claim for service connection. The Veteran has alleged that conflict with his first sergeant resulted in trauma and mental health issues. The Veteran testified at the December 2015 Board hearing that he coped with mental health issues after service by turning to drugs, alcohol, food, and religion. The Veteran noted that he did not start receiving formal mental health treatment until many years after service. However, despite these assertions, no doctor has directly related the Veteran's mental health diagnosis to service. In February 2018, a VA examiner opined the Veteran's diagnosis was major depressive disorder. The examiner opined the totality of the evidence of record and the in-person interview did not show that the Veteran's current mental symptoms met the diagnostic criteria for any mental disorder that can be attributed to the Veteran's military service or other service-connected conditions. In September 2020, a VA examiner opined that the Veteran's unspecified depression was less likely than not related service and that the Veteran had attributed his depression to other causes. Accordingly, the preponderance of the evidence is against a finding of direct service connection. However, the question remains if there is a nexus between the Veteran's currently diagnosed depressive disorder and one of his service-connected conditions. In September 2020, a VA examiner opined that the Veteran's unspecified depression was less likely than not related service or to the service-connected right knee condition, as the Veteran attributed his depression to his back pain. The examiner noted that the Veteran did not currently meet the diagnostic criteria for major depressive disorder, but a review of the records show that the Veteran had attributed his depression to other causes. The Veteran attributed his depression to his back condition upon examination. The examiner noted that the Veteran's depression appeared to have at least some relationship to back pain. In November 2020, the September 2020 VA examiner provided an addendum opinion. The examiner opined that the Veteran has been diagnosed with unspecified depressive disorder but based on the totality of the record it is less likely than not that the Veteran's unspecified depressive disorder was related to or caused specifically by his degenerative arthritis of the lumbar spine or his right knee condition. The examiner opined there was no objective evidence of a specific relationship between the Veteran's depression and his right knee condition or lumbar spine condition. The examiner also opined there was insufficient evidence to state that the Veteran's depressive disorder was aggravated beyond its natural progression by any of the Veteran's service-connected conditions. The Board finds the September 2020 and November 2020 VA examiner's opinions are conflicting. The November 2020 addendum opinion states that the Veteran's depression cannot be objectively attributed to any of the Veteran's service-connected conditions, however, the same examiner stated two months earlier that the Veteran's depression was at least partially attributed to his service-connected back condition. The Board has considered remanding this claim for an additional VA examination. However, as the record is clearly indicative that the Veteran's depression is at least somewhat related to his service-connected lumbar spine condition. In light of the positive September 2020 VA medical opinion, the Board finds that the evidence is, at minimum, in equipoise regarding the question of whether the Veteran's depressive disorder is related to his service-connected degenerative arthritis of the lumbar spine 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303. The benefit of the doubt will be conferred in the Veteran's favor. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; see Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Having satisfied all elements of secondary service connection, the service-connection claim for a depressive disorder is granted. 2. Entitlement to service connection for a left shoulder condition The Veteran asserts that his left shoulder condition is related to active duty service. Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of left acromioclavicular joint osteoarthritis as evidenced by the July 2016 VA examination. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period and was not noted in service with attributable continuity of symptomatology. VA Medical Center (VAMC) treatment records show the Veteran was not diagnosed with osteoarthritis until after an injury to his shoulder in 2000, decades after his separation from service and outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of shoulder issues since the in-service shoulder injury and consistently since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of the in-service shoulder injury, as the Veteran has not demonstrated the necessary medical expertise. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). The Board acknowledges the Veteran's December 2015 Board hearing testimony in which he stated he received treatment for his left shoulder following service in June of 1987 at the Little Rock VAMC. The Board requested the Regional Office obtain the records of treatment in 1987, however, a request for those records indicated that the Veteran did not start receiving treatment at the Little Rock VAMC until July 1992. The Board does not call into question the veracity of the Veteran's testimony; however, the medical evidence of record does not show the Veteran sought treatment for a left shoulder condition until the early 2000s. The Board gives more probative weight to competent medical evidence, which establishes that these symptoms are instead attributable to the 2000 shoulder injury. The July 2016 VA examiner determined that the shoulder condition did not become chronic until many years after discharge and noted that there was no evidence of a chronic left shoulder impairment during service or immediately after discharge. The VA examiner noted that the Veteran did not seek treatment for a shoulder condition until early 2003-2004. The examiner opined the Veteran's shoulder condition was more likely than not related to the post-service injury. Further, VAMC treatment records attributed the symptoms of left shoulder pain and osteoarthritis to the Veteran's injury to the shoulder in 2000. The VAMC treatment notes specifically noted that the Veteran had trauma to the shoulder in the early 2000s and attribute his issues with his shoulder to that injury. See VAMC treatment dated April 2004, November 2004, and August 2005. Further, in November 2013, private treatment records indicate that the Veteran sought treatment for left shoulder pain. The Veteran acknowledged that he had fallen on his shoulder in the military but had never sought treatment. See November 2013 private treatment. Service connection for a left shoulder condition may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran's left shoulder condition and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The October 2011 VA examiner opined that the Veteran's left shoulder condition is not at least as likely as not related to an in-service injury, event, or disease, including the November 1985 shoulder injury. The rationale was that the Veteran did not seek treatment for a shoulder injury until 2003-2004, which is more likely related to his post-service injury shoulder injury in 2000. While the Veteran believes his left shoulder condition is related to the November 1985 treatment for a shoulder injury while playing football in service, he not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires specialized medical education. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Consequently, the Board gives more probative weight to the competent medical evidence. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran's left shoulder condition is related to his active service; rather, this condition is etiologically related to a post-service injury in 2000. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. 3. Entitlement to service connection for a bilateral foot disability, to include pes planus with arthritis and as secondary to the right knee disability The Veteran contends his bilateral foot disability, which has been diagnosed as pes planus, is related to service or alternatively secondary to his service-connected right knee disability. With regard to a present disability, an October 2011 diagnostic report showed bilateral pes planus. Thus, the first service connection element is met. In this respect, the Board acknowledges that the Veteran is seeking service connection for pes planus with arthritis. However, arthritis has not been diagnosed by a medical provider during the period on appeal, to include via x-ray imaging. Thus, a diagnosis inclusive of arthritis is not found, and presumptive service connection does not apply. With regard to an in-service disease or injury, the Veteran's STRs show the Veteran was sent to the podiatry clinic in February 1985. At the December 2015 Board hearing, the Veteran testified that he was treated for flat feet in 1985 and given arch supports. Accordingly, the second service connection element is also met. Turning to nexus, the evidence of record does not support that the Veteran's current bilateral foot disability is etiologically related to his active service. In October 2011, a VA examiner opined the Veteran's bilateral pes planus was less likely than not related to service. The examiner noted the Veteran had an avulsion of the great toenail in service, but it appeared to be healed after its initial treatment. The examiner noted that the records were silent concerning his feet except for cellulitis of his foot secondary to diabetes and the toenail removal secondary to onychomycosis. The examiner noted that the Veteran stated he had arch supports in service, however found that since there was no documentation of the arch supports in the record that it would be mere speculation to relate the Veteran's current disability to the alleged arch supports. In July 2016, a VA examiner opined the Veteran's bilateral pes planus was less likely than not related to military service because there was no history of foot injury and there was no arthritis found on examination. In August 2020, the July 2016 VA examiner clarified that there was no evidence of arthritis in the feet during service and therefore the opinion that the current pes planus was not related to service was affirmed. In August 2016 and January 2017, the Veteran submitted statements regarding his claim for service connection for his bilateral foot disorder. The Veteran's own lay opinion in this matter (that his foot condition is related to service) is not probative evidence. Lay persons are competent to provide opinions on some medical issues; however, the diagnosis and etiology of a foot condition is complex and could have multiple possible causes and thus, falls outside the realm of common knowledge of a lay person. Kahana v. Shinseki, 24 Vet. App. 428 (2011); Jandreau v. Nicholson, 429 F.3d 1372 (Fed. Cir. 2007). The question remains if the Veteran's bilateral pes planus is secondarily related to one of his service-connected disabilities to include his right knee disability. In August 2020, a VA examiner opined that it is less likely than not that the Veteran's bilateral foot condition is related to or was aggravated beyond its natural progression by his service-connected right knee condition. The examiner found there was no objective evidence of a clinical correlation in the medical record. The examiner noted that documentation does not show abnormal gait, excessive stress, or abnormal body mechanics to a degree that would support this association. Accordingly, the Board finds that the weight of the evidence is against finding the Veteran's bilateral pes planus is related to his active service or secondary to his service-connected right knee disability. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. As the preponderance of the evidence is against the claim, further application of the benefit-of-the-doubt doctrine is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. The Board is grateful for the Veteran's honorable service, and this decision is not meant to detract in any way from such. Unfortunately, however, for the reasons and bases discussed above, the competent and probative evidence of record preponderates against a finding that the Veteran's left shoulder condition or bilateral pes planus are service-connected. Increased Ratings Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R. Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Disability of the musculoskeletal system is primarily the inability, due to damage or inflammation in parts of the system, to perform normal working movements of the body with normal excursion, strength, speed, coordination and endurance. The functional loss may be due to absence of part or all of the necessary bones, joints and muscles, or associated structures, or to deformity, adhesions, defective innervation, or other pathology, or may be due to pain, supported by adequate pathology and evidenced by visible behavior of the claimant undertaking the motion. Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as disabled. See DeLuca v. Brown, 8 Vet. App. 202 (1995). In addition, when assessing the severity of a musculoskeletal disability that, as here, is at least partly rated on the basis of limitation of motion, VA must also consider the extent to which the Veteran may have additional functional impairment above and beyond the limitation of motion objectively demonstrated, such as during times when his symptoms are most prevalent ("flare-ups") due to symptoms such as pain. See also 38 C.F.R. §§ 4.40, 4.45. 4. Entitlement to an initial rating in excess of 10 percent prior to January 11, 2016 for chondromalacia patella of the right knee and in excess of 30 percent for a total right knee arthroplasty since March 1, 2017 The Veteran contends he is entitled to higher ratings for his service-connected right knee impairment. Prior to January 11, 2016, the Veteran's right knee was rated as 10 percent disabling for chondromalacia patella under Diagnostic Code 5261. From January 11, 2016 to February 28, 2017 the Veteran's right knee was rated at 100 percent disabling for a total knee arthroplasty. Following the Veteran's 100 percent rating, the Veteran's right knee has been rated as 30 percent disabling under Diagnostic Code 5055 from March 1, 2017. Therefore, the Board will consider the propriety of the ratings before and after the period of a 100 percent disability rating following the Veteran's knee replacement. Knee disabilities are unique in the rating code, as they are one of a few orthopedic disabilities in which a Veteran may receive multiple ratings based on separate symptoms in the same joint. While the law generally prevents considering the same symptoms under various diagnoses to support separate ratings, some of the relevant Diagnostic Codes for the knee have been interpreted to apply to different functions of the knee, therefore warranting separate consideration. Specifically, the evidence may warrant separate ratings for limitation of flexion of the knee, limitation of extension of the knee, and lateral instability and recurrent subluxation of the knee. The Board will explore all possibilities in this case. Diagnostic Code 5260 rates based on limitation of flexion. When flexion of the leg is limited to 60 degrees, a noncompensable rating is warranted. When flexion is limited to 45 degrees, a 10 percent rating is warranted. Flexion limited to 30 degrees warrants a 20 percent rating, while flexion limited to 15 degrees warrants the maximum 30 percent rating. Diagnostic Code 5261 rates based on limitation of extension. That code provides that when extension is limited to 5 degrees, a noncompensable rating is assigned. Extension limited to 10 degrees warrants a 10 percent rating. When limitation of extension is at 15 degrees, a 20 percent rating is warranted. Extension limited to 20 degrees warrants a 30 percent rating. Extension limited to 30 degrees warrants a 40 percent rating. Lastly, extension limited to 45 degrees warrants the maximum, 50 percent rating. The diagnostic criteria applicable to recurrent subluxation or lateral instability is found at 38 C.F.R. § 4.71a, Diagnostic Code 5257. Under that code, slight impairment is assigned a 10 percent rating, moderate impairment a 20 percent rating, and severe impairment a 30 percent rating. Other Diagnostic Codes pertaining to the knee include Diagnostic Code 5258, under which a maximum 20 percent rating is warranted for dislocated semilunar cartilage with frequent episodes of locking, pain, and effusion into the joint. Diagnostic Code 5259 holds that symptoms due to the removal of the semilunar cartilage of either knee warrant a 10 percent rating, which is the maximum rating under the diagnostic code. Because Diagnostic Codes 5258 and 5259 have been interpreted as already contemplating limitation of motion of the knee generally (which means it contemplates limitation of flexion and extension), the law does not allow for a separate rating under Diagnostic Codes 5259 and 5260 and/or 5261, because that would be compensating the same limitation of motion more than once. The diagnostic criteria applicable to impairment of the tibia and fibula are found at 38 C.F.R. § 4.71a, Diagnostic Code 5262. Under that code, a 10 percent evaluation is warranted when malunion of the tibia and fibula is productive of slight knee or ankle disability. A 20 percent evaluation is warranted when malunion of the tibia and fibula is productive of moderate knee or ankle disability, and a 30 percent evaluation is warranted when such disability is marked. A 40 percent evaluation is warranted for nonunion of the tibia and fibula, with loose motion, requiring a brace. Additional diagnostic codes pertaining to the knee include Codes 5256 (for ankylosis) and 5263 (for genu recurvatum). These disorders are not shown during the periods on appeal and will not be assessed herein. Finally, the diagnostic criteria applicable to knee replacement (prosthesis) are found at 38 C.F.R. § 4.71a, Diagnostic Code 5055. PRIOR TO JANUARY 11, 2016 Turning to the evidence prior to the Veteran's total knee replacement in January 2016, the Veteran was seen for a VA examination in October 2011. Range of motion testing showed flexion to 120 degrees with pain beginning at 0 degrees. Extension was normal. Normal strength and joint stability were found. There was no history of recurrent patellar subluxation or dislocation. The examiner noted there was evidence of a meniscal tear with frequent episodes of joint pain. The Veteran reported flare ups of the knees which resulted in a decreased ability to walk. The examiner did not provide an opinion regarding additional limitations as a result of flare ups. In December 2013, private range of motion testing showed flexion to 120 degrees and extension to -5 degrees. In February 2014, A VA examination showed flexion to 100 degrees with pain beginning at 90 degrees. Extension was normal. After repetitive testing flexion was limited to 95 degrees with pain on movement and interference with sitting, standing, and weight bearing. Muscle strength testing and joint stability were normal. A meniscus condition with frequent episodes of joint pain was noted. No flare ups affecting the right knee were noted. VAMC records show ongoing treatment for right knee pain. In August 2014, the Veteran was noted to have arthritic-type pain with swelling and tenderness. In May 2014, no laxity or instability was found. He was noted to wear a knee brace for ambulation. In October 2014, range of motion testing showed right knee flexion to 95 degrees and extension to -5 degrees. In October 2015, treatment records noted that the Veteran's arthritis had progressed to the point that there would be no expected benefit from conservative treatment and a total knee replacement was recommended. In December 2015, the Veteran testified that he received surgery on his right knee because of instability. The Veteran testified his knee pops when he gets up and there is constant pain. The Veteran testified he wears a brace on his right knee almost all the time. In January 2017, the Veteran submitted a statement that prior to his total disability rating, his right knee warranted an increased rating due to lateral instability. The evidence of record demonstrates the Veteran's right knee disability has manifested with flexion to 90 degrees and extension to 5 degrees. Anything greater than 60 degrees of flexion is to be rated noncompensable under Diagnostic Code 5260. 38 C.F.R. § 4.71a. The Veteran was awarded a 10 percent disability evaluation on the basis of painful motion. Even with consideration of the Veteran's reported additional limitations due to flare ups, the Veteran's range of motion has not more nearly approximated the limitations of range of motion as required for the next higher, 20 percent rating. Accordingly, prior to January 11, 2016, an increased evaluation is not warranted. However, as noted above, in order to meet the standards for a separate compensable rating under Diagnostic Code 5258, the record must show evidence of a dislocated cartilage with frequent episodes of "locking," pain, and effusion. Affording the Veteran the full benefit of the doubt, the Board finds the record supports pain and effusion have been present throughout the period at issue. Thereby, Diagnostic Code 5258 provides a basis for a separate compensable rating beginning May 31, 2011. All possibly applicable diagnostic codes have been considered, but the Veteran could not receive a higher disability rating for his right knee during this period based on the evidence other than that which has already been established herein. See 38 C.F.R. § 4.71a. There is no evidence of ankylosis or impairment of the tibia or fibula per the VA treatment and examination reports. The right knee symptoms were generally consistent during the period prior to the Veteran's total knee replacement such that staged ratings are not appropriate. See Hart v. Mansfield, 21 Vet. App. 505 (2007). BEGINNING MARCH 1, 2017 Following the Veteran's total knee replacement, his right knee was rated under Diagnostic Code 5055. Diagnostic Code 5055 provides that prosthetic replacement of the knee joint warrants a 30 percent minimum rating. With intermediate degrees of residual weakness, pain or limitation of motion, the disability is to be rated by analogy to Diagnostic Codes 5256, 5261, or 5262. A 60 percent rating is warranted for chronic residuals consisting of severe painful motion or weakness in the affected extremity. Briefly, the Board notes that portions of the rating schedule addressing the musculoskeletal system were revised effective February 7, 2021. Although portions of Diagnostic Code 5055 were revised, these portions are not applicable to the instant case. Specifically, the criteria pertaining to an award of 60 percent under Diagnostic Code 5055 were not altered. As such, the criteria applied to this appeal remain intact, whether evaluated under the old or new regulations. Turning to the evidence following the Veteran's period of a total disability rating following his right knee replacement, he was afforded a VA examination in March 2018. The Veteran's range of motion in the right knee was all normal. There was evidence of pain on weight bearing. There was no additional functional loss after three repetitions. Muscle strength was normal and there was no evidence of ankylosis. There was no evidence of recurrent subluxation of lateral instability, but there was evidence of recurrent effusion. The Veteran reported flareups described as increased discomfort with prolonged walking or standing. The examiner declined to provide an opinion regarding functional limitations during flare ups. In September 2020, bilateral knee radiographs showed a total knee arthroplasty with well intact hardware and no evidence of loosening, migration, or periprosthetic fracture. There was trace suprapatellar joint fluid. VAMC treatment notes show the Veteran maintained full range of motion in his right knee. See April 2018 and October 2018 VAMC treatment. In October 2020, a VA examination showed flexion to 135 degrees and extension to 0 degrees with pain on extension. The Veteran reported flare ups which were described as sharp pain in the knee resulting in a limited ability to bend the knee. The examiner found the Veteran would be further limited in flexion to 125 degrees during a flare up. Muscle strength testing was normal and there was no evidence of ankylosis. There was no evidence of recurrent subluxation, lateral instability, or recurrent effusion. Given the foregoing, the Board finds that a rating in excess of the 30 percent rating assigned pursuant to Diagnostic Code 5055 is not warranted for the period beginning March 1, 2017. The VA examinations of record and the treatment records post-surgical history reflect consistent problems mild to moderate with pain and decreased mobility following his total right knee replacement. In order to warrant a rating in excess of 30 percent, the evidence would have to show chronic residuals consisting of severe painful motion or weakness in the right knee. The March 2018 and October 2020 VA examinations showed the Veteran maintained flexion to 135 degrees and normal extension. Even when considering his reports of pain during flare-ups, the Veteran was only additionally limited to 125 degrees of flexion. Further, the VAMC treatment notes indicated the Veteran maintained a full range of motion. Under Diagnostic Code 5055, the Veteran's disability may also be rated under analogy under Diagnostic Codes 5256, 5261, or 5262. However, the medical evidence of record does not demonstrate evidence of ankylosis, limitation of extension to 30 degrees, or an impairment of the tibia or fibula resulting in loose motion and requiring a brace. Thus, higher ratings are not warranted under any of these additional diagnostic codes. Accordingly, the Board finds that a rating in excess of 30 percent for right knee replacement is not warranted from March 1, 2017. In conclusion, the Board finds a separate 20 percent rating is warranted for semilunar cartilage dislocation with frequent episodes of pain and effusion beginning May 31, 2011. However, the preponderance of the evidence is against a rating in excess of 10 percent for chondromalacia of the right knee prior to January 11, 2016, and a rating in excess of 30 percent for right knee total replacement from March 1, 2017. In denying such ratings, the benefit of the doubt doctrine is not applicable. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7. 5. Entitlement to an initial compensable rating for bruxing habit/attrition with history of temporomandibular joint disorder (TMD) symptoms The Veteran contends his bruxing habit/attrition with a history of TMD symptoms warrants a rating in excess of the currently assigned noncompensable rating. The Veteran's jaw disability was evaluated in Diagnostic Code 9905-9913. Bruxing habit/attrition does not have a specific diagnostic code in the rating schedule. When a Veteran is diagnosed with an unlisted condition, it must be rated under an analogous diagnostic code. 38 C.F.R. §§ 4.20, 4.27. The diagnostic code is "built-up" by assigning the first two digits from that part of the schedule most closely identifying the part of the body involved and then assigning "99" for the last two digits for all unlisted conditions. Then, the disease is rated by analogy under a diagnostic code for a closely related disease that affects the same anatomical functions and has closely analogous symptomatology. Therefore, the Veteran's service-connected bruxing habit/attrition with a history of TMD symptoms was rated according to the analogous condition of TMD under Diagnostic Code 9905 and to the loss of teeth due to loss of substance of body of maxilla or mandible without loss of continuity under Diagnostic Code 9913. For the reasons set forth herein, the Board finds that the Veteran's bruxing habit/attrition with a history of TMD symptoms warrants a compensable rating under Diagnostic Code 9905. Under Diagnostic Code 9905, a 10 percent rating is warranted when the range of lateral excursion is limited from 0 to 4 millimeters (mm) or the inter-incisal range is limited to 31 to 40 mm; a 20 percent evaluation is applicable when the inter-incisal range is limited to 21 to 30 mm; a 30 percent rating is for contemplation when the inter-incisal range is limited to 11 to 20 mm; and a 40 percent rating is assigned when the inter-incisal range is limited to 0 to 10 mm. 38 C.F.R. § 4.150, Diagnostic Code 9905. Under Diagnostic Code 9913, a noncompensable rating is warranted where the loss of masticatory surface can be restored by suitable prosthesis. Where the lost masticatory surface cannot be restored by a suitable prosthesis: a 10 percent disability rating is warranted for the loss of all upper anterior teeth, all lower anterior teeth, or all upper and lower teeth on one side; a 20 percent disability rating is warranted for the loss of all upper and lower posterior or anterior teeth; a 30 percent disability rating is warranted for the loss of all upper or lower teeth; and a 40 percent disability rating is warranted for the loss of all teeth. 38 C.F.R. § 4.150, Diagnostic Code 9913. The ratings under Diagnostic Code 9913 apply only to bone loss through trauma or disease such as osteomyelitis and not to the loss of the alveolar process as a result of periodontal disease. Upon VA examination in January 2012, the Veteran reported soreness in his jaw during speaking and chewing. The Veteran was missing teeth numbers 3, 15, 19, and 31, which were replaceable by prosthesis and numbers 1, 16, 17, and 32 which were not replaceable. The average vertical excursion of the mandible was about 31mm. The initial measurement of excursion was 41.5mm. Right lateral excursion was 8 mm and left lateral excursion was 6mm. Both sides had pain, but it did not tend to increase with continuous movement. There was a loss of alveolar bond due to the loss of teeth and periodontitis. There was a loss of alveolar bone due to loss of teeth and periodontal disease. The examiner found the Veteran had the diagnoses of bruxing habit/attrition and a history of TMD. Upon private examination in November 2013, the Veteran's range of motion for moth opening was between 11 and 20mm. The Veteran's lateral excursion was greater than 4 mm. The examiner noted additional functional loss following repetitive use to include less movement than normal, weakened movement, pain on movement, and incoordination. The examiner noted the Veteran's TMD resulted in severe headaches. In December 2015, the Veteran testified that the Veteran's TMD resulted in headaches and a need to wear night guards throughout the day. The Veteran stated he took muscle relaxers for pain as well as Tylenol. Upon VA examination in July 2016, the Veteran reported constant pain. Right lateral excursion was 12mm and left lateral excursion was 11mm. Inter-incisal distance was to 25mm. The examiner noted the Veteran's range of motion would be the same during flare ups. The examiner also noted that the Veteran had pain opening past 20mm. After a review of the record, the Board finds that prior to November 12, 2013, a 10 percent rating is warranted. While the January 2012 VA examination showed the Veteran's maximum vertical interincisal range was 41.5mm, the Veteran's average interincisal range was 31mm considering reported pain following repetitions. Accordingly, the Board finds that the Veteran's pain warrants a compensable, 10 percent, rating. However, the evidence of record does not warrant a rating in excess of 10 percent. The Veteran was not shown to require dietary restrictions nor was he limited to a 21 to 29 maximum unassisted vertical opening as required for a higher, 20 percent, rating under Diagnostic Code 9905. Beginning November 12, 2013, the Board finds a 30 percent rating is warranted. The November 2013 private examination found the Veteran was limited to between 11 to 20mm vertical opening. Further, the July 2016 VA examination noted that the Veteran had pain opening past 20mm. However, the evidence of record does not warrant a rating in excess of 30 percent. The Veteran was not shown to required dietary restrictions nor was he limited to a 0 to 10mm maximum unassisted vertical opening as required for a higher, 40 percent, rating under Diagnostic Code 9905. Further, a higher rating is also not warranted under Diagnostic Code 9913. Under Diagnostic Code 9913, ratings for loss of teeth are warranted for bone loss through trauma or disease. The evidence of record has not shown the Veteran qualifies for a rating under this Diagnostic Code. Further, the Veteran's loss of teeth has not risen to the level for a compensable rating under this code. In sum, in light of the totality of the evidence and affording the Veteran the benefit of the doubt, a 10 percent rating is granted prior to November 12, 2013 and a 30 percent rating is granted effective thereafter. 6. Entitlement to special monthly compensation (SMC) based on the need for regular aid and attendance or at the housebound rate Special monthly compensation (SMC) is payable under 38 U.S.C. § 1114(l) if, as the result of a service-connected disability, the Veteran is so helpless as to be in need of regular aid and attendance of another person or is permanently bedridden. 38 U.S.C. § 1114(l); 38 C.F.R. § 3.350(b). Under 38 C.F.R. § 3.352(a), criteria for establishing such need include the following factors: (1) inability of the Veteran to dress or undress himself, or to keep himself ordinarily clean and presentable; (2) frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without such aid; (3) inability of the Veteran to feed himself because of the loss of coordination of upper extremities or because of extreme weakness; (4) inability to attend to the wants of nature; or (5) physical or mental incapacity which requires care or assistance on a regular basis to protect the Veteran from the hazards or dangers incident to his daily environment. It is not required that all of the disabling conditions enumerated in 38 C.F.R. § 3.352(a) be found to exist before a favorable rating may be made. The particular personal functions which the Veteran is unable to perform should be considered in connection with his condition as a whole. It is only necessary that the evidence establish that the Veteran is so helpless as to need regular aid and attendance, not that there is a constant need. 38 C.F.R. § 3.352(a); see Turco v. Brown, 9 Vet. App. 222, 224 (1996) (holding that at least one factor listed in § 3.352(a) must be present to grant special monthly compensation based on the need for aid and attendance). The Veteran contends that SMC is warranted based on his need for regular aid and attendance or on account of housebound status. The critical question to be determined in this case is whether the Veteran's service-connected disabilities have resulted in the need for regular aid and attendance of another person because of the resultant helplessness due to his mental and/or physical impairments. Based on a review of the record, the Board concludes that the criteria have not been met. Upon VA examination in February 2018, the Veteran stated that he enjoyed going to church and the movies. He stated that he enjoyed walking or riding a stationary bike in the past but cannot do those things any longer due to his weight. He stated that he goes to a kidney transplant meeting once per month. In June 2018, a VA examination for Housebound Status of Permanent Need for Regular Aid and Attendance was submitted by E.C., A.P.R.N., of the Central Arkansas Veterans Healthcare System. She noted that the Veteran was able to feed himself, but his caregiver prepared all meals. The Veteran did not need assistance in bathing and tending to other hygiene needs and did not require nursing home care. The Veteran was noted to receive medication and financial affairs management from his caregiver. He was noted to have difficulty ambulating but could leave his home at will. In August 2018, the Veteran requested assistance with aid and attendance noting that his wife cared for him and assisted with all of his activities of daily living and home care. Upon consideration of the evidence, the Board finds that the Veteran's service-connected disabilities did not result in the need for regular aid and attendance of another person because of resultant helplessness due to his service-connected mental and/or physical impairments. While the Veteran has been receiving assistance from his wife at home, the record shows that he is able to maintain his activities of daily living including feeding himself and personal hygiene. The medical records do not establish that the Veteran was permanently bedridden or was otherwise so helpless as to be in need of regular aid and attendance due to his service-connected disabilities; rather, he was able to leave the home at will to participate in various activities. Therefore, the Board finds that the preponderance of the evidence is against finding that the Veteran was in need of regular aid and attendance due to a service-connected disability. Insofar as the Veteran's representative argues that a June 2019 Statement of the Case (SOC) concedes that he is bedridden, the Board is not bound by this finding and instead, actively disagrees. See May 2020 representative's brief. A claimant is 'bedridden" when his or her condition, through its essential character, requires that they remain in bed. 38 C.F.R. § 3.352(a). At no time has a VA examiner concluded that the Veteran is bedridden due to his service-connected disabilities, nor is such a finding supported by the medical evidence. Per the Veteran's own admission, he remains capable of ambulating and performing certain activities without assistance. Thus, the notation of the SOC does not warrant a positive finding in this case, as the competent medical evidence weights entirely against such a conclusion. The Board has also considered entitlement to SMC pursuant to 38 U.S.C. § 1114(s); however, the criteria have not been met. SMC is payable under 38 U.S.C. § 1114(s) if the Veteran has a single service-connected disability rated as 100 percent and, (1) has additional service-connected disability or disabilities independently ratable at 60 percent, separate and distinct from the 100 percent service-connected disability and involving different anatomical segments or bodily systems, or (2) is permanently housebound by reason of a service-connected disability or disabilities. The second requirement is met when the Veteran is substantially confined, as a direct result of service-connected disabilities, to his dwelling and the immediate premises, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). An award of TDIU, if it based upon a single service-connected disability, is sufficient to satisfy § 1114(s) requirement of a service-connected disability rated as 100 percent disabling. Bradley v. Peake, 22 Vet. App. 280, 293 (2008); see also Buie v. Shinseki, 24 Vet. App. 242, 250 (2010); however, a TDIU rating that is based on multiple underlying disabilities cannot satisfy the § 1114(s) requirement of "a service-connected disability" because that requirement must be met by a single disability. Id. In this case, the Regional Office granted a TDIU from June 2017 based on the limitations stemming from the combination of the Veteran's service-connected disabilities. See March 2018 Rating Decision. Therefore, the TDIU was not granted based on a single disability, he does not have a single disability rated as 100 percent disabling, and he does not have a separate service-connected disability independently rated as 60 percent disabling. Therefore, he does not meet the legal criteria for payment of compensation at the housebound rate under that criterion. See 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350. Furthermore, as detailed above, the medical evidence does not show that the Veteran was housebound due to service-connected disabilities. The record indicates the Veteran can and does leave his house at will. Therefore, the Veteran does not qualify for special monthly compensation by reason of being housebound due to a service-connected disability. As the preponderance of the evidence is against this claim, reasonable doubt may not be resolved in the Veteran's favor. In sum, the Board finds that the Veteran is not, as the result of service-connected disabilities, with such significant disabilities as to be in need of regular aid and attendance and is not, by reason of service-connected disabilities, permanently housebound. As such, the Board concludes that the criteria for SMC based on the need for aid and attendance or housebound status have not been met. 38 U.S.C. §§ 1114(l), (s), 5121; 38 C.F.R. §§ 3.350, 3.352, 3.1000. Accordingly, entitlement to SMC based on the need for aid and attendance or housebound status is denied. Of final note, the Veteran has not raised any other issues, nor have any other issues been reasonably raised by the record, for the Board's consideration. See Doucette v. Shulkin, 28 Vet. App. 366, 369-370 (2017) (confirming that the Board is not required to address issues unless they are specifically raised by the claimant or reasonably raised by the evidence of record). REASONS FOR REMAND Although the Board regrets the delay, remand is required to ensure there is a complete record on which to decide the Veteran's remaining claims. 1. Entitlement to compensation under 38 U.S.C. § 1151 for left lower extremity deep vein thrombosis is remanded. 2. Entitlement to compensation under 38 U.S.C. § 1151 for right lower extremity deep vein thrombosis is remanded. Due to the similar nature of the claims for compensation under 38 U.S.C. § 1151 for bilateral lower extremity deep vein thrombosis, the claims have been discussed together herein. The Veteran seeks entitlement to compensation under 38 U.S.C. § 1151 for deep vein thrombosis (DVT) of the bilateral lower extremities. He contends that VA failed to properly treat his back pain in October 2016 and in so delaying treatment, he developed bilateral DVT and had to have surgery to remove blood clots. He further states that blood clots stopped his kidney transplant from working properly; a heparin drip caused him to bleed internally and have 7 pints of blood transfused; he had to get dialysis; developed an infection; and was under doctor care and suffering from October 2016 to January 2017. See January 2017 Veteran's Statement. Here, the record shows the Veteran was seen at the VAMC emergency room for complaints of back pain on October 1, 2016. On October 3, 2016, the Veteran called to ask for a pain management consultation. On October 7, 2016, a neurosurgery nurse informed the Veteran he would have to go through his primary care provider in order to receive a pain medication stronger than Tylenol. On October 8, 2016, the VAMC called the Veteran to find out what type of pain management was being requested, but there was no answer. On October 12, 2016, a pain management consult was requested by VA and a voicemail was left for the Veteran. On October 14, 2016, the Veteran called to say he had completed the x-rays on his back. On October 21, 2016, the Veteran went to the VAMC and requested pain medication. The nurse informed the Veteran that he would not be able to be seen by a physician until after his scheduled appointment. The Veteran reported he was going to go to the emergency room. On October 21, 2016, the Veteran was seen at the VAMC emergency department for a complaint of back pain. Upon discharge, the Veteran was noted to be stable with a pain level of 8. The Veteran was advised to stop taking codeine and start taking oxycodone. On October 22, 2016, the Veteran was seen at Baptist Health with a complaint of back pain. The Veteran was transferred to the University of Arkansas Medical Sciences (AUMS) Hospital due to his renal transplant with acute elevation of creatine. The record shows the Veteran was treated at UAMS Hospital from October 23, 2016. In May 2018, Dr. S.D. opined it was less likely than not that the claimed DVT and blood clots in the legs were caused by or became worse as a result of the VA treatment at issue, or that the additional disability resulted from the attending VA personnel's failure to follow the appropriate standard of care, or that the additional disability resulted from an event that could have not been reasonably foreseen by a reasonable healthcare provider, or that failure on the part of VA to timely diagnose and/or properly treat the claimed disability allowed the disability to continue or to progress. In August 2019, an independent medical examiner reviewed the Veteran's medical records and opined it was less likely than not that the Veteran's bilateral lower extremity DVT was caused by or became worse as a result of the VA treatment. The examiner noted the Veteran had multiple comorbid conditions which put him at risk for DVT. The examiner opined the Veteran's care met the standard of care and was appropriate and timely. The Board notes that neither the May 2018 nor the August 2019 examiners reviewed the events taking place in October 2016. Both examiners focus their discussion of the Veteran's DVT treatment to events from 2014 and 2015. Accordingly, an examiner has not addressed the Veteran's specific contentions that the Veteran's treatment in October 2016 resulted in the additional impairments caused by DVT. Accordingly, a remand is necessary to obtain a new medical opinion that considers the Veteran's allegations of a lack of proper VA care resulting in the complications of DVT in October 2016. The matters are REMANDED for the following action: Forward the record and a copy of this remand to a VA physician, qualified to provide the information requested below, for preparation of an opinion. Whether an additional in person examination is required is left to the examiner's discretion. The examiner should address the following questions: (a.) Provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that the treatment provided by the VA in October 2016 for the Veteran's back pain caused additional disability. The examiner should consider the October 2016 VA treatment records, which reflect that the Veteran called several times regarding his back pain. (b.) If the examiner determines that the October 2016 treatment, or lack thereof, caused additional disability, the examiner should offer an opinion as to whether the proximate cause of any such disability was the result of either (i) carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of the VA facility care or medical treatment or (ii) an event not reasonably foreseeable. [CONTINUED ON NEXT PAGE] (c.) The examiner should address the Veteran's contentions that he was denied proper treatment and testing when he presented for back pain in the emergency room in that the Veteran's blood clots and DVT should have been treated sooner. Kate E. Kovarovic Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Laura C. Owens 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.