Citation Nr: 21041358 Decision Date: 07/09/21 Archive Date: 07/08/21 DOCKET NO. 16-53 987 DATE: July 9, 2021 REMANDED Entitlement to service connection for a left knee disability, to include as secondary to the service-connected residual fracture of the left ankle with traumatic arthritis, is remanded. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected residual fracture of the left ankle with traumatic arthritis, is remanded. Entitlement to service connection for a frequent urination disorder is remanded. Entitlement to service connection for skin cancer, to include as due to herbicide agent exposure, is remanded. Entitlement to an initial disability rating of 60 percent for coronary artery disease is remanded. Entitlement to a disability rating in excess of 30 percent for unspecified anxiety disorder is remanded. Entitlement to an initial disability rating in excess of 20 percent for diabetes mellitus to include erectile dysfunction and hypertension is remanded. Entitlement to a disability rating in excess of 10 percent for a residual fracture of the left ankle with traumatic arthritis is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had active military service from January 1970 to January 1973. These issues are on appeal from a May 2014 rating decision. In February 2019, the Board of Veterans' Appeals (Board) remanded this appeal for further development. 1. Entitlement to service connection for a left knee disability, to include as secondary to the service-connected residual fracture of the left ankle with traumatic arthritis, is remanded. 2. Entitlement to service connection for a right knee disability, to include as secondary to the service-connected residual fracture of the left ankle with traumatic arthritis, is remanded. 3. Entitlement to service connection for a frequent urination disorder is remanded. 4. Entitlement to service connection for skin cancer, to include as due to herbicide agent exposure, is remanded. 5. Entitlement to an initial disability rating of 60 percent for coronary artery disease is remanded. 6. Entitlement to a disability rating in excess of 30 percent for unspecified anxiety disorder is remanded. 7. Entitlement to an initial disability rating in excess of 20 percent for diabetes mellitus to include erectile dysfunction and hypertension is remanded. 8. Entitlement to a disability rating in excess of 10 percent for a residual fracture of the left ankle with traumatic arthritis is remanded. In February 2019, the Board remanded the claims, in pertinent part, for the Veteran to be scheduled for several VA examinations. A December 26, 2019, Compensation and Pension Examination Inquiry report shows that several examinations were requested on that date. The record then contains several Examination Scheduling Request Contention Cancellation reports dated on February 14, 2020, stating that the examinations were cancelled due to "No Show." In a September 2020 Statement in Support of Claim, the Veteran asked to be rescheduled for the February 2020 VA examinations. He stated that he was not notified of the February 2020 appointments, and that he would report for future examinations. The evidence of record does not contain a letter addressed to the Veteran detailing the general consequences of his failure to report for his examinations and informing him of the date and time of his examinations. The Board finds that it is unclear exactly when and how the attempts to RSVP for the examinations were facilitated due to the lack of Appointment Confirmation letters in the record. Accordingly, the Board finds good cause for the Veteran to be rescheduled for these VA examinations. 9. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issues could significantly impact a decision on the TDIU issue, the issues are inextricably intertwined. A remand of the TDIU claim is required. The matters are REMANDED for the following actions: 1. Send the Veteran a letter with the date and time of his scheduled examinations, and include a copy of this letter in the claims file. The letter must detail the consequences of the Veteran's failure to report for the examinations. 2. Schedule the Veteran for a VA examination for his bilateral knee disabilities. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the bilateral knee disability at least as likely as not related to service? Please note and comment on the March 1972 service treatment record. If the Veteran has a diagnosis of osteoarthritis of either knee, the examiner must also address whether it is at least as likely as not that the osteoarthritis of the knee (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. Is the bilateral knee disability at least as likely as not proximately due to the service-connected residual fracture of the left ankle with traumatic arthritis? In providing this opinion, the examiner must address the March 2003 Phoenix Health letter, in which the clinician opined "Probable knee involvement due to gait abnormality of the left knee." Is the bilateral knee disability at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected residual fracture of the left ankle with traumatic arthritis? In providing this opinion, the examiner must address the March 2003 Phoenix Health letter, in which the clinician opined "Probable knee involvement due to gait abnormality of the left knee." Provide a rationale to support the opinions. 3. Schedule the Veteran for a VA examination for his claimed frequent urination. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below. The examiner is asked to provide a response to the following: Is the frequent urination at least as likely as not related to service? Is the frequent urination a symptom of the Veteran's service-connected diabetes mellitus with erectile dysfunction and hypertension or a distinct disability? a) If the frequent urination is a distinct disability, then is the frequent urination at least as likely as not proximately due to the service-connected diabetes mellitus with erectile dysfunction and hypertension? b) If the frequent urination is a distinct disability, then is the frequent urination at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected diabetes mellitus with erectile dysfunction and hypertension? Provide a rationale to support the opinions. 4. Schedule the Veteran for a VA examination for his skin cancer. The examiner must review the claims file. The examiner is asked to provide a response to the following: Is it at least as likely as not that the skin cancer (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service? Is the skin cancer at least as likely as not related to in-service exposure to herbicide agents? The examiner is advised that a negative opinion cannot be based solely on the fact that the skin cancer is not on the list of diseases that are presumptively associated with exposure to herbicide agents. Provide a rationale to support the opinions. 5. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected coronary artery 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. 6. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected unspecified anxiety disorder. 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. The examiner must attempt to elicit information regarding the severity, frequency, and duration of symptoms. To the extent possible, the examiner should identify any symptoms and social and occupational impairment due to his service-connected unspecified anxiety disorder alone. 7. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected diabetes mellitus with erectile dysfunction and hypertension. 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. 8. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected residual fracture of the left ankle with traumatic arthritis. 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). In so doing, 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). (Continued on the next page) 9. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to a TDIU. If the benefits sought are not granted to the Veteran's satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Emily Tamlyn Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shauna M. Watkins, 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.