REPLACEMENT OF KNEE WITH PROSTHESIS

STEVEN D. REISS · 2026 · Case ID: 26005025

MIXED

Summary

The Veteran served in the United States Army from February 1978 to July 1986, including active duty for training and additional service in the Army National Guard. The Veteran appeals a January 2018 rating decision, seeking service connection for multiple conditions including obstructive sleep apnea, respiratory disability (sinusitis), neck disability, low back disability, bilateral shoulder disabilities, headaches, psychiatric disability, right knee scars, and TDIU. The Board granted a 60 percent rating for the right total knee replacement effective November 1, 2021, based on severe painful motion and weakness. The Board found the criteria for this rating were met. Several other claims, including obstructive sleep apnea, ankle disabilities, and TDIU, were previously remanded. During the appeal, subsequent rating decisions granted service connection for obstructive sleep apnea and ankle conditions with earlier effective dates, rendering those specific issues no longer on appeal. However, the Board remanded claims for respiratory disability (sinusitis), neck, low back, bilateral shoulder, headaches, psychiatric disability, and right knee scars for additional development, including VA examinations and nexus opinions. The Board noted that while the Veteran claimed sinusitis, the VA examiner diagnosed allergic rhinitis and found no objective evidence for sinusitis, but also failed to provide a nexus opinion for the allergic rhinitis. The Board recharacterized the sinusitis claim to a broader respiratory disability claim due to the lack of a specific diagnosis and the need for a nexus opinion.

Rationale

Criteria for 60 percent rating met; Severe painful motion and weakness

Service Branch

ARMY

Special Benefit

SMC - AID & ATTENDANCE; TDIU

Diagnostic Code

5055

Docket No.

19-34 673

Full Decision Text

Citation Nr: 26005025
Decision Date: 04/29/26 Archive Date: 04/29/26

DOCKET NO. 19-34 673
DATE: April 29, 2026

ORDER

Entitlement to a rating of 60 percent for right total knee replacement (TKR) since November 1, 2021, is granted.

REMANDED

Entitlement to service connection for a respiratory disability, to include sinusitis, is remanded.

Entitlement to service connection for neck disability is remanded.

Entitlement to service connection for low back disability is remanded.

Entitlement to service connection for right shoulder disability is remanded.

Entitlement to service connection for left shoulder disability is remanded.

Entitlement to service connection for headaches is remanded.

Entitlement to service connection for psychiatric disability is remanded.

Entitlement to an initial rating in excess of 10 percent for right knee scars is remanded.

Entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded.

Entitlement to special monthly compensation (SMC) based on the need for aid and attendance is remanded.

FINDING OF FACT

From November 1, 2021, the Veteran's right TKR has been manifested by chronic residuals consisting of severe painful motion and weakness in the affected extremity.

CONCLUSION OF LAW

1. From November 1, 2021, the criteria for entitlement to a rating of 60 percent for right TKR have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.3, 4.7, 4.10, 4.59, 4.71a, Diagnostic Code 5055.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran served on active duty in the United States Army from February 1980 to July 1986, including active duty for training from May 1978 to August 1978, as well as additional service in the Army National Guard.

These matters come before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO).

In a September 2020 VA Form 21-8940, the Veteran raised a claim for TDIU, and this issue is part of the instant appeal pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009).

During the pendency of this appeal, a January 2021 rating decision awarded a temporary total rating for the Veteran's right knee disability, rated 100 percent disabling, effective September 10, 2020, to November 1, 2021. Such period is not before the Board and will not be addressed herein.

The Veteran testified before the undersigned Veterans Law Judge in a June 2023 virtual hearing.

These matters were previously before the Board in November 2023 when they were remanded for additional development.

The November 2023 Board decision also remanded the claims of service connection for obstructive sleep apnea, a right ankle disability, and a left ankle disability. During the pendency of the appeal, a September 2025 rating decision granted service connection for obstructive sleep apnea, right ankle strain, and left ankle strain, effective May 15, 2025. A March 2026 rating decision granted an earlier effective date for obstructive sleep apnea, effective February 7, 2017. And an April 2026 rating decision granted an earlier effective date for right and left ankle strain, effective February 7, 2017. As the benefits sought have been provided, the matters are no longer on appeal and will not be addressed herein.

Increased Rating

Disability evaluations are determined by the application of a schedule of ratings, which is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive
identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. The percentage ratings in VA's Schedule for Rating Disabilities (Rating Schedule) represent as far as can practicably be determined the average impairment in earning capacity resulting from such disabilities and their residual conditions in civil occupations. 38 C.F.R. § 4.1.

Where there is a question as to which of two ratings shall be applied, the higher rating will be assigned if the disability more closely approximates the criteria for that rating. Otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. When there is an approximate balance of positive and negative evidence regarding the merits of an issue material to the determination of the matter, the benefit of the doubt in resolving each such issue shall be given to the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. §§ 3.102, 4.3.

Where entitlement to compensation has already been established and increase in disability is at issue, the present level of disability is of primary concern. See Francisco v. Brown, 7 Vet. App. 55 (1994). However, "staged" ratings are appropriate where the factual findings show distinct time periods when the service-connected disability exhibits symptoms that would warrant different ratings. See Hart v. Mansfield, 21 Vet. App. 505 (2007); see also Fenderson v. West, 12 Vet. App. 119 (1999).

When evaluating joint disabilities rated on the basis of limitation of motion, VA must consider granting a higher rating in cases in which functional loss due to pain, weakness, excess fatigability, or incoordination is demonstrated, and those factors are not contemplated in the relevant rating criteria. See 38 C.F.R. §§ 4.40, 4.45, 4.59; DeLuca v. Brown, 8 Vet. App. 202 (1995). The Court has clarified that although pain may be a cause or manifestation of functional loss, limitation of motion due to pain is not necessarily rated at the same level as functional loss where motion is impeded. See Mitchell v. Shinseki, 25 Vet. App. 32 (2011); cf. Powell v. West, 13 Vet. App. 31, 34 (1999); Hicks v. Brown, 8 Vet. App. 417, 421 (1995); Schafrath v. Derwinski, 1 Vet. App. 589, 592 (1991).

Instead, the Court in Mitchell explained that pursuant to 38 C.F.R. §§ 4.40 and 4.45, the possible manifestations of functional loss include decreased or abnormal excursion, strength, speed, coordination, or endurance, as well as less or more movement than is normal, weakened movement, excess fatigability, and pain on movement (as well as swelling, deformity, and atrophy) that affects stability, standing, and weight-bearing. See 38 C.F.R. §§ 4.40, 4.45. Thus, functional loss caused by pain must be rated at the same level as if the functional loss were caused by any of the other factors cited above. In evaluating the severity of a joint disability, VA must determine the overall functional impairment due to these factors.

1. Entitlement to a rating in excess of 30 percent for right TKR since November 1, 2021.

As explained above in the Introduction, effective from September 10, 2020, the Veteran's right knee disability is rated 100 percent disabling due to surgery, and effective from November 1, 2021, the Veteran's right knee disability is rated under Diagnostic Code 5055 for right total knee replacement.

Under Diagnostic Code 5055, a 60 percent rating was warranted if the disability was productive of chronic severe residuals consisting of severe painful motion or weakness. The minimum 30 percent rating under this code was warranted for intermediate degrees of residual weakness, pain or limitation of motion, which was also to be rated by analogy to Diagnostic Codes 5256, 5261 and 5262.

Effective February 7, 2021, VA revised the criteria for evaluating musculoskeletal disorders. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020); Correction, 86 Fed. Reg. 8142, 8143 (Feb. 4, 2021) (changing new diagnostic code applicable to plantar fasciitis from 5285
. The minimum 30 percent rating under this code was warranted for intermediate degrees of residual weakness, pain or limitation of motion, which was also to be rated by analogy to Diagnostic Codes 5256, 5261 and 5262.

VA's General Counsel has held that where a law or regulation changes during the pendency of a claim for a higher rating, the Board must first determine whether the revised version is more favorable to the veteran. In so doing, it may be necessary for the Board to apply both the old and new versions of the regulation. If the revised version of the regulation is more favorable, the retroactive reach of that regulation under 38 U.S.C. § 5110(g) can be no earlier than the effective date of that change. The Board must generally apply both the former and the revised versions of the regulation for the period prior and subsequent to the regulatory change, but an effective date based on the revised criteria may be no earlier than the date of the change.

VA thus must consider the claim for a higher rating pursuant to the former and revised regulations during the latter part of this appeal. See VAOPGCPREC 3 2000, 65 Fed. Reg. 33,422 (2000); DeSousa v. Gober, 10 Vet. App. 461, 467 (1997). Therefore, the Board will consider the Veteran's claim under the old criteria prior to February 7, 2021, and both the old and new rating criteria from February 7, 2021. The criteria that is more favorable to the Veteran will be applied.

Effective February 7, 2021, the new regulation changed Diagnostic Code 5055 and added "Resurfacing" to the section title as it is a newer treatment approach similar to replacement and is now rated the same as replacement for the 100 percent rating period, but not afterwards. Notes were added to preclude an additional rating under 4.71a when there is a rating under this section and to clarify that replacement means a "total replacement." The 100 percent rating was changed from 12 months to 4 months following implantation of prosthesis or resurfacing.

The Board has reviewed the record in light of the aforementioned changes to the musculoskeletal criteria, but concludes that, under the circumstances of this case, to the extent the changes apply, the old rating criteria are more favorable to the Veteran for the period on appeal.

During the pendency of the appeal, an October 2025 rating decision granted an increased 60 percent rating for the Veteran's right TKR, effective September 16, 2025.

After a review of the evidence of record, the Board finds that a 60 percent rating is warranted effective from November 1, 2021. On September 2025 VA knee and lower leg examination, the Veteran reported his current symptoms included right knee pain, stiffness, weakness, and instability. He reported daily and severe flare-ups that lasted numerous hours. There was pain on flexion and extension range of motion testing. It was noted the Veteran had recurrent subluxation or persistent instability. The examiner found the Veteran had chronic residuals consisting of severe painful motion or weakness. The September 2025 VA examination was the basis for the award of an increased 60 percent rating. However, the findings of the September 2025 VA examination were consistent with those found on October 2024 VA knee and lower leg examination wherein the Veteran complained of sharp pain and numbness of the right knee, recurrent subluxation or persistent instability were noted, and his right knee disability was indicated to have an impact on extended walking, standing, and squatting. The earliest VA examination during the period since November 1, 2021, is the October 2024 VA examination. Thus, the Board finds that the Veteran's right TKR warrants a 60 percent rating effective from November 1, 2021.

However, the Board finds that a rating in excess of 60 percent is not warranted from November 1, 2021. The amputation rule provides that, in pertinent part, that the combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were an amputation
ation or persistent instability were noted, and his right knee disability was indicated to have an impact on extended walking, standing, and squatting. The earliest VA examination during the period since November 1, 2021, is the October 2024 VA examination. Thus, the Board finds that the Veteran's right TKR warrants a 60 percent rating effective from November 1, 2021.

As relevant here, amputation of the leg at the knee warrants a 60 percent rating under Diagnostic Code 5162. 38 C.F.R. § 4.71a. While a rating of 100 percent is available for the year following knee replacement under Diagnostic Code 5055, that period ended October 31, 2021. Therefore, any rating for the Veteran's right knee disability should not exceed 60 percent because this would run afoul of the amputation rule under 38 C.F.R. § 4.68. Hrvatin v. Principi, 3 Vet. App. 426, 430 (1992) (holding that since the veteran was assigned the highest rating under the Diagnostic Code, any error in not awarding a higher rating was harmless).

The Board finds that the Veteran has been assigned the maximum 100 percent rating from September 10, 2020, to October 31, 2021, representing the full one-year period following the knee replacement.

Also, the Board further finds that the Veteran has been assigned the maximum 60 percent rating from November 1, 2021, which contemplates chronic residuals consisting of severe painful motion or weakness, available for his service-connected TKR under the applicable diagnostic criteria. The assignment of a disability rating in excess of 60 for this period is not warranted.

REASONS FOR REMAND

2. Entitlement to service connection for a respiratory disability, to include sinusitis, is remanded.

The Veteran has reported nose bleeds, drainage, and nasal congestion for years. See October 2024 VA sinusitis/rhinitis and other conditions of the nose, throat, larynx and pharynx. He contends that such symptomatology had its onset during service and has been recurrent since service. See June 2023 Board hearing. Alternatively, the Veteran contends that his respiratory disability is secondary to his service-connected obstructive sleep apnea with asthma. See January 2019 VA Form 21-0958; see also September 2025 rating decision (awarding service connection for obstructive sleep apnea and rating the disability with his service-connected asthma).

The Board remanded the matter of service connection for sinusitis in November for additional development, to include for a VA examination. See McLendon v. Nicholson, 20 Vet. App. 79 (2006); see also El-Amin v. Shinseki, 26 Vet. App. 136 (2013).

The Veteran was afforded a VA examination in October 2024 and the diagnosis was allergic rhinitis; sinusitis was not diagnosed. Inasmuch as the examiner found no objective evidence to support a current diagnosis of sinusitis, a nexus opinion as to the etiology of the disability was not provided. Significantly, the examiner provided no nexus opinion as to the etiology of the diagnosed allergic rhinitis. Additionally, while the October 2024 VA examiner, and the February 2026 VA examiner, failed to diagnose sinusitis, the evidence shows a diagnosis of such during the pendency of the appeal. See June 2017 treatment record; see also August 2021, February 2022 VA treatment records.

In light of the October 2024 VA examination and the diagnosis of allergic rhinitis, the Board has recharacterized the claim for service connection for sinusitis to a claim for service connection for a respiratory disability (other than obstructive sleep apnea with asthma), because a claimant is not required to identify a precise medical diagnosis to sufficiently file a claim for benefits. See DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); Brokowski v. Shinseki, 23 Vet. App. 79, 84-87 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (stating
2024 VA examination and the diagnosis of allergic rhinitis, the Board has recharacterized the claim for service connection for sinusitis to a claim for service connection for a respiratory disability (other than obstructive sleep apnea with asthma), because a claimant is not required to identify a precise medical diagnosis to sufficiently file a claim for benefits. See DeLisio v. Shinseki, 25 Vet. App. 45, 53 (2011); Brokowski v. Shinseki, 23 Vet. App. 79, 84-87 (2009); see also Clemons v. Shinseki, 23 Vet. App. 1, 5 (2009) (stating that, when determining the scope of a claim, the Board must consider "the claimant's description of the claim; the symptoms the claimant describes; and the information the claimant submits or that the Secretary obtains in support of that claim.").

Inasmuch as there is no examination of record that has provided a nexus opinion regarding the etiology of the Veteran's respiratory disability, to include sinusitis, the Board finds that this matter must be remanded to obtain one. See also McClain v. Nicholson, 21 Vet. App. 319, 321 (2007) (holding that a "current disability" includes a disability present at the time of filing or during the pendency of a claim).

3. Entitlement to service connection for a neck disability is remanded.

As previously stated in the November 2023 Board remand, the Veteran contends that his neck disability was injured in an April 3, 2017, motor vehicle accident while traveling from his place of duty to his home while on orders for annual training.

The evidence of record shows the Veteran was assigned to Alabama Army National Guard annual training from March 31, 2017, to April 12, 2017.

An April 3, 2017, motor vehicle accident report shows the Veteran was involved in an accident. The report indicates it was raining during the accident and the roadway surface was wet. It notes the other driver was driving too fast for the conditions. For the Veteran, the report indicated he suffered no injury, and his condition at the time of the crash was apparently normal. It noted that the Veteran was not transported to a medical facility.

An April 3, 2017, Twin Cities Hospital CT of the cervical spine diagnosed degenerative changes of the cervical spine.

A June 2020 Army Board for Correction of Military Records report noted the record was void of medical documents or evidence of an injury from the motor vehicle accident. It was instructed that the Veteran's command should complete the line of duty process and issue him a DA Form 2173 with their findings and line of duty determination.

A September 2020 Department of the Army memorandum approved the recommendation of the Army Board for Correction of Military Records.

A February 2021 Casualty and Mortuary Affairs Operations Division report indicated the unit would initiate the investigation immediately upon receipt of this directive.

In November 2023, the Board remanded this matter to obtain the Veteran's complete personnel records, to include any line of duty determinations and records, such as a DA Form 2173, pertaining to the motor vehicle accident on April 3, 2017.

To date, it does not appear there is a line of duty determination that has been processed and associated with the claims file. Inasmuch as it does not appear that exhaustive development for the requested records has been sought, the matter must be remanded again to attempt to secure the outstanding records and associate them with the claims file, and if unavailable, the RO issue a Formal Finding of Unavailability. See Stegall v. West, 11 Vet. App. 268 (1998).

4. Entitlement to service connection for a low back disability is remanded.

The Veteran contends that his low back disability had its onset during service due to physical training and running on hard surfaces while carrying heavy equipment, and that his symptoms have been recurrent since service. See June 2023 Board hearing. Alternatively, the Veteran contends that his low back disability is secondary to his service-connected right knee disability. See January 2019 VA Form 21-0958. Notably, the Veteran has also been awarded service connection for bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities secondary to his service-connected right knee disability. See November 2023, July 2025, September 2025 rating decisions. Finally, the Veteran contends that his low back disability may be related to the above-noted April 3, 2017, motor vehicle accident. See June 2018 VA treatment record.

The Veteran was afforded VA examinations
recurrent since service. See June 2023 Board hearing. Alternatively, the Veteran contends that his low back disability is secondary to his service-connected right knee disability. See January 2019 VA Form 21-0958. Notably, the Veteran has also been awarded service connection for bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities secondary to his service-connected right knee disability. See November 2023, July 2025, September 2025 rating decisions. Finally, the Veteran contends that his low back disability may be related to the above-noted April 3, 2017, motor vehicle accident. See June 2018 VA treatment record.

The Veteran was afforded VA examinations and opinions in October 2024 and April 2025, which included a diagnosis of degenerative arthritis. After review of the October 2024 and April 2025 VA examination and opinions, the Board finds them to be conclusory in nature, without supporting rationale. See Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007). Additionally, the opinions did not address whether the Veteran's low back disability was secondary to his now service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities, which have also been found to be secondary to his service-connected right knee disability. Inasmuch as the Veteran was not provided an adequate examination and opinion to address the nature and etiology of his low back disability, the Board finds that this matter must be remanded for additional development. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (VA must provided an examination that is adequate for rating purposes).

5. Entitlement to service connection for a right shoulder disability is remanded.

6. Entitlement to service connection for a left shoulder disability is remanded.

The Veteran has testified that he noticed the onset of his shoulder symptoms during service. See June 2023 Board hearing. The Veteran has also stated that his activities during service resulted in injuring his back and consequently resulted in injuries to his shoulders, but that the underlying cause of his bilateral shoulder disabilities was his service-connected right knee disability. Id; see also January 2019 VA Form 21-0958. Notably, the Veteran has also been awarded service connection for bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities secondary to his service-connected right knee disability. See November 2023, July 2025, September 2025 rating decisions.

The Veteran was afforded a VA examination and opinion in October 2024, which included a diagnosis of bilateral shoulder strain. After review of the October 2024 VA examination and opinion, the Board finds it to be conclusory in nature, without supporting rationale. See Stefl, 21 Vet. App. at 123. Additionally, the opinion did not address whether the Veteran's right and left shoulder disabilities were secondary to his now service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities, which have also been found to be secondary to his service-connected right knee disability. Inasmuch as the Veteran was not provided an adequate examination and opinion to address the nature and etiology of right and left shoulder disabilities, the Board finds that these matters must be remanded for additional development. See Barr, 21 Vet. App. at 311.

7. Entitlement to service connection for headaches is remanded.

The Veteran contends that his headaches are due to the above-noted April 3, 2017, motor vehicle accident and are secondary to his neck disability. See June 2023 Board hearing. The evidence of record suggests that his headaches may be secondary to his acquired psychiatric disorder and the prescribed medication to treat his psychiatric disorder. See October 2017 VA treatment record (noting the possible side effects of antidepressants include headaches). The evidence also suggests that the Veteran's headaches may be secondary to his service-connected obstructive sleep apnea with asthma. See November 2018 VA treatment record (noting the Veteran's complaint of headaches that start every morning and escalate by midday but indicating the Veteran was taking mediation for his sleep behavior disorder and insomnia). Finally, while not specifically raised by the Veteran, the evidence shows the Veteran was diagnosed with tension headache during his active duty service, and thus may be related to service. See November 1984 report (noting his complaint of temporal headaches for three months).

The Veteran was afforded a VA examination and opinion in October 2024. The diagnosis was unspecified headaches. After review of the October 2024 VA examination and opinion, the Board finds it to be conclusory in nature, without supporting rationale. See Stefl, 21 Vet. App. at
ing the Veteran's complaint of headaches that start every morning and escalate by midday but indicating the Veteran was taking mediation for his sleep behavior disorder and insomnia). Finally, while not specifically raised by the Veteran, the evidence shows the Veteran was diagnosed with tension headache during his active duty service, and thus may be related to service. See November 1984 report (noting his complaint of temporal headaches for three months).

The Veteran was afforded a VA examination and opinion in October 2024. The diagnosis was unspecified headaches. After review of the October 2024 VA examination and opinion, the Board finds it to be conclusory in nature, without supporting rationale. See Stefl, 21 Vet. App. at 123. Notably, the examiner indicated that the prevalence of headaches in obstructive sleep apnea was moderate, but did not increase the risk of headache, but did not address the etiology of headaches in the Veteran's individual circumstances in light of his service-connected obstructive sleep apnea. Inasmuch as the Veteran was not provided an adequate examination and opinion to the nature and etiology of his headaches, the Board finds that this matter must be remanded for additional development. See Barr, 21 Vet. App. at 311.

8. Entitlement to service connection for an acquired psychiatric disorder is remanded.

The Veteran has testified that his acquired psychiatric disorder is secondary to his service-connected disabilities, and particularly his service-connected orthopedic disabilities, including his service-connected right knee disability. See June 2023 Board hearing; see also September 2025 Veteran statement. He has testified that the chronic pain and functional limitations caused by his orthopedic disabilities have caused his acquired psychiatric disorder. Alternatively, the Veteran contends that his acquired psychiatric disorder is secondary to his service-connected obstructive sleep apnea with asthma. See November 2018 VA treatment record (noting the Veteran was taking medication for his sleep behavior disorder and insomnia and that his anxiety level was higher). Finally, the Veteran contends that his acquired psychiatric disorder is related to service, and in particular due to his duties identifying and processing deceased service members from overseas operations. See April 2026 Veteran statement.

This matter was remanded by the Board in November 2023 to provide the Veteran a VA examination to determine the nature and etiology of his acquired psychiatric disorder. See McLendon v. Nicholson, 20 Vet. App. 79 (2006).

The evidence shows the Veteran was scheduled for a VA psychiatric examination on October 1, 2024, but that he failed to show. However, there is no evidence the Veteran received notice of such examination, and there is no evidence that an attempt was made to reschedule the examination. The Board finds this particularly significant in this case because the record shows the Veteran subsequently attended multiple VA examinations in October 2024, and since the Board remand in November 2023.

In light of the circumstances, the Board finds that this matter should be remanded again to afford the Veteran another opportunity to attend a VA examination to determine the nature and etiology of his acquired psychiatric disorder.

9. Entitlement to an initial rating in excess of 10 percent for right knee scars.

In the November 2023 decision, the Board granted an initial 10 percent rating for the Veteran's right knee scars effective from February 7, 2017. The Board also remanded entitlement to an initial rating in excess of 10 percent for the Veteran's right knee scars, but erroneously listed the issue as entitlement to a rating in excess of 30 percent for status post right knee surgery with degenerative arthritis prior to September 10, 2020, in the "Remanded" portion of the decision. Notably, in the section labeled "Reasons for Remand," the issue was listed correctly, and the development requested was consistent with the nature of the disability.

Notably, the RO has not issued a Supplemental Statement of the Case (SSOC) since the receipt of the additional evidence since the November 2023 Board remand that included the matter of entitlement to an initial rating in excess of 10 percent for the Veteran's right knee scars. See April 2025 SSOC.

Under 38 C.F.R. § 20.1000(a)(3), denial of due process will be conceded and will warrant vacating a decision for a legacy appeal, as defined in 38 C.F.R. § 19.2, when an SOC or SSOC was not provided.

Pursuant to 38 C.F.R. § 19.31, the Agency of Original Jurisdiction (AOJ) will provide an SSOC to the appellant and their representative when the AOJ receives additional pertinent evidence after an SOC or the most recent SSOC has been
the matter of entitlement to an initial rating in excess of 10 percent for the Veteran's right knee scars. See April 2025 SSOC.

Pursuant to 38 C.F.R. § 19.31, the Agency of Original Jurisdiction (AOJ) will provide an SSOC to the appellant and their representative when the AOJ receives additional pertinent evidence after an SOC or the most recent SSOC has been issued and before the appellant record is transferred to the Board. If the pertinent evidence is received prior to the transfer of the case to the Board, a request for waiver of AOJ review is not appropriate, and the case must be remanded for a new SSOC. 38 U.S.C. § 7105(e); 38 C.F.R. §§ 19.31, 19.37(a).

In light of the foregoing, the Board finds that the matters on appeal must be remanded.

10. Entitlement to TDIU is remanded.

11. Entitlement to SMC based on the need for aid and attendance is remanded.

Additionally, because the Veteran's TDIU and SMC claims are inextricably intertwined with the claims remaining on appeal, appellate consideration of entitlement to a TDIU rating and to SMC are deferred pending resolution of the remaining claims on appeal. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). Outstanding treatment records should also be secured.

Finally, in a May 2024 letter from the Social Security Administration (SSA), it was indicated that the Veteran became disabled in April 2018. The Veteran also indicated he was in receipt of SSA disability benefits in a May 2024 VA Form 21-8940. Inasmuch as there are no SSA records associated with the claims file, such should also be secured on remand. See Golz v. Shinseki, 590 F.3d 1317, 1323 (Fed. Cir. 2010).

The matters are REMANDED for the following action:

1. Issue a Supplemental Statement of the Case to the Veteran addressing entitlement to an initial rating in excess of 10 percent for right knee scars. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review.

2. Contact all appropriate official sources, to include the Department of the Army, to obtain the Veteran's complete personnel records, to include any line of duty determinations and records, such as a DA Form 2173, pertaining to the motor vehicle accident on April 3, 2017.

All attempts and responses should be documented in the claims file.

3. Make a formal determination that the service personnel records are complete, or that further efforts to obtain such records would be futile.

Following such, (a) notify the Veteran and his representative of the specific records that it was unable to obtain, (b) explain the efforts VA has made to obtain that evidence, and (c) describe any further action it will take with respect to the claim.

The Veteran and his representative must be given an opportunity to respond.

4. Obtain any outstanding VA treatment records.

5. Secure for the record copies of the complete SSA records pertaining to the Veteran, to include all medical records considered in any determination on a claim for SSA disability benefits. If such records are unavailable, it must be so certified for the record (with an explanation of the reason why they are unavailable).

6. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his respiratory disability (other than his service-connected obstructive sleep apnea with asthma). All indicated tests and studies should be conducted, and all findings reported in detail. After review of the claims file and examination of the Veteran, the examiner is asked to address the following:

(a) Provide a diagnosis for any respiratory disability (other than obstructive sleep apnea with asthma) found. If sinusitis is not diagnosed, the examiner is asked to resolve such finding with the evidence of record reflecting such diagnosis
the reason why they are unavailable).

(b) Please opine as to the likelihood the Veteran's respiratory disability (other than obstructive sleep apnea with asthma) had its onset directly during the Veteran's service, or is otherwise related to the Veteran's service. In providing the requested opinion, the examiner is asked to address the December 1984 service treatment records reflecting treatment for respiratory symptomatology.

(c) What is the likelihood the Veteran's respiratory disability is proximately due to his service-connected obstructive sleep apnea with asthma?

(d) What is the likelihood the Veteran's respiratory disability has been aggravated by his service-connected obstructive sleep apnea with asthma?

A complete rationale should be given for all opinions and conclusions expressed. If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

7. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his low back disability. All indicated tests and studies should be conducted, and all findings reported in detail. After review of the claims file and examination of the Veteran, the examiner is asked to address the following:

(a) Please opine as to the likelihood the Veteran's low back disability had its onset in service or is otherwise related to service, to include due to physical training and running on hard surfaces while carrying heavy equipment.

(b) What is the likelihood the Veteran's low back disability is proximately due to his service-connected right knee disability?

(c) What is the likelihood the Veteran's low back disability has been aggravated by his service-connected right knee disability?

(d) What is the likelihood the Veteran's low back disability is proximately due to, individually or cumulatively, his service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities?

(e) What is the likelihood the Veteran's low back disability has been aggravated by, individually or cumulatively, his service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities?

8. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his right and left shoulders. All indicated tests and studies should be conducted, and all findings reported in detail. After review of the claims file and examination of the Veteran, the examiner is asked to address the following:

(a) Please opine as to the likelihood the Veteran's right and/or left shoulder disability had its onset in service or is otherwise related to service.

(b) What is the likelihood the Veteran's right and/or left shoulder disability is proximately due to his service-connected right knee disability?

(c) What is the likelihood the Veteran's right and/or left shoulder disability has been aggravated by his service-connected right knee disability?

(d) What is the likelihood the Veteran's right and/or left shoulder disability is proximately due to, individually or cumulatively, his service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities?

(e) What is the likelihood the Veteran's right and/or left shoulder disability has been aggravated by, individually or cumulatively, his service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities?

9. Schedule the Veteran for a
likelihood the Veteran's right and/or left shoulder disability is proximately due to, individually or cumulatively, his service-connected bilateral hip, bilateral ankle, bilateral foot, and left knee disabilities?

9. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his headaches. All indicated tests and studies should be conducted, and all findings reported in detail. After review of the claims file and examination of the Veteran, the examiner is asked to address the following:

(a) Please opine as to the likelihood the Veteran's headaches had their onset in service or are otherwise related to service. In providing the requested opinion, the examiner is asked to address the November 1984 service treatment record noting his complaint of temporal headaches for three months.

(b) What is the likelihood the Veteran's headaches are proximately due to his neck disability?

(d) What is the likelihood the Veteran's headaches are proximately due to his acquired psychiatric disorder, to include prescribed medication to treat his psychiatric disorder?

(e) What is the likelihood the Veteran's headaches have been aggravated by his acquired psychiatric disorder, to include prescribed medication to treat his psychiatric disorder?

(f) What is the likelihood the Veteran's headaches are proximately due to his service-connected obstructive sleep apnea with asthma?

(g) What is the likelihood the Veteran's headaches have been aggravated by his service-connected obstructive sleep apnea with asthma?

10. Schedule the Veteran for a VA examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) to determine the nature and etiology of his acquired psychiatric disorder. All indicated tests and studies should be conducted, and all findings reported in detail. After review of the claims file and examination of the Veteran, the examiner is asked to address the following:

(a) Provide a diagnosis for any acquired psychiatric disorder found.

(b) Please opine as to the likelihood the Veteran's acquired psychiatric disorder had its onset in service or is otherwise related to service. In providing the requested opinion, the examiner is asked to address the Veteran's April 2026 statement relating his acquired psychiatric disorder to his duties during service, including assisting with the identification and processing of deceased service members from overseas operations.

(c) What is the likelihood the Veteran's acquired psychiatric disorder is proximately due to his service-connected disabilities (i.e., bilateral foot disability, obstructive sleep apnea with asthma, bilateral knee disability, bilateral ankle disability, bilateral hip disability, and gastroesophageal reflux disease), to include the chronic pain and functional limitations caused by his orthopedic disabilities?

(d) What is the likelihood the Veteran's acquired psychiatric disorder has been aggravated by his service-connected disabilities (i.e., bilateral foot disability, obstructive sleep apnea with asthma, bilateral knee disability, bilateral ankle disability, bilateral hip disability, and gastroesophageal reflux disease), to include the chronic pain and functional limitations caused by his orthopedic disabilities?

A complete rationale should be given for all opinions and conclusions expressed.

If unable to provide a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge.

STEVEN D. REISS

Veterans Law Judge

Board of Veterans' Appeals

Attorney for the Board J. Marley, 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.

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