Citation Nr: 21031133 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 18-23 635 DATE: May 20, 2021 REMANDED Entitlement to an increased disability rating in excess of 10 percent for lumbar spine anterolisthesis with degenerative disk disease is remanded. Entitlement to an increased disability rating in excess of 10 percent for right knee degenerative joint disease is remanded. Entitlement to service connection for psoriasis, secondary to service-connected major depressive disorder and obsessive compulsive disorder, is remanded. REASONS FOR REMAND The Veteran served on active duty from December 2003 to March 2009. These matters come to the Board of Veterans' Appeals (Board) from a May 2017 rating decision issued by the Agency of Original Jurisdiction (AOJ). In September 2019, the Veteran's case was received at the Board and, in September 2020, a Board hearing was conducted. The hearing transcript has been associated with the Veteran's file. 1. Entitlement to an increased disability rating in excess of 10 percent for lumbar spine anterolisthesis with degenerative disk disease is remanded. The Veteran contends the current severity of her service-connected back disability warrants a greater than 10 percent disability rating. See June 2017 Notice of Disagreement (NOD) at 2. She als contends her back disability has worsened since her last disability examination. See Transcript dated September 2020 at 6. Although the Board regrets the delay, another remand is necessary before the Board is able to decide on the merits. The VA examiner who conducted the April 2017 disability examination noted the Veteran observed flare-ups and functional loss due to pain, but did not quantify those effects in terms of range of motion limitations. See VA Disability Benefits Questionnaire (DBQ) at 5-6. Thus, it is not adequate to decide the Veteran's increased rating claim and a new disability examination is warranted. Mitchell v. Shinseki, 25 Vet. App. 32, 37-38 (2011). The Board recognizes the Veteran has asserted her back disability has worsened since her last disability examination. Because her claim is remanded for a new examination, the next one will evaluate the current severity of her disability. 2. Entitlement to an increased disability rating in excess of 10 percent for right knee degenerative joint disease is remanded. The Veteran contends her service connected right knee disability warrants a greater than 10 percent disability rating. See June 2017 NOD at 2. The VA examiner who conducted the April 2017 disability examination noted the Veteran observed flare-ups but did not quantify those effects in terms of range of motion limitations nor sufficiently explain why he was unable to do so. See VA DBQ at 8. Thus, it is not adequate to decide the Veteran's increased rating claim and a new VA disability examination is warranted. Mitchell, 25 Vet. App. at 37-38. 3. Entitlement to service connection for psoriasis, secondary to service-connected major depressive disorder and obsessive compulsive disorder, is remanded. The Veteran contends her diagnosed psoriasis is secondary to her service connected major depressive disorder. See June 2017 NOD at 2. Although the Board regrets the delay, the Veteran's claim must be remanded for a new disability examination before it is able to decide on the merits. During the Veteran's November 2020 Board hearing, she testified her April 2017 disability examination was brief, the examiner appeared to dismiss her reports, and did not take the time to investigate the patches of itchy skin she directed the examiner's attention to. See Transcript at 22. In light of the Veteran's testimony it is unclear whether the examiner who conducted the examination was fully informed of the relevant details of the Veteran's past medical history when he rendered his opinion. Nievez-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2006). Thus, a new VA disability examination is warranted. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected lumbar spine anterolisthesis with degenerative disk disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. Also, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected right knee degenerative joint disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. Also, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training. 3. Schedule the Veteran for a VA examination for her psoriasis. The examiner must review the claims file. The examiner is asked to provide a response to the following: a. Is it at least as likely as not (50 percent or greater probability) proximately due to her service-connected major depressive disorder and obsessive compulsive disorder? b. Is her psoriasis at least as likely as not (50 percent or greater probability) aggravated, i.e., worsened beyond its natural progression, by her service-connected major depressive disorder and obsessive compulsive disorder? Provide a rationale to support the opinion(s). The examiner, in coming to his or her conclusion, is asked to comment on the following: i. Address the January 12, 2018, VA Medical Center Record by M.V., MD. He noted Veteran has psoriasis and it is associated with mental conditions. He noted "skin, mucous membranes, and brains all come from the cell line [,] as such, skin conditions are common sequalae to mental conditions, including chest/face rashes, psoriasis, hand rashes (has a history of), and are expected to get worse in times of stress. ii. Discuss the April 2017 VA medical opinion that concluded the Veteran's psoriasis is not secondary to her service-connected major depressive disorder and obsessive compulsive disorder. In providing the requested opinion, consider the Veteran's description of her symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's symptoms, this should be noted. Stated another way, do the Veteran's reports about her symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? DAVID L. WIGHT Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Dean, Michael S. 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.