Citation Nr: 21030293 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 17-21 396 DATE: May 18, 2021 ORDER The application to reopen a claim for service connection for a left knee disability is granted. The application to reopen a claim for service connection for gouty arthritis is granted. The appeal of the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for Guillain Barre Syndrome is dismissed. Service connection for a left knee disability, diagnosed as degenerative joint disease, is granted. Service connection for a left ankle disability, diagnosed as a lateral, collateral ligament sprain, is granted. REMANDED Entitlement to service connection for gouty arthritis is remanded. Entitlement to an increase in a 10 percent rating for low back degenerative disc disease and degenerative joint disease is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. At the December 2019 hearing before the Board, the Veteran withdrew his appeal concerning the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for Guillain Barre Syndrome. 2. The Veteran's left knee disability, diagnosed as degenerative joint disease, had its onset in service. 3. The Veteran's left ankle disability, diagnosed as a lateral, collateral ligament sprain, had its onset in service. CONCLUSIONS OF LAW 1. The criteria for withdrawal of the appeal of the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for Guillain Barre Syndrome have been met. 38 U.S.C. § 7105; 38 C.F.R. § 20.204. 2. The criteria for service connection for a left knee disability, diagnosed as degenerative joint disease, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. 3. The criteria for service connection for a left ankle disability, diagnosed as a lateral, collateral ligament sprain, have been met. 38 U.S.C. §§ 1101, 1110, 1112, 1113, 1131, 1137, 1154(a), 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309, 3.310. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the Army from August 1977 to July 1985. This matter is before the Board of Veterans' Appeals (Board) on appeal of a May 2015 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO) that determined that new and material evidence had not been received to reopen claims for entitlement to service connection for a left knee disability (listed as a left knee condition); Guillain Barre Syndrome; and for gouty arthritis. By this decision, the RO also denied service connection for a left ankle disability (listed as a left ankle condition). The RO further denied an increase in a 10 percent rating for low back degenerative disc disease and degenerative joint disease. The Board notes that the May RO decision found that new and material evidence had not been received to reopen claims for entitlement to service connection for a left knee disability; Guillain Barre Syndrome; and for gouty arthritis. The Board observes that service connection for a left knee disability (listed as a bilateral knee disorder) was previously denied in a final November 2008 Board decision. Additionally, service connection for Guillain Barre Syndrome and for gouty arthritis were last denied in a final February 2004 RO decision. Thus, the Board must address whether new and material evidence has been received to reopen the Veteran's claims for service connection for a left knee disability; Guillain Barre Syndrome; and for gouty arthritis. In December 2019, the Veteran appeared at a Board videoconference hearing before the undersigned Veterans Law Judge. The Board observes that in a July 2016 rating decision, the RO denied a claim for a TDIU. Although that rating action has not specifically been appealed, the Board observes that the United States Court of Appeals for Veterans Claims (Court) has held that a claim for a TDIU is part of an increased rating claim when such claim is raised by the record. Rice v. Shinseki, 22 Vet. App. 447 (2009). In this case, the Board finds that a TDIU is part of the claim for a higher rating on appeal. Additionally, the RO has listed the issue of entitlement to a TDIU in a March 2017 statement of the case and a February 2017 supplemental statement of the case. As discussed above, the Board observes that service connection for a left knee disability was previously denied in a final November 2008 Board decision. Additionally, service connection for gouty arthritis was last denied in a final February 2004 Board decision. The Board finds, however, that new and material evidence has been received to reopen those claims pursuant to 38 C.F.R. § 3.156(a). Therefore, this decision will address the merits of the underlying service connection claims for a left knee disability and for gouty arthritis disorder. The Board observes that the Veteran has appealed issues of entitlement to an initial higher (compensable) rating for bilateral hearing loss and entitlement to an initial rating higher than 10 percent for tinnitus. In a February 2020 VA Form 9, the Veteran requested that he be scheduled for a Board videoconference hearing, as to the issues of entitlement to an initial higher (compensable) rating for bilateral hearing loss and entitlement to an initial rating higher than 10 percent for tinnitus. The Board notes that the Veteran has not been afforded a Board videoconference regarding the issues of entitlement to an initial higher (compensable) rating for bilateral hearing loss and entitlement to an initial rating higher than 10 percent for tinnitus. Thus, those issue are not currently before the Board. 1. Withdrawn Claim The Board may dismiss any appeal that fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 19.55. Withdrawal may be made by the Veteran or by his or her authorized representative. 38 C.F.R. § 20.204. At the December 2019 Board hearing, the Veteran withdrew his appeal as to the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for Guillain Barre Syndrome. Thus, there remain no allegations of errors of fact or law for appellate consideration as to that issue. As such, the Board does not have jurisdiction to review the appeal, and the issue of whether new and material evidence has been received to reopen a claim for entitlement to service connection for Guillain Barre Syndrome is dismissed. 2. Left Knee Disability Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table). Determinations as to service connection will be based on review of the entire evidence of record, to include all pertinent medical and lay evidence, with due consideration to VA's policy to administer the law under a broad and liberal interpretation consistent with the facts in each individual case. 38 U.S.C. § 1154(a); 38 C.F.R. § 3.303(a). Secondary service connection may be granted for a disability that is proximately due to, the result of, or aggravated by an established service-connected disability. 38 C.F.R. § 3.310 (2015); see also Allen v. Brown, 7 Vet. App. 439 (1995). In making all determinations, the Board must fully consider the lay assertions of record. A layperson is competent to report on the onset and recurrence of symptoms. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can also be competent and sufficient evidence of a diagnosis or to establish etiology if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). When considering whether lay evidence is competent the Board must determine, on a case by case basis, whether the Veteran's particular disability is the type of disability for which lay evidence may be competent. Kahana v. Shinseki, 24 Vet. App. 428 (2011); see also Jandreau v. Nicholson, 492 F.3d at 1377 (Fed. Cir. 2007) (holding that "[w]hether lay evidence is competent and sufficient in a particular case is a factual issue to be addressed by the Board"). The Board is charged with the duty to assess the credibility and weight given to evidence. Madden v. Gober, 125 F.3d 1477, 1481 (Fed. Cir. 1997), cert. denied, 523 U.S. 1046 (1998); Wensch v. Principi, 15 Vet. App. 362, 367 (2001). Indeed, in Jefferson v. Principi, 271 F.3d 1072 (Fed. Cir. 2001), the United States Court of Appeals for the Federal Circuit (Federal Circuit), citing its decision in Madden, recognized that that Board had inherent fact-finding ability. Id. at 1076; see also 38 U.S.C. § 7104(a) (West 2002). Moreover, the United States Court of Appeals for Veterans Claims (Court) has declared that in adjudicating a claim, the Board has the responsibility to weigh and assess the evidence. Bryan v. West, 13 Vet. App. 482, 488-89 (2000); Wilson v. Derwinski, 2 Vet. App. 614, 618 (1992). As a finder of fact, when considering whether lay evidence is satisfactory, the Board may also properly consider internal inconsistency of the statements, facial plausibility, consistency with other evidence submitted on behalf of the Veteran, and the Veteran's demeanor when testifying at a hearing. See Dalton v. Nicholson, 21 Vet. App. 23, 38 (2007); Caluza v. Brown, 7 Vet. App. 498, 511 (1995), aff'd per curiam, 78 F.3d 604 (Fed. Cir. 1996). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The initial inquiry in determining probative value is to assess whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case. A review of the claims file is not required, since a medical professional can also become aware of the relevant medical history by having treated a Veteran for a long period of time or through a factually accurate medical history reported by a Veteran. See Id. at 303-04. The second inquiry involves consideration of whether the medical expert provided a fully articulated opinion. See Id. A medical opinion that is equivocal in nature or expressed in speculative language does not provide the degree of certainty required for medical nexus evidence. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). The third and final factor in determining the probative value of an opinion involves consideration of whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, 22 Vet. App. at 304; see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) ("[A] medical opinion... must support its conclusion with an analysis that the Board can consider and weigh against contrary opinions."). The Veteran is service-connected for pes planus of the left foot, with a calcaneal spur and posttraumatic arthritis. He is also service-connected for low back degenerative disc disease and degenerative joint disease; right ankle recurrent sprains, and degenerative joint disease; bilateral hearing loss; and for tinnitus. The Veteran contends that he has a left knee disability that is related to service. He specifically maintains that he was treated for left knee problems during service, which were caused by walking and running activities. The Veteran indicates that he was given a left knee brace during service. He essentially asserts that he suffered from left knee problems during service and since service. The Veteran served on active duty in the Army from August 1977 to July 1985. His DD Form 214 lists his occupational specialty as a medical specialist for seven years and six months. The Veteran's service treatment records show that he was treated for left knee problems on multiple occasions. An August 1977 treatment entry notes that the Veteran was seen for pain and a possible injury to the left leg, over the tibia, with an abrasion and sore spot. The examiner reported that x-rays show no abnormality, but that the Veteran has tenderness and mild erythema around the lesion. The examiner stated that the Veteran was provided with a gel cast and a Crece shoe. A February 1979 treatment entry indicates that the Veteran complained of chronic knee pain that was worse when running. The assessment was knee pain. An additional February 1979 treatment entry, the next day, reflects that the Veteran continued to have pain in his knees. The assessment was pain in the knees. A subsequent February 1979 entry notes that the Veteran was seen for chronic pain in the bilateral knees. The assessment was knee pain, chronic. A September 1982 objective examination report notes, as to diagnoses, that the Veteran had knee pain after exercise, with no history of an injury. The examiner reported that the Veteran would perform physical therapy and quad exercises. There was also a notation that the Veteran's lower extremities were normal. Post-service private and VA treatment records, including a VA examination report, show treatment for variously diagnosed left knee problems, including knee pain, and left knee degenerative joint disease, with normal stability. In a statement, received in November 2004, D. L. Lindzey, M.D., indicated that he had reviewed the Veteran's service treatment records. Dr. Lindzey maintained that it was his opinion that the Veteran's left knee condition, which he currently experienced, was at least as likely as not related to the left knee condition he experienced while on active duty in the Army. A November 2006 VA orthopedic examination report includes a notation that the Veteran's claims file was reviewed. The Veteran reported that he had throbbing pain at night in both knees, while sitting, with an eight out ten in intensity. He stated that he also had sharp pains on and off, with walking. The Veteran indicated that the sharp pains were very frequent, and occurred every few seconds, when he walked, with a nine out of ten in intensity. The Veteran reported that he used to complain of knee pain, repeatedly, during his military service. He maintained that the pain had continued throughout his life. He stated that he had no specific injuries to his knees. It was noted that there was decreased endurance due to weakness secondary to residuals of Guillain Barre Syndrome and diabetic peripheral neuropathy of the lower extremities. The examiner also stated that the Veteran had gouty arthritis that affected his joints, including his knees. The diagnoses included left knee degenerative joint disease, with normal stability. The examiner indicated that the Veteran had no specific injuries in service to explain the internal derangement on his right side. The examiner reported that the Veteran used to have pain in the knees, without swelling, during his military service. The examiner stated that the Veteran had recurrent gout attacks in both knees, and that he had Guillain Barre Syndrome. The examiner stated that both conditions, Guillain Barre Syndrome, which caused weakness in the weight bearing joints, and the gout attacks of the knees, which complicated degenerative joint disease later on, were more likely the cause of the Veteran's knee conditions. The examiner maintained that the Veteran's bilateral knee condition was less likely than not related to his military service. At a December 2019 Board hearing, the Veteran's wife reported that she had been with the Veteran for fifty years, including the whole time that he was in the service. She reported that the Veteran had suffered from left knee problems since service. The probative value of medical opinion evidence "is based on the medical expert's personal examination of the patient, the physician's knowledge and skill in analyzing the data, and the medical conclusion that the physician reaches.... As is true with any piece of evidence, the credibility and weight to be attached to these opinions [are] within the province of the adjudicators..." Guerrieri v. Brown, 4 Vet. App. 467, 470-71 (1993). The determination of credibility is the province of the Board. It is not error for the Board to favor the opinion of one competent medical expert over that of another when the Board gives an adequate statement of reasons or bases. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The Board observes that there are etiological opinions of record, as to the Veteran's claimed left knee disability, pursuant to a November 2006 VA orthopedic examination, and a statement, received in November 2004, from Dr. Lindzey. The November 2006 VA orthopedic examination report relates a diagnosis of left knee degenerative joint disease, with normal stability. The examiner, following a review of the claims file, indicated that the Veteran's left knee condition was less likely than not related to his military service. The examiner reported that the Veteran used to have pain in the knees, without swelling, during his military service. The examiner stated that the Veteran had recurrent gout attacks in both knees, and that he had Guillain Barre Syndrome. The examiner indicated that both conditions, Guillain Barre Syndrome, which caused weakness in the weight bearing joints, and the gout attacks of the knees, which complicated degenerative joint disease later on, were more likely the cause of the Veteran's knee conditions. The Board observes that it is unclear why the examiner related the Veteran's left knee problems to Guillain Barre Syndrome and gout attacks, but not to his pain in the knees during military service. Additionally, the examiner did not address the Veteran's reports of left knee problems during service and since service. The Veteran specifically reported, at the examination, that he used to complain of knee pain, repeatedly, during his military service, and that the pain had continued throughout his life. The Board observes that the Veteran is competent to report left knee problems during service and since service. See Davidson, 581 F.3d at 1313. Additionally, the Veteran served as a medical specialist during service. Therefore, the Board finds that the examiner's opinions, pursuant to the November 2006 VA orthopedic examination report, are not probative in his matter. A statement from Dr. Lindzey, received in November 2004, indicates that he had reviewed the Veteran's service treatment records. Dr. Lindzey maintained that it was his opinion that the Veteran's left knee condition, which he currently experienced, was at least as likely as not related to the left knee condition he experienced while on active duty in the Army. The Board observes that although Dr. Lindzey reported that he reviewed the Veteran's service treatment records, there is no indication that he reviewed the Veteran's entire claims file. Although claims file review is not necessary, the probative value of a medical opinion is based on its reasoning and its predicate in the record so that the opinion is fully informed. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). The Boards also notes that Dr. Lindzey did not specifically diagnose a current left knee disability, other than referring to a left knee condition. The Board notes, however, that Dr. Lindzey's opinion is more consistent with the evidence of record. Therefore, the Board finds that Dr. Lindzey's opinion is probative in this matter. See Wensch v. Principi, 15 Vet. App. 362 (2001). The Board observes that the Veteran's service treatment records show that he was treated for left knee problems, and that he was diagnosed with chronic knee pain. Additionally, the Board notes that post-service treatment records, to include a VA examination report, show treatment for left knee problems, including left knee degenerative joint disease. The Board further notes that the Veteran's wife has reported that she had been with the Veteran for fifty years, including the whole time that he was in the service, and that he had suffered from left knee problems since service. The Board observes that the Veteran is currently diagnosed with a left knee disability, diagnosed as degenerative joint disease. The Board finds the Veteran's reports of left knee problems during and since his period of service to be credible, especially in light of him serving as a medical specialist during service. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board also finds the lay statement from the Veteran's wife that she had been with the Veteran for fifty years, including the whole time that he was in the service, and that he had suffered from left knee problems since service, to be credible. The Board further notes that a probative statement from Dr. Lindzey has related the Veteran's current left knee disability to the left knee condition he experienced during service. Resolving any doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran's left knee disability, diagnosed as degenerative joint disease, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a left knee disability, diagnosed as degenerative joint disease. Therefore, service connection for a left knee disability, diagnosed as degenerative joint disease, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. 3. Left Ankle Disability The Veteran is service-connected for pes planus of the left foot, with a calcaneal spur and posttraumatic arthritis, and for right ankle recurrent sprains, and degenerative joint disease. He is also service-connected for low back degenerative disc disease and degenerative joint disease; bilateral hearing loss; and for tinnitus. As discussed above, the Veteran is also now service-connected for a left knee disability, diagnosed as degenerative joint disease. The Veteran contends that he has a left ankle disability that is related to service, or, more specifically, that is related to his service-connected right ankle recurrent sprains, and degenerative joint disease. He specifically maintains that he sprained his left ankle during basic training and that he wore a case for a few weeks. The Veteran also reports that he was treated for left ankle problems within a year after his separation from service. He essentially asserts that he suffered from left ankle problems during service and since service. The Veteran served on active duty in the Army from August 1977 to July 1985. His DD Form 214 lists his occupational specialty as a medical specialist for seven years and six months. The Veteran's service treatment records do not specifically show treatment for left ankle problems. Such records do indicate that, in August 1977, the Veteran was seen for pain and a possible injury to the left leg, over the tibia, with an abrasion and sore spot, and that he was provided with a gel cast and a Crece shoe, at that time. Post-service private and VA treatment records, including a VA examination report, show treatment for left ankle problems, including left ankle pain; left ankle pain/calcaneal spur; and a left ankle, lateral, collateral ligament sprain. A March 2015 VA ankle conditions examination report includes a notation that the Veteran's claims file was reviewed. The Veteran reported that he sprained his left ankle during basic training, and that he wore a cast for a few weeks. He stated that he had left ankle pain, with and without activity. The Veteran related that he also injured his right ankle and toe when stepping off a landing during service in 1978. The diagnosis was a lateral, collateral ligament sprain of the left ankle. The examiner indicated that the claimed condition was less likely than not (less than 50 percent probability) proximately due to, or the result of, the Veteran's service-connected condition. The examiner reported that the Veteran stated that he had a history of spraining both ankles, and that the left ankle was treated with a cast. The examiner maintained that the medical record reflects a right ankle sprain in 2006. It was noted that the Veteran related that a right ankle sprain occurred in 1978. The examiner reported that a left ankle x-ray in 2009 shows degenerative changes. The examiner stated that no further medical records were available to help with an opinion. The examiner indicated that there were no medical reports indicating that the Veteran's left ankle condition was caused by a right ankle injury. At a December 2019 Board hearing, the Veteran's wife reported that she had been with the Veteran for fifty years, including the whole time that he was in the service. She stated that the Veteran had suffered from left ankle problems during and since service. The Board observes that the service treatment records do not specifically show treatment for any left ankle problems. The Board notes that post-service treatment records, including a VA examination report, show treatment for left ankle problems, including left ankle pain; left ankle pain/calcaneal spur; and a left ankle, lateral, collateral ligament sprain. Additionally, the Board notes that the Veteran's wife reported that she had been with the Veteran for fifty years, including the whole time that he was in the service. She stated that the Veteran had suffered from left ankle problems during and since service. The Board notes that a March 2015 VA ankle conditions examination report relates a diagnosis of a lateral, collateral ligament sprain of the left ankle. The examiner, following a review of the claims file, indicated that the claimed condition was less likely than not proximately due to, or the result of, the Veteran's service-connected condition. The examiner reported that the Veteran stated that he had a history of spraining both ankles, and that the left ankle was treated with a cast. The examiner maintained that the medical record reflects a right ankle sprain in 2006. It was noted that the Veteran related that a right ankle sprain occurred in 1978. The examiner stated that no further medical records were available to help with an opinion. The examiner indicated that there were no medical reports indicating that the Veteran's left ankle condition was caused by a right ankle injury. The Board observes that the VA examiner did not specifically address direct service connection. Additionally, the examiner did not address whether the Veteran's service-connected right ankle recurrent sprains, and degenerative joint disease, aggravated his claimed left ankle disability. In El-Amin v. Shinseki, 26 Vet. App. 136 (2013), a decision issued by the United States Court of Appeals for Veterans Claims (Court), the Court vacated a decision of the Board where a VA examiner did not specifically opine as to whether a disability was aggravated by a service-connected disability. The Board also notes that the examiner did not address the Veteran's reports, and those of his wife, of left ankle problems during and since service. The Veteran was a medical specialist during service. The Board observes that the Veteran is competent to report left ankle problems and left shin problems during service and since service. See Davidson, 581 F.3d at 1313. Therefore, the Board finds that the opinions provided by the examiner, pursuant to the March 2015 VA ankle conditions examination report, are not probative in this matter. The Board observes that the Veteran is currently diagnosed with a left ankle disability, diagnosed as a lateral, collateral ligament sprain. The Board finds the Veteran's reports of left ankle problems during and since his period of service to be credible, especially in light of him serving as a medical specialist during service. See Jandreau v. Nicholson, 492 F.3d 1372 (2007) (holding that lay evidence can be competent and sufficient to establish a diagnosis of a condition when a lay person is competent to identify the medical condition, or reporting a contemporaneous medical diagnosis, or the lay testimony describing symptoms at the time supports a later diagnosis by a medical professional). The Board also finds the statement from the Veteran's wife that she had been with the Veteran for fifty years, including the whole time that he was in the service, and that he had suffered from left ankle problems during and since service, to be credible. Resolving any doubt in the Veteran's favor, the Board finds that the evidence is at least in equipoise as to whether the Veteran's left knee disability, diagnosed as a lateral, collateral, ligament sprain, commenced during his period of service. In light of the evidence, the Board cannot conclude that the preponderance of the evidence is against granting service connection for a left ankle disability, diagnosed as a lateral, collateral ligament sprain. Therefore, service connection for a left ankle disability, diagnosed as a lateral, collateral ligament sprain, is warranted. See 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. As the Board has granted direct service connection in this matter, it need not address other theories of service connection. REASONS FOR REMAND The remaining issues on appeal are entitlement to service connection for gouty arthritis; entitlement to an increase in a 10 percent rating for low back degenerative disc disease and degenerative joint disease; and entitlement to a TDIU. As discussed above, the Board has granted service connection for a left knee disability, diagnosed as degenerative joint disease, and for a left ankle disability, diagnosed as a lateral, collateral ligament sprain. Given this change in circumstances, and to accord the Veteran due process, the RO should readjudicate the issue of entitlement to service connection for gouty arthritis. The Veteran is service-connected for pes planus of the left foot, with a calcaneal spur and posttraumatic arthritis, and for right ankle recurrent sprains, and degenerative joint disease. He is also service-connected for low back degenerative disc disease and degenerative joint disease; bilateral hearing loss; and for tinnitus. As discussed above, the Veteran is now further service-connected for a left knee disability, diagnosed as degenerative joint disease, and a left ankle disability, diagnosed as a lateral, collateral ligament sprain. The Veteran contends that has gouty arthritis that is related to service. He specifically maintains that his gouty arthritis started when he got out of the service, possibly a year or two after service. The service treatment records do not specifically show treatment for gouty arthritis. Such records do show treatment for left foot and right ankle problems. Post-service private and VA treatment records show treatment for gout and gouty arthritis. The Veteran was last afforded a VA general medical examination, as to his claim for gouty arthritis, in January 1991. The Board finds that the VA examination is inadequate. For example, the examiner did not provide any etiological opinions, as to the Veteran's clamed gouty arthritis. In light of the above, the Board finds that the Veteran should be afforded a VA examination with the opportunity to obtain responsive etiological opinions, following a thorough review of the record, as to his claim for service connection for gouty arthritis. Such an examination must be accomplished on remand. 38 C.F.R. § 3.159(c)(4); McLendon v. Nicholson, 20 Vet. App. 79 (2006); Stefl v. Nicholson, 21 Vet. App. 120, 125 (2007). As to the Veteran's claim for an increased rating for his service-connected low back degenerative disc disease and degenerative joint disease, the Board notes that the Veteran was last afforded a VA back conditions examination in March 2015. The diagnosis was low back degenerative disc disease and degenerative joint disease. The Board notes that the U.S Court of Appeals for Veteran's Claims (Court) has issued decisions in Correia v. McDonald, 28 Vet. App. 158, 166 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017) concerning the adequacy of VA orthopaedic examinations. The Court in Correia held that the final sentence of 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on 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. In Sharp, the Court held that before a VA examiner opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation based on the fact that the examination was not performed during a flare, the examiner must "elicit relevant information as to the veteran's flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the veteran's functional loss due to flares based on all the evidence of record, including the veteran's lay information, or explain why she could not do so." In light of these decisions, and as the findings pursuant to the March 2015 VA back conditions examination report are inadequate, the Board finds that a new VA examination should be provided addressing the Veteran's service-connected low back degenerative disc disease and degenerative joint disease. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Finally, as the Veteran's claim for a TDIU rating is inextricably intertwined with his claim for service connection, and for an increased rating for a low back degenerative disc disease and degenerative joint disease, on appeal, those matters must be addressed together on remand. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Ask the Veteran to identify all medical providers who have treated him for gout arthritis and low back degenerative disc disease and degenerative joint disease, since May 2018. After receiving this information and any necessary releases, obtain copies of the related medical records which are not already in the claims folder. Document any unsuccessful efforts to obtain the records, inform the Veteran of such, and advise him that he may obtain and submit those records himself. 2. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of his in-service and post-service symptomatology regarding his claimed gouty arthritis, as well as the nature, extent, and severity of his low back degenerative disc disease and degenerative joint disease. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 3. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the onset and/or etiology of his claimed gouty arthritis. The examiner must indicate if the Veteran has currently diagnosed gout or gouty arthritis. Then, the examiner must opine as to whether it is at least as likely as not that any currently diagnosed gout, or gouty arthritis, are related to and/or had their onset during his period of service. The examiner must specifically acknowledge and discuss any reports by the Veteran of symptoms he thought were due to gouty arthritis during and since service. The examiner must further opine as to whether the Veteran's service-connected disabilities caused or aggravated any currently diagnosed gout, or gouty arthritis. 4. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc. if an in-person examination is not feasible) to determine the extent and severity of his service-connected low back degenerative disc disease and degenerative joint disease. All indicated tests must be conducted, including x-ray, and all symptoms associated with the Veteran's service-connected low back degenerative disc disease and degenerative joint disease. Specifically, the examiner must conduct a thorough orthopedic examination of the Veteran's service-connected low back degenerative disc disease and degenerative joint disease and provide diagnoses of any pathology found. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. D. Regan, 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.