Citation Nr: 21041903 Decision Date: 07/10/21 Archive Date: 07/10/21 DOCKET NO. 13-34 134A DATE: July 10, 2021 ORDER Service connection for ocular histoplasmosis of both eyes is granted. REMANDED Entitlement to initial higher ratings for right knee degenerative arthritis status-post arthroscopic surgery with residual scars, currently evaluated as noncompensable prior to August 9, 2014 and 10 percent disabling from that date is remanded. FINDING OF FACT The Veteran's ocular histoplasmosis of both eyes began during active duty service. CONCLUSION OF LAW The criteria for service connection for ocular histoplasmosis of both eyes are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1985 to November 1989, November 1995 to February 1997, and March 1997 to July 2011. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2011 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). During the pendency of the appeal, in a September 2014 Supplemental Statement of the Case, the RO increased the rating for right knee degenerative arthritis with residual scars to 10 percent, effective August 9, 2014. Inasmuch as higher ratings are available for this disability and the Veteran has not indicated satisfaction, the claim remains on appeal. See A.B. v. Brown, 6 Vet. App. 35 (1993). The Veteran was afforded a virtual hearing before the undersigned Veterans Law Judge in May 2021. A transcript of the hearing is associated with the claims file. Entitlement to service connection for ocular histoplasmosis of both eyes The Veteran contends that he has had bilateral histoplasmosis symptoms continuously since service. In the alternative, he alleges that his condition is secondary to service-connected coccidioidomycosis residuals (also referred to as "Valley Fever"). See May 2021 Hearing Testimony. Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Shedden v. Principi, 381 F.3d 1163, 1166 -67 (Fed. Cir. 2004). The Board concludes that the Veteran has a current disability that began during active duty service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The Veteran has a current diagnosis of ocular histoplasmosis (also known as spots on both eyes near retinol). See May 2011 VA Examination Report. The examiner noted that "the condition has existed since 1986" during service. To this regard, January 1998 service treatment records document tiny scattered spots on both eyes. April 1998 service treatment records note that an eye exam is performed every two years because floaters were noticed. An assessment of presumed ocular histoplasmosis was provided. The Board finds that service medical records documenting treatment for the claimed eye condition satisfy the in-service incurrence element. The remaining question is whether there is a causal relationship. Here, as discussed, during service the Veteran was provided an assessment of presumed ocular histoplasmosis and his current diagnosis is the same. Notably, his diagnosed eye condition is also known as spots on both eyes, which 1998 service medical records document treatment for this symptom. Further, the Veteran is competent to report that he has been experiencing the same symptoms continuously since service and the May 2011 VA examination indicates that his reports are credible. There are no medical opinions of record disputing that conclusion. Accordingly, the Board finds service connection for ocular histoplasmosis warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. REASONS FOR REMAND Entitlement to initial higher ratings for right knee degenerative arthritis status-post arthroscopic surgery with residual scars, currently evaluated as noncompensable prior to August 9, 2014 and 10 percent disabling from that date is remanded. During the May 2021 hearing, the Veteran testified that his right knee disability has increased in severity since his last examination. He stated that a private physician recommended knee replacement due to lack of cartilage. He reported symptoms of constant pain, difficulty walking downstairs, decreased range of motion, use of a nonprescribed knee brace, and that his knee "gives away" 3 to 4 times per month. In support of his contentions, he submitted October 2018 private imaging studies of the right knee showing severe degenerative changes and degenerative complex tearing of the menisci. The Veteran was last afforded a VA knee examination in August 2014, at which time the examiner referenced October 2013 x-rays of the right knee showing moderate to advanced medial compartment degenerative joint disease. As the evidence in this case suggests that the Veteran's disability picture has changed since his last examination, a new VA examination is warranted. 38 C.F.R. §§ 3.326, 3.327; Snuffer v. Gober, 10 Vet. App. 400 (1997) (a veteran is entitled to a new VA examination where there is evidence that the condition has worsened since the last examination). The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the current symptoms, level of severity, and functional impairment associated with his right knee disability. The claims file should be reviewed by the examiner. Conduct all tests and examinations deemed necessary, to include range of motion testing with active and passive motions as well as with weight-bearing and in nonweight-bearing. If any motion cannot be tested, explain why. If factors, such as pain, weakness, fatigability or incoordination limit range of motion or functional ability, discuss its impact in terms of the severity thereof. The examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flare-ups or repetitive use, and if so, estimate range of motion during flare-ups or repetitive use. If the examination does not take place during a flare-up or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flare-ups or repetitive use and provide the extent of motion loss described in terms of degrees based upon the lay and medical evidence of record. If an opinion cannot be rendered without resorting to mere speculation, the examiner should state the same and explain why. M. Donohue Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Amanda Baker, 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.