Citation Nr: 18160354
Decision Date: 12/27/18	Archive Date: 12/26/18

DOCKET NO. 14-38 981
DATE:	December 27, 2018
Entitlement to a higher than 20 percent rating for service-connected left ankle disability is remanded.
In his February 2014 notice of disagreement, the Veteran sought a secondary service connection for his knee disability.  This issue is REFERRED to the RO for appropriate adjudication.   
The Board finds that an updated examination is warranted for the Veteran’s left ankle disability.  He underwent a VA examination in July 2013 for his left ankle disability, the report of which showed the Veteran had plantar flexion of 10 degrees and full dorsiflexion of 20 degrees.  VA treatment reports showed continued complaints of left ankle pain and physical therapy notes revealed that he had full muscle strength at 5 out of 5 in his ankle.  During his September 2017 hearing before the undersigned, the Veteran asserted that his left ankle condition had worsened since his July 2013 VA examination.  The Veteran also stated that he could not preform his mechanic job duties due to his ankle disability.
In an August 2018 medical opinion, the Veteran’s private physician opined that it is at least likely as not that the Veteran’s ankle disability produces severe and disabling pain.  The physician noted that the Veteran’s ankle disability should be rated higher than the current 20 percent disability rating.  According to the Veteran’s private physician, aside from the pain and limitation of motion, the Veteran also suffers from instability; inability to stand for long periods of time; and disturbance of locomotion.  The physician concluded that the Veteran should be compensated higher based on his additional ankle disability symptoms.  
As there is evidence that the Veteran’s symptoms have worsened since his last examination, a new VA examination is necessary to determine the current severity of the service-connected left ankle disability.
The matter is REMANDED for the following actions:
1. Schedule the Veteran for an examination to determine the current severity of his left ankle disability.  The relevant documents in the electronic file should be made available to, and be reviewed by, the VA examiner.  The VA examiner should note such review in the examination report. A history should be elicited from the Veteran. 
Range of motion studies must include active and passive motion and weight-bearing and non-weight-bearing as well as range of motion measurements of the opposite, undamaged joint (if possible). 
The examiner must also note any further functional limitations due to pain, weakness, fatigue, incoordination, or other such factors.  If there is pain observed on range of motion testing, the examiner must note the point (in degrees) at which pain begins.
Additionally, the examiner must specifically express an opinion concerning whether there would be additional limitations on functional ability on repeated use or during flare-ups, and, to the extent possible, provide an assessment of the functional impairment on repeated use or during flare-ups in terms of the degree of additional range of motion loss, using lay observations specifically elicited from the Veteran.
In discussing the severity of the Veteran’s disability, the examiner must specifically address the Veteran’s inability to work and accompanying physical effects.
A detailed rationale must be provided for any opinion provided, including a discussion of the evidence of record, and medical principles which led to the conclusions reached.
2. After completing the above, and any other development deemed necessary, readjudicate the Veteran’s appeal based on the entirety of the evidence. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, he and his representative should be provided with a supplemental statement of the case. An appropriate period of time should be allowed for response. 

Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Mahlet Makonnen, Law Clerk

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