Citation Nr: 21047479 Decision Date: 08/03/21 Archive Date: 08/03/21 DOCKET NO. 18-13 465 DATE: August 3, 2021 ORDER The application to reopen a claim of service connection for bilateral hip disability is granted. The application to reopen a claim of service connection for right knee disability is granted. Entitlement to service connection for bilateral hip osteoarthritis is granted. Entitlement to service connection for right knee osteoarthritis is granted. Entitlement to service connection for left knee meniscal tear and osteoarthritis is granted. Entitlement to service connection for degenerative disc disease of the lumbosacral spine is granted. Entitlement to service connection for degenerative disc disease of the cervical spine, secondary to service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement, on a causation basis, is granted. Entitlement to service connection for migraine headaches, secondary to service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement, on a causation basis, is granted. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities, from March 11, 2016 through April 2, 2016, is dismissed. REMANDED Entitlement to an effective date earlier than October 30, 2013 for the award of service connection for left shoulder scars, status post-surgery, is remanded. Entitlement to an effective date earlier than July 5, 2017 for the award of service connection for right shoulder scars, status post-surgery, is remanded. Entitlement to an initial compensable rating for gastroesophageal reflux disease (GERD) is remanded. Entitlement to an initial rating higher than 20 percent for right shoulder impingement (except for a period when a temporary 100 percent rating was in effect) is remanded. Entitlement to an initial compensable rating for right shoulder scars, status post-surgery, is remanded. Entitlement to an initial compensable rating for left shoulder scars, status post-surgery, is remanded. Entitlement to a rating in excess of 10 percent for left ankle osteoarthritis is remanded. Entitlement to a rating in excess of 20 percent for left shoulder separation status post arthroscopic repair (except for a period when a temporary 100 percent rating was in effect) is remanded. Entitlement to a TDIU due to service-connected disabilities, from October 30, 2013 through March 10, 2016, is remanded. FINDINGS OF FACT 1. The Veteran's claims of service connection for bilateral hip disability and right knee disability were originally denied in a May 1994 rating decision on the basis that there was no evidence of any such disabilities that were related to service; the Veteran submitted a timely notice of disagreement (NOD) with the denial of service connection for bilateral hip disability and right knee disability in October 1994 and a statement of the case (SOC) was issued in November 1994, but the Veteran did not file a substantive appeal. 2. Evidence received since the May 1994 agency of original jurisdiction (AOJ) decision includes information that was not previously considered and which relates to unestablished facts necessary to substantiate the claims of service connection for bilateral hip disability and right knee disability, the absence of which was the basis of the previous denial. 3. The Veteran's bilateral hip osteoarthritis is related to service. 4. The Veteran's right knee osteoarthritis is related to service. 5. The Veteran's left knee meniscal tear and osteoarthritis are related to service. 6. The Veteran's degenerative disc disease of the lumbosacral spine is related to service. 7. The evidence is at least evenly balanced as to whether the Veteran's degenerative disc disease of the cervical spine is caused by his service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement. 8. The evidence is at least evenly balanced as to whether the Veteran's migraine headaches are caused by his service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement. 9. As a 100 percent rating and special monthly compensation (SMC) pursuant to 38 U.S.C. § 1114 (s) have been awarded for the entire period from March 11, 2016 through April 2, 2016, the issue of entitlement to a TDIU during this period is rendered moot. CONCLUSIONS OF LAW 1. The AOJ's May 1994 rating decision which denied the claims of service connection for bilateral hip disability and right knee disability is final. 38 U.S.C. § 7105; 38 C.F.R. §§ 3.104, 19.20, 19.32, 19.52, 20.1103. 2. The evidence received since the May 1994 AOJ decision is new and material and reopening of the claims of service connection for bilateral hip disability and right knee disability is therefore warranted. 38 U.S.C. § 5108; 38 C.F.R. § 3.156 (a). 3. The criteria for service connection for bilateral hip osteoarthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 4. The criteria for service connection for right knee osteoarthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 5. The criteria for service connection for left knee meniscal tear and osteoarthritis are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 6. The criteria for service connection for degenerative disc disease of the lumbosacral spine are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 7. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for degenerative disc disease of the cervical spine, as secondary to service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement, on a causation basis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 8. With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for migraine headaches, as secondary to service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement, on a causation basis, are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. 9. The question of whether the Veteran is entitled to a TDIU, during the period from March 11, 2016 through April 2, 2016, is rendered moot by his receipt of a 100 percent rating and SMC pursuant to 38 U.S.C. § 1114 (s) during this entire period, leaving no question of law or fact to decide regarding the TDIU issue during this period. 38 U.S.C. §§ 7104, 7105; 38 C.F.R. §§ 3.340, 3.341, 4.14, 4.16. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from February 1985 to July 1993. These matters come before the Board of Veterans' Appeals (Board) from August 2014, September 2014, August 2015, October 2015, and October 2017 rating decisions. In the August 2014 decision, the AOJ awarded an increased (20 percent) rating from November 13, 2012 through December 20, 2013, a temporary 100 percent rating due to surgical or other treatment requiring convalescence from December 21, 2013 through January 31, 2014, and a 20 percent rating from February 1, 2014, for left shoulder separation status post arthroscopic repair. In the September 2014 decision, the AOJ denied service connection for degenerative lumbar disc disease with intervertebral disc syndrome, headaches, and cervical degenerative disc disease. In the August 2015 decision, the AOJ denied the Veteran's application to reopen a claim of service connection for right knee disability and denied entitlement to a rating in excess of 10 percent for left ankle osteoarthritis. In the October 2015 decision, the AOJ made the following determinations: awarded service connection for right shoulder impingement syndrome and assigned an initial 20 percent disability rating, from April 3, 2015; awarded service connection for GERD and assigned an initial noncompensable disability rating, from April 3, 2015; and denied service connection for left and right hip sacroiliac arthralgia and left knee meniscus tear. In May 2016, the AOJ awarded a temporary 100 percent rating due to surgical or other treatment requiring convalescence for the service-connected right shoulder disability and SMC pursuant to 38 U.S.C. § 1114 (s), both from March 11, 2016 through June 30, 2016. The Veteran testified before a Decision Review Officer (DRO) at a July 2016 hearing and a transcript of the hearing is associated with his claims file. In October 2017, the AOJ made the following determinations: awarded service connection for shoulder surgical scars and assigned an initial noncompensable disability rating, from July 5, 2017; and awarded a TDIU, from July 5, 2017. The Veteran testified before a second DRO at a June 2018 hearing and a transcript of the hearing is associated with his claims file. In February 2019, the AOJ assigned an effective date of October 30, 2013 for the award of left shoulder surgical scars and assigned an effective date of April 3, 2016 for the award of a TDIU. A separate noncompensable disability rating for right shoulder surgical scars remained in effect, from July 5, 2017. The Veteran testified before the undersigned Veterans Law Judge (VLJ) at a March 2021 hearing and a transcript of the hearing is associated with his claims file. As for characterization of the issues on appeal, since the Veteran was awarded a 100 percent rating from December 21, 2013 through January 31, 2014 for his service-connected left shoulder disability and a 100 percent rating from March 11, 2016 through June 30, 2016 for his service-connected right shoulder disability, the ratings for these disabilities during these periods will not be addressed by the Board. Cf. AB v. Brown, 6 Vet. App. 35, 38 (1993). As a final preliminary matter, the Board notes that the AOJ adjudicated the bilateral hip issue on appeal on a de novo basis in the October 2015 rating decision and a January 2018 SOC. As explained in more detail below, a claim of service connection for bilateral hip disability was denied by way of a final May 1994 rating decision. Where the claim in question has been finally adjudicated, the Board must initially determine whether new and material evidence has been submitted with regard to the claim of service connection for bilateral hip disability. Jackson v. Principi, 265 F.3d 1366 (Fed. Cir. 2001). Only where the Board concludes that new and material evidence has been received does it have jurisdiction to consider the merits of this claim. Hickson v. West, 11 Vet. App. 374, 377 (1998). Therefore, the Board has included the issue of whether new and material evidence has been received to reopen the claim of service connection for bilateral hip disability. I. Applications to Reopen Generally, an AOJ decision denying a claim which has become final may not thereafter be readjudicated or allowed. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. The exception to this rule is 38 U.S.C. § 5108, which provides that if new and material evidence is presented or secured with respect to a claim which has been disallowed, the Secretary shall reopen the claim and review the former disposition of the claim. 38 U.S.C. § 5108. New evidence is defined as existing evidence not previously submitted to VA, and material evidence is defined as existing evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last prior final denial of the claim sought to be reopened, and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156 (a). The newly presented evidence is presumed to be credible for purposes of determining whether it is new and material. Justus v. Principi, 3 Vet. App. 510, 512-513 (1992). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. See Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). For the purpose of determining whether new and material evidence has been presented to reopen a claim, the evidence for consideration is that which has been presented or secured since the last time the claim was finally disallowed on any basis. Evans v. Brown, 9 Vet. App. 273, 285 (1996). The applications to reopen claims of service connection for bilateral hip disability and right knee disability The AOJ initially denied the Veteran's claims of service connection for bilateral hip disability and right knee disability in a May 1994 rating decision on the basis that there was no evidence of any such disabilities that were related to service. The Veteran submitted a timely NOD with the denial of service connection for bilateral hip disability and right knee disability in October 1994 and an SOC was issued in November 1994. Appellate review is initiated by an NOD and completed by a substantive appeal filed after an SOC has been furnished to an appellant. 38 U.S.C. § 7105 (a); 38 C.F.R. § 19.20. A substantive appeal must be filed within 60 days from the date of mailing of an SOC, or within the remainder of the one-year period from the date of mailing of the notification of the determination being appealed, whichever period ends later. 38 U.S.C. § 7105 (b)(2); 38 C.F.R. § 19.52 (b)(1). In the absence of a properly perfected appeal, the AOJ may close the appeal and the decision becomes final. 38 U.S.C. § 7105 (d)(3); Roy v. Brown, 5 Vet. App. 554, 556 (1993); 38 C.F.R. § 19.32. The AOJ did so in this case, as evidenced by the fact that it did not certify to the Board the issues of entitlement to service connection for bilateral hip disability and right knee disability following the November 1994 SOC. As neither the Veteran nor his representative submitted any document that could be construed as a timely substantive appeal pertaining to the claims of service connection for bilateral hip disability and right knee disability following the November 1994 SOC, the AOJ closed the appeal. The AOJ did not certify either of these issues to the Board at that time and no further action was taken by VA to suggest that either issue was on appeal. Thus, the May 1994 rating decision became final as to the denial of service connection for bilateral hip disability and right knee disability. See 38 U.S.C. § 7105 (d)(3); Fenderson v. West, 12 Vet. App. 119, 128-31 (1999) (discussing the necessity of filing a substantive appeal which comports with governing regulations); 38 C.F.R. §§ 3.104, 20.1103. The pertinent new evidence received since the May 1994 denial of service connection for bilateral hip disability and right knee disability includes Hip and Thigh Conditions and Knee and Lower Leg Disability Benefits Questionnaires (DBQ), both dated in March 2021, and a March 2021 letter from R. Mando, M.D.. This evidence includes diagnoses of bilateral hip and right knee osteoarthritis and a medical opinion that the Veteran's claimed bilateral hip and right knee disabilities are related to service. Therefore, the additional evidence pertains to elements of the claims of service connection for bilateral hip disability and right knee disability that were previously found to be lacking and raises a reasonable possibility of substantiating the claims by indicating that the Veteran has current bilateral hip and right knee disabilities that are related to service. The evidence is, therefore, new and material, and the claims of service connection for bilateral hip disability and right knee disability are reopened. II. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. 1. Entitlement to service connection for bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, and degenerative disc disease of the lumbosacral spine The Veteran contends that he has current bilateral hip disability, bilateral knee disability, and back disability which are related to hip, knee, and back problems in service. The Board finds, for the following reasons, that the Veteran has current diagnoses of bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, and degenerative disc disease of the lumbosacral spine, and that these disabilities are related to service. Medical records, including the Hip and Thigh Conditions and Knee and Lower Leg DBQs and a Back Conditions DBQ, all dated in March 2021, show that the Veteran has been diagnosed as having bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, and degenerative disc disease of the lumbosacral spine. Therefore, current bilateral hip, bilateral knee, and back disabilities have been demonstrated. Service treatment records reflect that in August 1986, the Veteran was treated for a 2-month history of right knee pain and was diagnosed as having a strained ligament. In April 1987, he pulled a back muscle which limited his ability to stoop and bend. He again strained his back in November 1987 and was treated for lower back pain in March 1988 after heavy lifting. Examinations revealed muscle spasms in the lumbar area, limited motion of the spine, and tenderness to palpation, and a diagnosis of a lumbosacral strain was provided. In March 1991, the Veteran was diagnosed as having left hip great trochanter bursitis. The Veteran re-injured his left hip in September 1991 due to a fall and was diagnosed as having a contusion of the left iliac area. In 1992, he injured his hips, knees, and back when he was pinned between a forklift and another vehicle. Examinations conducted shortly following the accident and in the months following the accident revealed abrasions in the area of the iliac crest, a large area of ecchymosis with associated tenderness, tenderness in the right groin area, bilateral hip pain, bilateral knee pain, right knee popping, and low back pain. The Veteran was placed on restricted duty and was diagnosed as having a pelvic contusion, mild tendinitis of the gluteus medius muscle of the right hip, and sacroiliac arthralgia Bilateral hip crepitus was noted during the Veteran's April 1993 separation examination and he was diagnosed as having a right hip calcium deposit/tendonitis. Moreover, he was evaluated in July 1993, prior to his separation from service, for popping in both knees and right knee pain. A diagnosis of knee pain secondary to patella lateral subluxation was provided. As for whether the Veteran's current bilateral hip, bilateral knee, and back disabilities are related to service, there are conflicting medical opinions. The Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the Veteran. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994). The Board may favor one medical opinion over another, provided an adequate statement of reasons or bases is provided. See Owens v. Brown, 7 Vet. App. 429, 433 (1995). The physiatrist who conducted an April 2014 VA back examination opined that the Veteran's back disability was not likely ("less likely than not"/"less than 50 percent probability") incurred in or caused by service, to include being hit by a forklift. He noted that the Veteran had lumbar pain, that a January 2008 MRI revealed mild to moderate degenerative change with a bulging annulus at L3-4 and an annular tear at L5-S1, and that these findings were related to degenerative disc disease, but did not provide any further explanation or rationale for his opinion. In September 2014, the examiner who conducted the April 2014 VA back examination opined that the Veteran's back disability was unrelated to any back trauma or strain in service. He reasoned that the disability was a common complaint/symptom in the general population and occurs and progresses independent of any trauma in the vast majority of cases. The physician who conducted September 2015 VA hip and knee examinations explained, in pertinent part, that the Veteran was caught between a forklift and a trailer in service, that his initial pelvic x-rays were negative, that he sustained another injury to the left hip in service where he experienced a laceration to the iliac area with surrounding contusion, that there was crepitation in both hips during his April 1993 separation examination, and that bilateral hip x-rays were negative. The Veteran's September 2015 hip examination was normal, the slightly decreased range of motion was due to anticipatory pain in that the range of motion was normal with manual manipulation, and his gait was normal. Overall, it was not likely ("less likely than not") that the events in service produced long term effects on the left hip since the x-rays were normal and the September 2015 examination was normal (including no crepitus felt during the examination). The September 2015 examiner also explained, in pertinent part, that the Veteran was diagnosed with bilateral lateral subluxation of the patella in July 1993 and was treated with physical therapy. His April 1993 separation examination did not mention any concerns/problems with his left knee, but this examination was completed before the July 1993 knee diagnosis, and he was separated from service following the diagnosis. He did not report any trauma to the left knee from 1993 to 2012 and he was diagnosed as having a left knee medial meniscal tear (for which he underwent surgery) in 2012. Since more than 20 years passed before he was diagnosed with a torn medial meniscus, it was not likely ("less likely than not") that the patellar subluxation in service was related to the torn meniscus 20 years later. Also, the two things are different conditions. In his March 2021 letter, Dr. Mando noted that the Veteran's service records and medical history were reviewed and that he was diagnosed as having bilateral hip osteoarthritis, lumbar degenerative disc disease, and a bilateral knee disability. Dr. Mando explained, in pertinent part, that there are numerous records that document multiple in-service injuries affecting the Veteran's hips, back, and knees. He was involved in an in-service accident where he was pinned between a forklift and a trailer, he suffered hip injury as a result of this accident, he experienced another left hip injury due to a fall, and there was crepitation involving both hips during his April 1993 separation examination. Also, he experienced back and knee problems on multiple occasions in service (including when he was pinned between a forklift and a trailer). Moreover, Dr. Mando explained that according to medical research, osteoarthritis occurs when the cartilage in the joints gradually deteriorates. Injuries, such as those sustained by the Veteran where he was involved in a significant accident being pinned between a forklift and a trailer and his other documented injuries in service, can increase the risk of osteoarthritis. Even injuries that occurred many years ago, and those that seemingly healed, increase the risk of osteoarthritis. Medical literature revealed that arthritis may remain asymptomatic for decades after the trauma. Medical research indicates that the osteoarthritis development in the injured joints initiates during the initial traumatic event. Overall, upon consideration of the Veteran's medical history, medical research, and other possible etiologies, Dr. Mando concluded that it was likely ("at least as likely as not") that the Veteran's bilateral hip osteoarthritis, lumbar degenerative disc disease, and bilateral knee disability were the result of his time in service and the many in-service injuries he sustained. The April 2014 opinion is of minimal, if any, probative weight because it is not accompanied by any specific explanation or rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (most of the probative value of a medical opinion comes from its reasoning; threshold considerations are whether the person opining is suitably qualified and sufficiently informed). The September 2014 opinion is also of little probative weight because the physiatrist only provided a general rationale that does not address any of the Veteran's specific injuries/symptoms in service and does not reflect any consideration of his reports of continuous symptoms in the years since service. In this regard, a medical opinion is inadequate if it is based solely on the absence of documentation in the record and does not take into account the Veteran's reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). Moreover, the September 2015 opinions are of minimal probative weight because the hip opinion is based on a finding that the Veteran did not have any current hip disability, and the knee opinion does not reflect consideration of the Veteran's reports of continuous knee symptoms in the years since service. See Id. Dr. Mando's March 2021 opinion, by contrast, is based upon a review of the Veteran's treatment records and medical literature, and consideration of his reported history, and it is accompanied by a specific rationale that is consistent with the evidence of record. Therefore, the March 2021 opinion is adequate and entitled to substantial probative weight. See Nieves-Rodriguez, 22 Vet. App. at 304. In light of Dr. Mando's March 2021 medical opinion, the Board finds that the preponderance of the evidence is in favor of a conclusion that the Veteran's current bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, and degenerative disc disease of the lumbosacral spine are related to his hip, knee, and back injuries and symptoms in service. Therefore, service connection for bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, and degenerative disc disease of the lumbosacral spine is warranted. 2. Entitlement to service connection for degenerative disc disease of the cervical spine and migraine headaches The Veteran contends that he has current cervical spine and headache disabilities which are associated with his service-connected left and right shoulder disabilities. The Board finds, for the following reasons, that the Veteran has current degenerative disc disease of the cervical spine and migraine headaches, and that the evidence is at least evenly balanced as to whether these disabilities are caused by his service-connected shoulder disabilities. Dr. Mando's March 2021 letter indicates that the Veteran has been diagnosed as having degenerative disc disease of the cervical spine and migraine headaches. Therefore, current disabilities have been demonstrated. As for whether these disabilities are caused by the Veteran's service-connected shoulder disabilities, there are conflicting medical opinions. The examiner who conducted an April 2014 VA cervical spine examination opined that the Veteran's cervical spine disability was not likely ("less likely than not"/"less than 50 percent probability") proximately due to or the result of his service-connected shoulder disability. He noted that the Veteran had cervical pain, that a June 2013 MRI revealed mild diffuse disc bulging at C3-4 and C4-5 and left paramedian disc protrusion at C5-6, and that these findings were unrelated to his service-connected shoulder disability, but did not provide any further explanation or rationale for his opinion. In September 2014, a VA physician reviewed the Veteran's claims file and opined that the Veteran's "left side and back of neck stiffness also claimed as headaches" was not proximately due to or the result of his service-connected left shoulder disability. The physician reasoned that these two disabilities involve distinct and separate anatomic locations. In his March 2021 letter, Dr. Mando explained, in pertinent part, that the Veteran reported that his neck disability was the result of his left shoulder disability due to overuse of the shoulder joint and reduced range of motion, which had worsened since his second surgery. Also, he reported that after his shoulder surgery in 2012, he began to experience headaches, resulting in his current headache disability. Medical research, including reports from The Centers for Advanced Orthopedics, document that shoulder problems can cause neck pain and headaches because the shoulder and neck share the same muscles. Specifically, the levator scapulae and the trapezius also attach to the cervical spine and base of the skull. Also, because the shoulder joint is held in position by muscle tone rather than by joint compression, and some of these muscles attach to the neck and head, unnatural shoulder mechanics (a functional problem in which muscles or joints do not move optimally, creating stress to the tissues) can cause neck pain and headaches. A Mayo Clinic report on neck pain indicates that muscle overuse and strain to the surrounding areas, such as the shoulder and neck, can trigger a headache or migraine. Considering all possible etiologies, the pertinent medical history, and relevant medical research, Dr. Mando opined that the Veteran's current cervical spine disability and headaches were likely ("at least as likely as not") a result of his service-connected bilateral shoulder disability. The April 2014 opinion is of minimal, if any, probative weight because it is not accompanied by any specific explanation or rationale. See Nieves-Rodriguez, 22 Vet. App. at 304. The September 2014 and March 2021 opinions, by contrast, are based upon a review of the Veteran's treatment records and/or medical literature, and consideration of his reported history, and they are accompanied by specific rationales that are consistent with the evidence of record. Therefore, these opinions are entitled to substantial probative weight. See Id. In light of the above medical opinions, the Board finds that the evidence is at least evenly balanced as to whether the Veteran's degenerative disc disease of the cervical spine and migraine headaches are caused by his service-connected left and right shoulder disabilities. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for degenerative disc disease of the cervical spine and migraine headaches, as secondary to service-connected left shoulder separation status post arthroscopic repair and right shoulder impingement, on a causation basis, is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. III. TDIU Entitlement to a TDIU due to service-connected disabilities, from March 11, 2016 through April 2, 2016 A TDIU may be assigned "where the schedular rating is less than total" and the evidence shows that a veteran is precluded, by reason of his service-connected disabilities, from securing and following "substantially gainful employment" consistent with his education and occupational experience. 38 C.F.R. §§ 3.340, 3.341, 4.16. In this case, the Veteran is in receipt of a 100 percent rating during the entire claim period from March 11, 2016 through April 2, 2016. Hence, there remains no time during this period where the schedular rating is "less than total," as required for a TDIU. See 38 C.F.R. § 4.16 (a). The Board is cognizant of the fact that the receipt of a 100 percent schedular disability rating for a service-connected disability or disabilities does not necessarily moot the issue of entitlement to a TDIU because a TDIU rating based on a single service-connected disability may still form the basis for assignment of SMC pursuant to 38 U.S.C. § 1114 (s). See Bradley v. Peake, 22 Vet. App. 280 (2008). In this case, the Veteran has already been awarded SMC pursuant to 38 U.S.C. § 1114 (s) during the period from March 11, 2016 through April 2, 2016. Therefore, the issue of entitlement to a TDIU, from March 11, 2016 through April 2, 2016, must be dismissed as moot. REASONS FOR REMAND 1. Entitlement to an effective date earlier than October 30, 2013 for the award of service connection for left shoulder scars, status post-surgery, and entitlement to an effective date earlier than July 5, 2017 for the award of service connection for right shoulder scars, status post-surgery, are remanded. A July 2017 letter from the United States Office of Personnel Management indicates that the Veteran was awarded federal disability retirement benefits for bilateral shoulder disability, among other disabilities. Any outstanding records pertaining to the Veteran's claim for federal disability retirement benefits may be relevant to the effective date issues on appeal, as they may reflect that entitlement to compensation for the Veteran's service-connected shoulder scars may be factually ascertainable earlier than the currently assigned effective dates. Hence, the AOJ should attempt to obtain any such relevant records upon remand. 2. Entitlement to an initial compensable rating for GERD is remanded. The evidence reflects that the Veteran's service-connected GERD may have worsened since he was last examined by VA in September 2015. For instance, the September 2015 examination report indicates that the only symptom associated with the Veteran's GERD was reflux. However, he reported during the July 2016 DRO hearing that he experienced stomach and chest pain (suggestive of pyrosis) associated with his GERD. In light of this information and the fact that the issue of entitlement to a higher initial rating for GERD must otherwise be remanded to obtain outstanding federal disability retirement records, the Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of his service-connected GERD. Also, the evidence indicates that there may be outstanding relevant VA treatment records. The most recent VA treatment records in the claims file are from the Saginaw Vista electronic records system (dated to August 2019), the Detroit Vista electronic records system (dated to September 2017), and the West Haven Vista electronic records system (dated to July 2016). Any VA treatment records are within VA's constructive possession, and must be obtained regardless of their relevance as long as they are sufficiently identified. Sullivan v. McDonald, 815 F.3d 786, 793 (Fed. Cir. 2016) (VA has a duty to assist in obtaining sufficiently identified VA medical records regardless of their relevance). See also Jones v. Wilkie, 918 F.3d 922 (Fed. Cir. 2019) (confirming the holding in Sullivan). A remand is required to allow VA to obtain them. Lastly, all outstanding federal disability retirement records should be secured upon remand. 3. Entitlement to an initial rating higher than 20 percent for right shoulder impingement (except for a period when a temporary 100 percent rating was in effect), entitlement to initial compensable ratings for right and left shoulder scars, status post-surgery, entitlement to a rating in excess of 10 percent for left ankle osteoarthritis, and entitlement to a rating in excess of 20 percent for left shoulder separation status post arthroscopic repair (except for a period when a temporary 100 percent rating was in effect) are remanded. While the Veteran was most recently afforded VA examinations regarding his service-connected left ankle and bilateral shoulder disabilities in June 2015 and September 2017, respectively, the examinations do not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) and/or Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). With respect to the June 2015 ankle examination, the examination report does not contain passive range of motion measurements or pain on both weight-bearing and non weight-bearing testing. Also, the Veteran reported flare ups of ankle pain multiple times per week, the examination was not being conducted during a flare up, and the examiner noted that fatigue significantly limited functional ability of the ankle during flare ups. However, the examiner was unable to describe such additional functional loss in terms of additional limitation of ankle motion and the only explanation was that the Veteran was not experiencing a flare up at the time of the examination and an estimation of additional range of motion loss would be speculation. Moreover, the examiner noted that while the examination was not being conducted immediately after repetitive use over time and fatigue significantly limited functional ability of the ankle with repeated use over time, she was unable to describe such additional functional loss in terms of additional limitation of ankle motion. The only explanation was that the disturbance of function was intermittent and estimates of additional range of motion loss would be speculation. As for the September 2017 shoulder examination, the Veteran reported during the examination that he experienced flare ups of shoulder symptoms with overuse depending upon activity. The examination was not being conducted during a flare up or immediately after repetitive use over time, and the examiner noted that it was unable to be determined whether pain, weakness, fatigability, or incoordination significantly limited functional ability of the shoulders during flare ups or following repeated use over time. The only explanation for this conclusion was that the Veteran was not being examined during a flare up or after repetitive use. In light of the above inadequacies of the June 2015 and September 2017 examinations, the Veteran should be afforded new examinations upon remand to determine the current severity and manifestations of his service-connected left ankle and bilateral shoulder disabilities. Also, all outstanding VA treatment records and federal disability retirement records should be secured upon remand. Lastly, as additional information will be obtained during the requested VA shoulder examination which is pertinent to the issues of entitlement to higher initial ratings for right and left shoulder scars, Board action on these matters at this time would be premature. Hence, these matters are being remanded, as well. 4. Entitlement to a TDIU due to service-connected disabilities, from October 30, 2013 through March 10, 2016, is remanded. The Veteran's TDIU claim is on appeal as part and parcel of the other higher rating matters on appeal, and the claim period dates back to October 30, 2013. Since the AOJ's implementaion of the Board's award of service connection for bilateral hip disability, bilateral knee disability, back disability, cervical spine disability, and headaches, and a decision on the other remanded effective date and higher rating issues could significantly impact a decision on the issue of entitlement to a TDIU prior to March 11, 2016, the issues are inextricably intertwined. A remand of the claim for a TDIU is required. Also, all outstanding VA treatment records and federal disability retirement records should be secured upon remand. The matters are REMANDED for the following action: 1. Implement the Board's award of service connection for bilateral hip osteoarthritis, right knee osteoarthritis, left knee meniscal tear and osteoarthritis, degenerative disc disease of the lumbosacral spine, degenerative disc disease of the cervical spine, and migraine headaches, to include the assignment of initial disability ratings. 2. Obtain the Veteran's outstanding VA treatment records from the Saginaw Vista electronic records system for the period since August 2019; the Detroit Vista electronic records system for the period since September 2017; the West Haven Vista electronic records system for the period since July 2016; and all such relevant records from any other sufficiently identified VA facility. 3. Contact the United States Office of Personnel Management and request all records relied upon in making any disability retirement determination(s). Document all requests for information as well as all responses in the claims file. 4. After all efforts have been exhausted to obtain and associate with the claims file any federal disability retirement records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected GERD. 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 provide reasons for any opinion given. 5. After all efforts have been exhausted to obtain and associate with the claims file any federal disability retirement records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left and right shoulder disabilities. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran's disabilities 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 of both the left and right shoulder. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and with repeated use over time. 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 and with repeated use over time 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). The examiner may not rely solely upon his or her inability to personally observe the Veteran during a period of flare-up or following repeated use over time. The examiner should also report the nature and severity of any scarring associated with the service-connected left and right shoulder disabilities, to include whether any scar causes any limited motion or loss of function. Each scar size (including BOTH scar length and width) and whether any scar is superficial, deep, associated with underlying soft tissue damage, nonlinear, unstable, or painful should also be noted. The examiner must provide reasons for any opinion given. 6. After all efforts have been exhausted to obtain and associate with the claims file any federal disability retirement records and additional treatment records, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left ankle disability. 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 of both the left and right ankle. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and with repeated use over time. 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 and with repeated use over time 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). The examiner may not rely solely upon his or her inability to personally observe the Veteran during a period of flare-up or following repeated use over time. The examiner must provide reasons for any opinion given. Jonathan Hager Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Elwood, 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.