Citation Nr: 21031416 Decision Date: 05/21/21 Archive Date: 05/21/21 DOCKET NO. 20-27 049 DATE: May 21, 2021 REMANDED Entitlement to service connection for right knee instability is remanded. Entitlement to service connection for left knee instability is remanded. Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. Entitlement to a rating in excess of 20 percent for degenerative disc disease of the lumbar spine (lumbar spine disability) is remanded. Entitlement to a compensable rating for left hip limitation of flexion is remanded. Entitlement to a rating in excess of 10 percent for left hip degenerative arthritis with residuals of left femur fracture is remanded. Entitlement to a rating in excess of 10 percent for a right knee meniscal tear with arthritis is remanded. Entitlement to a rating in excess of 10 percent for residuals of a left knee injury with arthritis is remanded. Entitlement to a compensable rating for hemorrhoids is remanded. Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service from May 1981 to May 2005. These matters are before the Board of Veterans' Appeals (Board) on appeal from a rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 1. Entitlement to service connection for right knee instability is remanded. 2. Entitlement to service connection for left knee instability is remanded. 3. Entitlement to a compensable rating for a bilateral hearing loss disability is remanded. 4. Entitlement to a rating in excess of 20 percent for a lumbar spine disability is remanded. 5. Entitlement to a compensable rating for left hip limitation of flexion is remanded. 6. Entitlement to a rating in excess of 10 percent for left hip degenerative arthritis with residuals of left femur fracture is remanded. 7. Entitlement to a rating in excess of 10 percent for a right knee meniscal tear with arthritis is remanded. 8. Entitlement to a rating in excess of 10 percent for residuals of a left knee injury with arthritis is remanded. 9. Entitlement to a compensable rating for hemorrhoids is remanded. 10. Entitlement to a TDIU is remanded. The evidence indicates there may be outstanding relevant VA treatment records. On his VA Form 21-8940, the Veteran reported receiving VA treatment as recently as September 20, 2021. Additionally, an August 26, 2020 VA treatment record indicates that the Veteran was to return for a follow up appointment in January 2021. VA treatment records dated after August 28, 2020 have not been associated with the claims file. Additionally, VA treatment records from November 29, 2018 and September 4, 2018 indicate that November 7, 2018 and August 23, 2018 audiology records had been scanned into VistA Imaging. It does not appear that the referenced records have been associated with the claims file. A remand to obtain the outstanding records is required. Regarding the Veteran's lumbar spine, hip, and knee claims, while he was provided VA examinations for these claims in March 2020 further clarification is required. While the examiner indicated that the Veteran had pain with lumbar spine, bilateral knee, and left hip motion, the examiner did not indicate where the pain started. While the hip and knee examination reports noted that passive range of motion testing was conducted, they do not contain passive range of motion measurements. Finally, while the lumbar spine report noted that the Veteran had hypoactive lower extremity reflexes and reported low back pain that radiated into his lower extremities, the examiner did not explain those symptoms when he later opined that there were no signs or symptoms of radiculopathy. Considering the above, additional VA examinations are required. The matters are REMANDED for the following actions: 1. Ask the Veteran to provide the names and addresses of all medical care providers who have recently treated him for his claimed disabilities, including his primary care provider via TRICARE. After securing any necessary releases, request any relevant records identified. In addition, obtain updated VA treatment records dated since August 28, 2020 as well as the VistA Imaging audiology records referenced in the November 29, 2018 and September 4, 2018 VA record entries. If any requested records are unavailable, the Veteran should be notified of such. 2. After the above record development is completed to the extent possible, schedule the Veteran for a VA thoracolumbar spine examination to determine the current severity of his lumbar spine disability and any associated neurological complication. The claims file should be reviewed by the examiner. All necessary tests should be performed, and the results reported. All symptomatology associated with the Veteran's lumbar spine disability. (a.) For each range of motion testing conducted, the examiner must state where in the range of motion the Veteran reports that he begins to experience pain. If the examiner is unable to conduct any of the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (b.) The examiner should also state whether there is likely to be additional range of motion loss due to flare-ups and due to pain, weakness, fatigability, or incoordination. If so, the examiner is asked to describe the additional loss, in degrees, if possible. In doing so, the examiner should 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. (c.) If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). (d.) In addressing whether the Veteran has neurological complications attributable to his lumbar spine disability, the examiner should address the March 2020 examination report noting that the Veteran had hypoactive reflexes as well as his March 2020 and April 19, 2018 reports of low back pain that radiated into his lower extremities. 3. After the above record development is completed to the extent possible, schedule the Veteran for a VA hip examination to determine the current nature and severity of his service-connected left hip limitation of flexion and left hip degenerative arthritis with residuals of left femur fracture. The claims file should be reviewed in conjunction with the examination. All indicated tests should be conducted and the results reported. Range of motion testing should be undertaken, and should be tested actively and passively, in weight bearing, and after repetitive use. (a.) For each range of motion testing conducted, the examiner must state where in the range of motion the Veteran reports that he begins to experience pain. If the examiner is unable to conduct any of the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (b.) The examiner should also state whether there is likely to be additional range of motion loss due to flare-ups and due to pain, weakness, fatigability, or incoordination. If so, the examiner is asked to describe the additional loss, in degrees, if possible. In doing so, the examiner should 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. (c.) If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). 4. After the above record development is completed to the extent possible, schedule the Veteran for a VA knee examination to determine the current nature and severity of his service-connected right knee meniscal tear with arthritis and for residuals of a left knee injury with arthritis. The claims file should be reviewed in conjunction with the examination. All indicated tests should be conducted and the results reported. Range of motion testing should be undertaken, and should be tested actively and passively, in weight bearing, and after repetitive use. (a.) For each range of motion testing conducted the examiner must state where in the range of motion the Veteran reports that he begins to experience pain. If the examiner is unable to conduct any of the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (b.) The examiner should also state whether there is likely to be additional range of motion loss due to flare-ups and due to pain, weakness, fatigability, or incoordination. If so, the examiner is asked to describe the additional loss, in degrees, if possible. In doing so, the examiner should 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. (c.) If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). (d.) The examiner should also indicate whether the Veteran's cane and/or right knee brace was prescribed for lateral instability and/or recurrent subluxation or for other right or left knee symptoms. The examiner should address the April 20, 2017 orthopedic record noting that the Veteran was provided a right knee unloader brace to help compensate for his lack of an anterior cruciate ligament. K. A. BANFIELD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Anderson 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.