Citation Nr: 22012227 Decision Date: 03/02/22 Archive Date: 03/02/22 DOCKET NO. 17-48 315 DATE: March 2, 2022 ORDER A disability rating in excess of 10 percent for retropatellar syndrome of the right knee under Diagnostic Code (DC 5260) is denied. A disability rating in excess of 10 percent for retropatellar syndrome of the left knee under DC 5260 is denied. A 20 percent for right knee instability under DC 5257 is granted for the entire appeal period. A 20 percent for left knee instability under DC 5257 is granted for the entire appeal period. REMANDED The issue of entitlement to service connection for bilateral shin splints associated with bilateral retropatellar pain syndrome is remanded. FINDINGS OF FACT 1. The Veteran's retropatellar pain syndrome causes limitation of function, limitation of flexion, and primarily pain in both knees; he does not experience limitation of flexion beyond 45 degrees, even during flareups and following repetitive use. 2. For the entire appeal period, the Veteran has manifested moderate instability in both knees, which has caused him to fall, and requires the prescription of knee braces, but has not required knee surgery. CONCLUSIONS OF LAW 1. The criteria for a disability rating in excess of 10 percent for retropatellar pain syndrome of the right knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5260. 2. The criteria for a disability rating in excess of 10 percent for retropatellar pain syndrome of the left knee have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5260. 3. For the entire appeal period, the criteria for a 20 percent disability rating for instability of the right knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. 4. For the entire appeal period, the criteria for a 20 percent disability rating for instability of the left knee have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.10, 4.40, 4.45, 4.59, 4.71a, DC 5257. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from November 1986 to August 1996, when he was discharged on account of disability. He was awarded the Combat Infantry Badge, among other decorations. This matter comes before the Board of Veterans' Appeals (Board) from a February 2018 decision by the Agency of Original Jurisdiction, which continued 10 percent disability ratings for retropatellar pain syndrome of each knee. The Veteran presented sworn testimony in support of his appeal during a December 2019 hearing before the undersigned Veterans Law Judge. In April 2020 the Board remanded for further evidentiary development. In an April 2021 decision, the AOJ bifurcated the Veteran's knee ratings to award separate compensation for instability of each knee and separate compensation for retropatellar pain syndrome. The issues on appeal have been phrased to reflect this bifurcation above. In September 2021, the Board again remanded for evidentiary development which had not been fully accomplished following the April 2020 remand. Such development has been accomplished and the matter is once again before the Board for appellate review. Increased Ratings Disability evaluations are determined by the application of VA's Schedule for Rating Disabilities (Rating Schedule), 38 C.F.R. Part 4. The percentage ratings contained in the Rating Schedule represent, as far as can be practicably determined, the average impairment in earning capacity resulting from diseases and injuries incurred or aggravated during military service and the residual conditions in civil occupations. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.321(a), 4.1. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. "Staged" ratings are appropriate for any rating claim when the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007). In evaluating claims for increased ratings, we must evaluate the Veteran's condition with a critical eye toward the lack of usefulness of the body or system in question. 38 C.F.R. § 4.10. A disability of the musculoskeletal system is measured by the effect on ability to perform the normal working movements of the body with normal excursion, strength, speed, coordination, and endurance. Weakness is as important as limitation of motion in assigning the most accurate disability rating. 38 C.F.R. § 4.40. Although § 4.40 does not require a separate rating for pain, it does provide guidance for determining ratings under other diagnostic codes assessing musculoskeletal function. The Board has a special obligation to provide a statement of reasons or bases pertaining to § 4.40 in rating cases involving pain. Spurgeon v. Brown, 10 Vet. App. 194 (1997). Disability of the joints is measured by abnormalities of motion, such as limitation of motion or hypermobility, instability, pain on motion, or the inability to perform skilled motions smoothly. 38 C.F.R. § 4.45. Painful motion with joint or periarticular pathology and unstable joints due to healed injury are recognized as productive of disability entitled to at least a minimal compensable rating for the joint. 38 C.F.R. § 4.59. VA must analyze the evidence of pain, weakened movement, excess fatigability, or incoordination and determine the level of associated functional loss in light of 38 C.F.R. § 4.40, which requires the VA to regard as 'seriously disabled' any part of the musculoskeletal system that becomes painful on use. DeLuca v. Brown, 8 Vet. App. 202 (1995). Included within 38C.F.R. §4.71a are multiple DCs that evaluate impairment resulting from service-connected knee disorders, including DC 5256 (ankylosis), DC 5257 (other impairment, including recurrent subluxation or lateral instability), DC 5258 (dislocated semilunar cartilage), DC 5259 (symptomatic removal of semilunar cartilage), DC 5260 (limitation of flexion), DC 5261 (limitation of extension), DC 5262 (impairment of the tibia and fibula), and DC 5263 (genu recurvatum). Under DC 5260, a noncompensable rating is assigned when flexion of the leg is limited to 60 degrees; a 10 percent rating is assigned when flexion is limited to 45 degrees; a 20 percent rating is assigned when flexion is limited to 30 degrees; and a 30 percent rating is assigned when flexion is limited to 15 degrees. Under DC 5261, a noncompensable rating is assigned when extension of the leg is limited to 5 degrees; a 10 percent rating is assigned when extension is limited to 10 degrees; a 20 percent rating is assigned when extension is limited to 15 degrees; a 30 percent rating is assigned when extension is limited to 20 degrees; a 40 percent rating is warranted for extension limited to 30 degrees; and a 50 percent rating is assigned when extension is limited to 45 degrees. Under DC 5257, which evaluates recurrent subluxation or lateral instability of a knee, and assigns a 10 percent disabling for a slight impairment, 20 percent disabling for a moderate impairment, and 30 percent disabling for a severe impairment. Under DC 5258, a maximum 20 percent rating is warranted for semilunar cartilage, dislocated, with frequent episodes of "locking", pain, and effusion into the joint. Lastly, under DC 5259, a maximum 10 percent rating is warranted for removal of semilunar cartilage that is symptomatic. Separate ratings under DCs 5260 and 5261 may be assigned for disability of the same knee joint. See VAOPGCPREC 9-2004. Additionally, for a knee disability already rated under DCs 5260 and/or 5261, a claimant would have additional disability justifying a separate rating if there is instability and/or subluxation of the knee joint under DC 5257. See generally VAOPGCPREC 23-97. Furthermore, the rating criteria do not preclude separate ratings for meniscal injury under DCs 5258 and 5259 where there are separate ratings for limitation of motion under DCs 5260 and/or 5261, or instability under DCs 5257. Lyles v. Shulkin, 29Vet. App.107 (2017). The normal range of knee motion is 140 degrees of flexion and zero degrees of extension. 38C.F.R. §4.71, Plate II. The terms "slight," "moderate," and "severe" are not defined in the Rating Schedule. Rather than applying a mechanical formula, the Board must evaluate all of the evidence to the end that its decisions are "equitable and just." 38C.F.R. §4.6. The use of terminology such as "slight" or "moderate" by VA examiners and others, although an element of evidence to be considered by the Board, is not dispositive of an issue. All evidence must be evaluated in arriving at a decision regarding an increased rating. Slight has been defined as small of its kind or in amount. https://www.merriam-webster.com/dictionary/slight. Moderate has been defined as tending toward the mean or average amount of dimension. https://www.merriam-webster.com/dictionary/moderate. Severe has been defined as being of a great degree. https://www.merriam-webster.com/dictionary/severe. For the musculoskeletal system and muscle injuries, the applicable rating criteria, found at 38C.F.R. §4.71a, were amended effective February 7, 2021. The old rating criteria applies to rating periods prior to February 7, 2021; however, whichever set of criteria is more favorable applies to periods after February 7, 2021, if the claim was pending prior to this date. See Kuzma v. Principi, 341 F.3d 1327 (Fed. Cir. 2003). As the Veteran's claim was pending prior to this date, the more favorable criteria will apply. Under the new rating criteria for DC 5257, other impairments of the knee are rated under either recurrent subluxation or instability, or patellar instability. Under recurrent subluxation or instability, a 10 percent rating is warranted for sprain, incomplete ligament tear, or complete ligament tear (repaired, unrepaired, or failed repair) causing persistent instability, without a prescription from a medical provider for an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 20 percent rating is warranted for one of the following: (a) Sprain, incomplete ligament tear, or repaired complete ligament tear causing persistent instability, and a medical provider prescribes a brace and/or assistive device (e.g., cane(s), crutch(es), walker) for ambulation; or, (b) Unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation. A 30 percent rating is warranted for unrepaired or failed repair of complete ligament tear causing persistent instability, and a medical provider prescribes both an assistive device (e.g., cane(s), crutch(es), walker) and bracing for ambulation. Under patellar instability, a 10 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability (with or without history of surgical repair) that does not require a prescription from a medical provider for a brace, cane, or walker. A 20 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for one of the following: A brace, cane, or walker. A 30 percent rating is warranted for a diagnosed condition involving the patellofemoral complex with recurrent instability after surgical repair that requires a prescription by a medical provider for a brace and either a cane or a walker. Note 1 indicates for patellar instability, the patellofemoral complex consists of the quadriceps tendon, the patella, and the patellar tendon. Note 2 indicates that a surgical procedure that does not involve repair of one or more patellofemoral components that contribute to the underlying instability shall not qualify as surgical repair for patellar instability (including, but not limited to, arthroscopy to remove loose bodies and joint aspiration. A claimant bears the evidentiary burden to establish entitlement to the benefit sought. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b). The benefit of the doubt applies when the evidence for and against is in "approximate balance" or "nearly equal," but does not apply when the evidence persuasively favors one side or the other. Lynch v. McDonough, _ F4th_, 2021 U.S. App. LEXIS 37307, 2021 WL 5983923 (Fed. Cir. Dec. 17, 2021) (en banc). History and facts Historically, service connection for retropatellar pain syndrome of each knee was granted following the Veteran's discharge from service. Noncompensable disability ratings were assigned at that time. A March 2014 rating decision awarded 10 percent ratings for each knee based on instability. The left knee was coded as DC 5257 while the right knee was coded as DC 5299-5257. The Veteran filed claims for increased ratings in September 2017. His VA clinic records were significant for his report of knee pain of 6/10 severity. He had been taking prescription pain medication for knee pain and other orthopedic pain throughout. He was issued knee braces for both knees in 2012, 2013 and again in 2015, prior to the appeal period. During a December 2017 peripheral nerves examination, the Veteran had reduced right knee muscle strength at 4/5, but no muscle atrophy in the knees. His gait during that examination was described as antalgic due to back and knee impairment. He was using a cane for ambulation due to back and knee impairment. The report of a January 2018 VA orthopedic examination for purposes of compensation reflects diagnoses of retropatellar pain syndrome in both knees and knee strain in the left knee. The Veteran reported that his knees were so painful they felt they would explode from sharp pains under the kneecaps. He stated that his knees gave out once or twice a day, requiring knee braces for joint stability and a cane to prevent falls during any type of physical activity. During the examination, there was objective evidence of knee pain, with palpation, during weight bearing, and range of motion exercises. The examiner specified that limited motion and pain both contributed to functional loss. Range of motion was measured from 0 to 90 degrees, reflecting normal knee extension but limited flexion. The Veteran was not able to perform repetitive use testing due to fear of pain. Muscle strength testing showed normal muscle strength in both knees, with no muscle atrophy. Joint stability testing was within normal limits except for some (1+ (0 to 5 millimeters) lateral instability in both knees. His meniscus and knee cartilage were deemed normal in both knees. The examiner noted that the Veteran used a cane for ambulation and stability. The examiner commented that the Veteran's service-connected knee condition limited his ability to stand or walk for prolonged periods of time (greater than ten minutes). Climbing stairs or walking on uneven terrain was limited secondary to poor gait and increased his risk for falls. X-ray studies were interpreted as showing normal knees bilaterally, with no bony abnormalities, well-maintained joint spaces, and no abnormal calcification or joint effusion. During a February 2018 nursing visit, the Veteran reported having had one fall during the previous twelve months. The fall was caused by his knees giving out; fortunately, he was not injured. A February 2018 rating decision continued 10 percent ratings for each knee. The AOJ only considered range of motion findings, and did not discuss instability. The AOJ also recoded both disabilities under DC 5260 without explanation. During an August 2018 peripheral nerves examination, the Veteran again confirmed that he used a cane daily. Strength testing was normal with no muscle atrophy. An August 2018 nursing visit note reflected a history of falls caused by his knees giving out. According to a January 2019 VA examination report, the Veteran reported an increase in the frequency and intensity of his knee pain, especially throughout his workday. He reported that he wore knee braces on both knees while working and when standing. He characterized knee flare-ups as involving increased pain and swelling with increased activity. He had pain of 4/10 severity which increased to 8/10 severity by the end of the day. His range of right knee motion was measured as 0 to 75 degrees, while he had left knee motion from 0 to 95 degrees. There was demonstrable pain on motion and weight-bearing. The examiner specified that pain caused functional loss in terms of disturbance of locomotion and interference with standing. There was no additional motion loss with repetitive testing. The examiner quantified these factors by estimating the Veteran would have difficulty standing for five minutes and walking 1/8 of a mile. Muscle strength was normal, with no muscle atrophy. Joint stability testing was entirely normal, with no lateral instability found. The meniscus and knee cartilage were deemed normal bilaterally. An October 2019 neurology consultation report reflects normal muscle strength in both knees and normal gait. During the December 2019 hearing on appeal, the Veteran testified that he used hinged knee braces for support, and that he experienced frequent falls when his knees gave out or buckled. He explained that he had attempted physical therapy but that the exercises were so painful he stopped. A December 2019 written statement from the Veteran's co-worker attested to the Veteran falling when his knees gave out. According to the statement, the falls have increased over the years with the Veteran sometimes falling to the floor several times a day. A January 2021 primary care record shows that the Veteran had a history of two or more falls over the prior year, caused when his leg gave out. VA treatment records show that the Veteran reported for orthopedic treatment of left knee pain in January 2021. His gait was noted to be slightly antalgic. He was not using any assistive devices. Range of motion was within normal limits; muscle strength was normal. Tenderness was noted in the left knee, but not the right. Stress testing was normal. Grinding of 1+ was noted in both knees, however. An X-ray study was interpreted as showing no significant acute or chronic bony abnormality, with the knee joints anatomically aligned, articular surfaces and joint spaces preserved, and no joint effusion. The treating physician rendered a diagnosis of left knee primary osteoarthritis. He was given a left knee corticosteroid injection and was issued a left knee brace. The Veteran was provided with another VA examination in April 2021. He reported that his bilateral knee pain and stiffness had worsened. He also reiterated his history of falling due to his knees giving out. He reported that he took pain medication, used knee braces, and rested. He stated he experienced daily severe flare-ups, lasting for several hours at a time. The examiner noted that the Veteran's bending and squatting was limited by his knee impairments, and that he was unable to enjoy hobbies such as "yard work or work." Range of motion was from zero to 100 degrees in both knees, with pain on flexion and extension. Crepitus was observed in both knees. The examiner specified that the Veteran's knee pain was severe and caused by retropatellar pain syndrome. Based upon statements from the Veteran, (not clinical examination) the examiner estimated that after repetitive motion or during a flare-up, the Veteran's range of motion would be reduced to 0 to 40 degrees in each knee. There was no muscle atrophy in either knees or legs. The examiner noted recurrent patellar instability in both knees, with no ligament tears, strains, or meniscus problems. Knee braces were recommended for the instability, and the Veteran reported that he used knee braces constantly. With regard to the occupational impact of the Veteran's knee disabilities, the examiner opined that the Veteran would be unable to perform any job that involved running, such as being a fireman. In April 2021 the AOJ granted separate disability ratings for instability of both knees as secondary to the service-connected retropatellar pain syndrome. Separate 20 percent disability ratings were assigned for instability of each knee effective April 7, 2021 under DC 5257. Retropatellar pain syndrome The Veteran's retropatellar pain syndrome is rated by analogy using the limitation of knee motion criteria. In this case, review of the evidence during the time period at issue shows that the Veteran has always manifested normal, or full extension of both knees. His retropatellar pain syndrome does not impair his ability to straighten, or fully extend his knees. The VA opinion of functional impairment on use did not reflect any los of extension. A compensable disability rating under DC 5261 is not warranted. The measurements regarding the Veteran's range of knee flexion during the appeal period range from 90, to 95, to 75 degrees in 2018 and 2019. In 2021, during the VA examination, his knee flexion was to 100 degrees, but the examiner estimated flexion would be reduced to 40 degrees following repetitive motion or during a flare-up. During a treatment visit in 2021, however, his knee motion was within normal limits. In fact, the Veteran's primary and most significant symptom of retropatellar pain syndrome is the pain in his knees. The weight of the medical opinions and explanations is that it is his knee pain which causes the functional limitations, to include limitation of flexion. It appears that the pain can cause gait abnormalities, but does not always, as the medical evidence indicates that some medical care providers have identified his gait as normal, while others have observed an abnormal, antalgic gait. This evidence appears to be consistent with the Veteran's own reports of flare-ups precipitated by use. According to the treatment report in January 2021, it appears the Veteran is developing some arthritis in the left knee. The Veteran is competent to attest to the pain he suffers as a result of his bilateral retropatellar pain syndrome, and there is no indication in the evidence of record that he lacks credibility. See Jandreau v. Nicholson, 492 F. 3d 1372, 1377 (Fed. Cir. 2007). His descriptions of pain particularly during a flare-up are considered competent and credible. Upon careful consideration, the Board deems that the currently-assigned 10 percent disability ratings for each knee are more nearly analogous to the impairment resulting from retropatellar pain syndrome of each knee. His currently assigned 10 percent ratings contemplate painful but noncompensable motion loss. Even when considering additional motion loss during flare and functional impairment, the VA examiner estimated a 40 degree loss of flexion which is consistent with a 10 percent rating under DC 6260. This schedular rating supplants the prior minimum rating for painful motion. His overall findings do not more nearly approximate limitation of flexion to 30 degrees which is required for the next higher 20 percent rating. Instability As noted in the prior Board remand, separate disability ratings may be assigned for distinct disabilities resulting from the same injury as long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. See Esteban v. Brown, 6 Vet. App. 259, 262 (1994). For this reason, separate ratings may be awarded for arthritis, instability, limitation of both flexion and extension, and for meniscal injuries. See VAOPGCPREC 23-97; VAOPGCPREC 9-98; VAOPGCPREC 09-04; Lyles, 29 Vet. App. 107 (2017). As noted above, the Veteran's original 10 percent ratings for both knees were predicated on instability under DC 5257. The Veteran filed his claim for an increased rating in September 2017, and his 2018 VA examination noted lateral lateral instability bilaterally. The AOJ changed diagnostic codes to rate for painful motion, but did not explain why the prior rating for instability was being discontinued. Regardless, the January 2018 VA examination described 1+ (0 to 5 mm) lateral laxity in both knees. At that time, the Veteran described that his knees gave out once or twice a day, requiring knee braces for joint stability and a cane to prevent falls during any type of physical activity. The next month in the clinic setting the Veteran reported having had one fall during the previous twelve months due to knee give way. He again reported this in August 2018. No instability was detected on examination in January 2019, but a co-worker in December 2019 attested to the Veteran falling when his knees gave out sometimes falling to the floor several times a day. Here, the Veteran credibly reported instability since the inception of the appeal, and his January 2018 examination demonstrated 1+ lateral instability in both knees while the 2019 examination demonstrated no instability on examination. The clinic evaluations are more consistent with laxity which is slight or small in amount. However, there is credible history from the Veteran and a witness of multiple falling episodes due to his knee instability. This tends to show instability which is more than small in kind, but less than being of a great degree when considering the clinic findings. In totality, the Board finds that the Veteran has more nearly approximated moderate instability of both knees for the entire appeal period. As such, separate 20 percent ratings for each knee are warranted for the entire appeal period. The criteria for rating instability of the knees were substantially amended in the February 2021 revisions which forms the basis for the 20 percent ratings assigned by the AOJ effective April 2021. The Veteran has no history of complete ligament tear or surgical repairs. As such, a higher 30 percent rating under the new criteria is not warranted. Additional diagnostic codes The Board has also considered the application of the additional diagnostic codes. Ankylosis is an objective finding or symptom and not a diagnosis. Chavis v. McDonough, 34 Vet. App. 1 (2021). Notably, multiple definitions of "ankylosis" were discussed in Chavis including general medical dictionary definitions as follows: "[i]mmobility and consolidation of a joint due to disease, injury, or surgical procedure" (citing DORLAND'S ILLUSTRATED MEDICAL DICTIONARY 94 (33rd ed. 2019)), "[s]tiffening or fixation of a joint as the result of a disease process, with fibrous or bony union across the joint" (citing STEADMAN'S MEDICAL DICTIONARY 95 (28th ed. 2006)) and "[a] stiffening or immobilization of a joint as a result of injury, disease, or surgical intervention" (citing CHURCHILL'S ILLUSTRATED MEDICAL DICTIONARY 91 (1989). The Veteran's radiographic findings at most show some osteoarthritis but there is no competent evidence of disease, injury, or surgical procedure resulting in fibrous or bony union, stiffening or immobilization of either knee joint. The Veteran has limitation of motion, but has active motion in both flexion and extension. The Board also finds that ankylosis, or functional ankylosis, has not been present during any time during the appeal period. As such, a separate rating for ankylosis under DC 5256 is not warranted. There is no lay or medical history of meniscal injury or surgery, impairment of the tibia and fibula or genu recurvatum. As such, DCs 5258, 5259, 5262 and 5263 are not applicable. REASONS FOR REMAND The Board notes that VA is required to develop and adjudicate related claims for secondary service connection for disabilities that are reasonably raised during the adjudication of an increased rating claim for the primary disability. See Bailey v. Wilkie, 33 Vet. App. 188 (2021); Kisor v. Wilkie, 139 S. Ct. 2400, 2415 (2019); 38 C.F.R. § 3.155(d)(2) (stating that VA will consider all lay and medical evidence in order to adjudicate entitlement to benefits for the claimed condition as well as entitlement to any additional benefits for complications of the claimed condition, including those identified by the rating criteria for that condition in 38 CFR Part 4, Schedule for Rating Disabilities). During the April 2021 VA examination, the examiner also rendered a diagnosis of bilateral shin splints and indicated that the shin splints were directly related to the other service-connected knee disabilities, i.e., a progression of the disabilities. The examiner provided the explanation that, "Bilateral retropatellar pain syndrome causes shin pain due to the proximity of the knee to the shin. Pain radiates from knee to shin causing shin pain and tenderness." The examiner specified that the Veteran's shin splints did not affect range of knee motion or range of ankle motion. Thus, the only symptoms of shin splints appear to be shin pain and tenderness. In general, separate disability ratings may be assigned for distinct disabilities resulting from the same injury so long as the symptomatology for one condition is not "duplicative of or overlapping with the symptomatology" of the other condition. Esteban v. Brown, 6 Vet. App. 259, 262 (1994). On its face, a rating for shin splints should not overlap or duplicate the knee ratings which are already in place. The AOJ has not yet considered this diagnosis and medical opinion. Therefore, the Board remands a reasonably raised claim of service connection for bilateral shin splints. (continued on the next page) The matter is REMANDED for the following action: Adjudicate the issue of entitlement to service connection for bilateral shin splints. T. MAINELLI Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Harter, Heather J. 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.