Citation Nr: 1328468 Decision Date: 09/06/13 Archive Date: 09/16/13 DOCKET NO. 09-27 190 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Buffalo, New York THE ISSUES 1. Entitlement to a rating greater than 10 percent for a right knee disability. 2. Entitlement to a rating greater than 10 percent for a left knee disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD S.K.C. Boyce, Associate Counsel INTRODUCTION The Veteran served on active duty from April 1974 to March 1980. This matter comes before the Board of Veterans' Appeals (Board) on appeal from March 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Buffalo, New York, which denied the above claims. In July 2009, the Veteran asserted that gait changes caused by his service-connected knee disabilities cause hip discomfort. This contention raises the issue of service connection for a bilateral hip disability secondary to service-connected bilateral knee disabilities. This issue has not been adjudicated by the Agency of Original Jurisdiction (AOJ). Therefore, the Board does not have jurisdiction over it, and it is referred to the AOJ for appropriate action. The appeal is REMANDED to the RO via the Appeals Management Center (AMC) in Washington, DC. VA will notify the appellant if further action is required. REMAND The Veteran's representative contends that the last VA examination, conducted more than five years ago, is too old to accurately reflect the current severity of the Veteran's service-connected bilateral knee disabilities. See August 2013 Written Brief Presentation. The Veteran has also stated that his knees have worsened. See July 2009 VA Form 9. Accordingly, a remand is warranted for a current VA examination. Hart v. Mansfield, 21 Vet. App. 505, 508 (2007). Additionally, appropriate efforts should be made to obtain any outstanding relevant VA treatment records and associate them with the claims folder or electronic records file. 38 U.S.C.A. § 5103A; 38 C.F.R. § 3.159(c). Accordingly, the case is REMANDED for the following action: 1. Obtain the Veteran's outstanding relevant VA treatment records from the VA Medical Center in New Orleans, Louisiana, including his records from the VA Outpatient Clinic in Baton Rouge, Louisiana. All information which is not duplicative of evidence already received should be associated with the claims file or the Veteran's electronic claims folder. 2. Thereafter, schedule the Veteran for a VA orthopedic examination of his service- connected right and left knee disabilities. The claims file and a complete copy of this remand should be reviewed in association with the examination. All necessary studies and tests should be conducted, including x- rays, if warranted. Please note that x- ray reports from October 2008 recommended standing and Merchant's patella views of both knees. The examiner is asked to make the following medical determinations: (a) Provide a current diagnosis and identify all residuals attributable to the Veteran's right knee disability. (b) Provide a current diagnosis and identify all residuals attributable to the Veteran's left knee disability. (c) Provide the range of motion of the Veteran's right and left knees, i.e., flexion and extension. (d) Determine whether there is additional functional loss, including reduced range of motion, of the right and/or left knee that is due to, for example, weakness, fatigue, incoordination, swelling, deformity or atrophy, or pain. If there is additional limitation of motion caused by pain, the examiner should state the additional degree of limitation in terms of degrees, if possible. (e) Consider the Veteran's April 2009 statement on the flare-ups of his knee symptoms during cold weather and determine whether there is additional functional loss of the right and/or left knee, including reduced range of motion, upon (i) repetitive use or (ii) flare-ups that is due to, for example, weakness, fatigue, incoordination, swelling, deformity or atrophy, or pain. If there is additional limitation of motion caused by pain upon repetitive use or during flare-ups, the examiner should state the additional degree of limitation in terms of degrees, if possible. (f) Determine whether the Veteran's right and/or left knee disabilities cause instability, disturbance of locomotion, and/or interference with sitting, standing, and weight-bearing, and, if so, to what extent. (g) Determine whether there is objective evidence of lateral instability or recurrent subluxation of the right and/or left knee and if so, to what extent. (h) Determine whether there has been removal of the semilunar cartilage of the right and/or left knee that is symptomatic or whether the semilunar cartilage is dislocated and, if so, whether there are frequent episodes of locking, pain, and effusion into the joint. (i) Determine whether there is nonunion or malunion of the tibia and fibula of the right and/or left leg. If so, is there loose motion requiring a brace or other marked, moderate, or slight knee instability of the right and/or left knee? (j) Determine whether there is genu recurvatum of the right and/or left knee, and if so, if it is acquired and traumatic, with weakness and insecurity objectively demonstrated? If any requested information cannot be provided without resort to speculation, indicate whether the inability to provide a definitive opinion is due to a need for further information, because the limits of medical knowledge have been exhausted, or for some other reason. The examiner must identify the facts relied on in reaching any opinion provided and provide a full explanation as to why those particular facts support the examiner's conclusions. 4. Review the medical examination report obtained to ensure that the remand directives have been accomplished, and return the case to the examiner if all questions posed are not answered. 5. Finally, readjudicate the claim on appeal. If the claim remains denied, provide the Veteran and his representative with a supplemental statement of the case and allow an appropriate time for response. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ S. L. Kennedy Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002) only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).