Citation Nr: 18143416 Decision Date: 10/19/18 Archive Date: 10/18/18 DOCKET NO. 13-30 160 DATE: October 19, 2018 ORDER Service connection for a right knee disorder is denied. A 60 percent evaluation, and no more, for Hepatitis C from September 30, 2013, is granted. REMANDED Entitlement to an increased disability rating for a left knee disability, to include a left total knee replacement, is remanded. FINDINGS OF FACT 1. The Veteran's current right knee disorder, to include degenerative joint disease, was not incurred in service or caused by any in-service event, is not related to active service, did not manifest to a compensable degree in the year following separation from service, and is not caused or aggravated by his service-connected left knee disorder. 2. For the time period from September 30, 2013, the Veteran has been found to have daily fatigue, malaise, nausea, and anorexia; there was also a substantial weight loss, as defined by VA regulations, as the Veteran’s weight loss versus his baseline weight was more than 20 percent for over a 3 month period. 3. Throughout the entire appeal period, the Veteran's hepatitis C has not manifested in near-constant debilitating symptoms. CONCLUSIONS OF LAW 1. The criteria for service connection for a right knee disorder are not met. 38 U.S.C. §§ 1101, 1131 (2012); 38 C.F.R. §§ 3.303, 3.307, 3.309, 3.310 (2017). 2. The criteria for a 60 percent rating for hepatitis C from September 30, 30, 2013, and no more, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107(b) (2012); 38 C.F.R. §§ 3.102, 3.159, 4.114, DC 7354 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran, who is the appellant, had active service from July 1977 to January 1984. Right Knee Disorder The Veteran has indicated that it is his belief that his current right knee disorder is caused or aggravated by his service-connected left knee disorder. At the outset, the Board notes that service connection for a right knee disorder was denied in January 2008. The Veteran was notified of this decision later that month and did not appeal nor was any evidence received within the one-year period which would have allowed the claim to remain open. Thus, the decision, became final. See 38 U.S.C. § 7105. In July 2011, the Veteran requested that his claim for service connection for a right knee disorder be reopened. In a January 2012 rating determination, the Regional Office (RO) determined that new and material evidence had been received (see 38 C.F.R. § 3.156(b)) and reopened the claim and denied the claim on a de novo basis. Regardless of the RO's actions, the Board is required to determine if there was new and material evidence received. Jackson v. Principi, 265 F. 3d 1366 (Fed. Cir. 2001). Additional evidence received includes a current diagnosis of degenerative joint disease and a worsening of the Veteran’s service-connected left knee disorder since the time of the final denial. Following a review of the material received since the last final decision, the Board finds that the newly received evidence relates to previously unestablished elements of the claim of a current disability and a possible link between the current disability and service, by way of a service-connected disability, and provides a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). As such, the issue of service connection for a right knee disorder will now be addressed on a de novo basis below. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. §§ 1131; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). As a general matter, service connection for a disability requires evidence of: (1) the existence of a current disability; (2) the existence of the disease or injury in service, and; (3) a relationship or nexus between the current disability and any injury or disease during service. Shedden v. Principi, 381 F.3d 1163 (Fed. Cir. 2004); see also Hickson v. West, 12 Vet. App. 247, 253 (1999), citing Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd, 78 F.3d 604 (Fed. Cir. 1996). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. Presumptive periods are not intended to limit service connection to diseases so diagnosed when the evidence warrants direct service connection. The presumptive provisions of the statute and VA regulations implementing them are intended as liberalizations applicable when the evidence would not warrant service connection without their aid. 38 C.F.R. § 3.303(d). Arthritis is a "chronic disease" listed under 38 C.F.R. § 3.309(a). If present, the provisions of 38 C.F.R. § 3.303(b) are for application. Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). Where the evidence shows a "chronic disease" in service or "continuity of symptoms" after service, the disease shall be presumed to have been incurred in service. For the showing of "chronic" disease in service, there is required a combination of manifestations sufficient to identify the disease entity, and sufficient observation to establish chronicity at the time. With chronic disease as such in service, subsequent manifestations of the same chronic disease at any later date, however remote, are service-connected, unless clearly attributable to intercurrent causes. If a condition noted during service is not shown to be chronic, then generally, a showing of "continuity of symptoms" after service is required for service connection. 38 C.F.R. § 3.303(b). Where a veteran served continuously for ninety days or more during a period of war or during peacetime service after December 31, 1946, and arthritis becomes manifest to a degree of ten percent within one year of termination of such service, such disease shall be presumed to have been incurred in service even though there is no evidence of such disease during the period of service. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.307, 3.309. Service connection may be established on a secondary basis for a disability that is proximately due to or the result of a service-connected disease or injury. See 38 C.F.R. § 3.310(a); Harder v. Brown, 5 Vet. App. 183, 187 (1993). Additional disability resulting from the aggravation of a nonservice-connected condition by a service-connected condition is also compensable under 38 C.F.R. § 3.310(a). See Allen v. Brown, 7 Vet. App. 439, 448 (1995). Generally, lay evidence is competent with regard to a disease with "unique and readily identifiable features" that is "capable of lay observation." See Barr v. Nicholson, 21 Vet. App. 303, 308-09 (2007) (concerning varicose veins); see also Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007) (a dislocated shoulder); Charles v. Principi, 16 Vet. App. 370, 374 (2002) (tinnitus); Falzone v. Brown, 8 Vet. App. 398, 405 (1995) (flatfoot); Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a veteran is competent to report on that of which he or she has personal knowledge). Lay evidence can be competent and sufficient evidence of a diagnosis if (1) the layperson is competent to identify the medical condition, (2) the layperson is reporting a contemporaneous medical diagnosis, or (3) lay testimony describing symptoms at the time supports a later diagnosis by a medical professional. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Jandreau v. Nicholson, 492 F.3d 1372, 1376-77 (Fed. Cir. 2007). In weighing credibility, VA may consider interest, bias, inconsistent statements, bad character, internal inconsistency, facial plausibility, self-interest, consistency with other evidence of record, malingering, desire for monetary gain, and demeanor of the witness. Caluza v. Brown, 7 Vet. App. 498 (1995). When there is an approximate balance in the 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. The Court held that an appellant need only demonstrate that there is an "approximate balance of positive and negative evidence" in order to prevail. See Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990). The Court has also stated, “It is clear that to deny a claim on its merits, the evidence must preponderate against the claim.” Alemany v. Brown, 9 Vet. App. 518, 519 (1996), citing Gilbert. After a review of all the evidence, lay and medical, the Board finds that the weight of the evidence is against the conclusion that the Veteran's current right knee disorder had its onset in service. The Veteran's service treatment records contain no complaints or findings of right knee problems. Furthermore, there were no findings or complaints of right knee problems in the years immediately following service. In addition, the Veteran has not indicated that his current right knee disorder had its onset in service, within one year following service, or is otherwise the result of service. He has continuously indicated his belief that his right knee disorder is either caused or aggravated by his service-connected left knee disorder. As to the Veteran's belief that his current right knee disorder is related to his service-connected left knee disorder, the question of causation of a complex medical condition, such as right knee arthritis, extends beyond an immediately observable cause-and-effect relationship, and, as such, the Veteran is not competent to address etiology in the present case. See Jandreau v. Nicholson, supra. It has not been shown that he has the requisite training to diagnose the cause of his current right knee disorder, to include degenerative joint disease. Next, service connection may be granted when the evidence establishes a nexus between the Veteran’s current right knee disorder and his service-connected left knee disorder. The Veteran was afforded the opportunity to provide medical evidence and/or an opinion demonstrating such a relationship and has not done so. In contrast, a January 2012 VA examiner, following examination of the Veteran and review of the file, indicated that it was less likely than not that the Veteran’s right knee disorder was proximately due to or the result of the Veteran’s service-connected left knee disorder. The examiner indicated that the Veteran had had multiple problems with his left knee since his injury in service. He stated that there was no nexus between problems in the left knee and the development of problems in the right knee. He observed that the Veteran was 52 years old and the development of chondromalacia was not unusual for someone that age that had done the kind of work that he had done. The examiner noted that the x-ray findings for the right knee were essentially normal and his exam was normal. Therefore, based on the Veteran's history, a review of the medical records, and clinical experience and expertise, the right knee chondromalacia was less likely than not incurred in or caused by the knee patellectomy. In an April 2017 VA examination report, the VA examiner, following a comprehensive examination of the Veteran and review of the record, indicated that the right knee was less likely as not aggravated beyond its natural progression in relation to the left knee. She noted that just because the right knee had some degenerative changes this had no bearing on the left knee condition and the reason for the total knee replacement. She stated that there was no correlation from the right knee being aggravated by the left knee. An additional VA examination opinion was obtained in November 2017. Following a comprehensive review of the record, the examiner opined that the Veteran's right knee condition/degenerative joint disease (DJD) was less likely than not permanently aggravated beyond its natural progression by his service-connected left knee arthroplasty (formerly degenerative joint disease of the left knee). He stated that there was no objective medical record evidence to indicate otherwise. He reported that there is no mechanism of action for cause or permanent aggravation of a right knee condition/DJD by any left knee condition, to include knee arthroplasty (formerly degenerative joint disease of the left knee). He stated that the medical literature did not support the contention that DJD/pathology in one joint caused or permanently aggravated the same in the contralateral joint. The Board is placing greater weight on these opinions as they were rendered after a thorough review of the record with detailed rationale being set forth to support the opinions. There was no indication that the VA examiners were not fully aware of the Veteran's past medical history or that they misstated any relevant fact. In this case, the Veteran's right knee disorder, including arthritis, was not shown during active service or for many years thereafter, including no chronic symptoms during service, no manifestation to a compensable degree within one year of service separation, and no continuous post service symptoms. The right knee disorder has also not been shown to be related to the Veteran's service-connected left knee disorder. The weight of the competent evidence demonstrates that the currently diagnosed right knee disorder was neither incurred in nor related to active service nor secondary to the service-connected left knee disorder. For these reasons, the Board finds that service connection for a right knee disorder, to include arthritis, is not warranted. As the preponderance of the evidence is against the claim, the benefit of the doubt doctrine is not for application and the claim must be denied. See 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Hepatitis C Disability ratings are determined by applying the criteria set forth in the VA Schedule for Rating Disabilities, found in 38 C.F.R., Part 4. The percentage ratings are based on the average impairment of earning capacity as a result of a service-connected disability, and separate diagnostic codes identify the various disabilities and the criteria for specific ratings. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. If two disability evaluations are potentially applicable, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria for that rating; otherwise, the lower rating will be assigned. 38 C.F.R. § 4.7. All reasonable doubt as to the degree of disability will be resolved in favor of the claimant. 38 U.S.C. § 5107(b); 38 C.F.R. § 4.3. Staged ratings must be considered, which are appropriate when the evidence establishes that the claimed disability manifested symptoms that would warrant different ratings for distinct time periods during the appeal. Hart v. Mansfield, 21 Vet. App. 505, 509-10 (2007). It is the Board's responsibility to determine whether a preponderance of the evidence supports the claim or whether the evidence is in relative equipoise, with the veteran prevailing in either event, or whether there is a preponderance of evidence against the claim, in which case the claim must be denied. See Gilbert v. Derwinski, 1 Vet. App. 49 (1990). The Veteran contends that his Hepatitis C warrants evaluations in excess of those which are currently assigned. He maintains that the symptoms are worse than those associated with the currently assigned ratings The Veteran's hepatitis C is rated under 38 C.F.R. § 4.114, Diagnostic Code 7354. In relevant part, under Diagnostic Code 7354 hepatitis C with intermittent fatigue, malaise, and anorexia, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least one week, but less than two weeks, during the past 12-month period, is rated 10 percent disabling. 38 C.F.R. § 4.114, Diagnostic Code 7354. Hepatitis C with daily fatigue, malaise, and anorexia (without weight loss or hepatomegaly), requiring dietary restriction or continuous medication, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least two weeks, but less than four weeks, during the past 12-month period, is rated 20 percent disabling. Id. Hepatitis C with daily fatigue, malaise, and anorexia, with minor weight loss and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least four weeks, but less than six weeks, during the past 12-month period, is rated 40 percent disabling. Id. A 60 percent rating is warranted where hepatitis C manifests with daily fatigue, malaise, and anorexia, with substantial weight loss (or other indication of malnutrition), and hepatomegaly, or; incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period, but not occurring constantly. Id. A 100 percent rating is warranted for near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). Id. Note (1) provides for evaluation of sequelae, such as cirrhosis or malignancy of the liver, under an appropriate diagnostic code, but not for using the same signs and symptoms as the basis for evaluation under Diagnostic Code 7354 (and under the diagnostic code for sequelae). See also 38 C.F.R § 4.14. Note (2) provides that, for purposes of rating conditions under Diagnostic Code 7354, "incapacitating episode" means a period of acute signs and symptoms severe enough to require bed rest and treatment by a physician. Id. The term "substantial weight loss" means a loss of greater than 20 percent of the individual's baseline weight, sustained for three months or longer. The term "minor weight loss" means a weight loss of 10 to 20 percent of the individual's baseline weight, sustained for three months or longer. In addition, the term "inability to gain weight" means that there has been substantial weight loss with an inability to regain it despite appropriate therapy, and "baseline weight" means the average weight for the two-year period preceding onset of the disease. 38 C.F.R. § 4.112 (2017). The schedular rating for Hepatitis C under DC 7354 involves successive rating criteria; i.e., the criteria for a higher rating include those of a lesser rating, such that the higher rating is not warranted if the criteria for the lower rating are not met. See Camacho v. Nicholson, 21 Vet. App. 360, 366-67 (2007) (explaining that where a DC establishes a successive rating criteria, a claimant must meet all of the requirements of a lower rating criteria before he can be eligible for a higher rating criteria); see also Middleton v. Shinseki, 727 F.3d 1172, 1178 (Fed. Cir. 2013) (distinguishing between rating schedules that establish successive rating criteria from those where the criteria necessary for a higher rating are not dependent upon meeting the criteria of a lower rating and noting that it was not error by stating that § 4.7 does not apply). In conjunction with his claim, the Veteran was afforded a VA examination in May 2014. At that time, a diagnosis of hepatitis C was rendered. The Veteran was noted to be taking nausea medication at that time. The Veteran was reported to have daily symptoms of fatigue, anorexia, and nausea. He was also noted to have intermittent vomiting and right upper quadrant pain. There was no arthralgia present. The Veteran was found to have a baseline weight of 185 pounds and a current weight of 146 pounds. The weight loss had been sustained for three months or longer. The examiner specifically indicated that the Veteran had not had any incapacitating episodes (with symptoms of fatigue, malaise, nausea, anorexia, arthralgia, and right upper quadrant pain) over the past 12 months. There were no signs of cirrhosis of the liver. The examiner noted that the Veteran had missed time from work but that he was working janitorial services for VA. In a May 2014 statement, the Veteran’s spouse indicated that the Veteran’s health had been deteriorating. She noted that the past two years, she had witnessed his health progressively worsen. She stated that he was having constant debilitating symptoms such as fatigue, vomiting, joint pain, right upper quadrant pain, cramping, and malaise. She indicated that he had lost a substantial amount of weight and he looked unhealthy. She noted that these incapacitating episodes and daily debilitating symptoms were affecting him mentally and physically. He was struggling every day to get out of bed, to perform daily tasks, and to be able to function normally. She stated he was missing many days off work because of the constant feelings of discomfort, illness, and lack of feeling healthy or happy, due to the symptoms that he was experiencing daily. In a May 2014 statement, T. C., the Veteran’s daughter, noted his declining health over the past few years. She stated that his health had taken a turn for the worse, after serving in the United States Army, where he was diagnosed with Hep-C. She indicated that since then, he had to constantly battle with day to day tasks, like getting out of bed or keeping any food down that he ate. She reported that due to his condition, he had missed several days of work and family activities. She stated that every day she witnessed him having stomach cramps, fatigue, nausea and vomiting. She reported that over the past month he had lost a significant amount of weight. She was concerned that he was increasingly getting worse, without any signs of improvement and that this was draining him mentally and physically. She noted that not one week has passed by, in the past few weeks, that he had a day where he felt completely healthy. In a May 2014 letter, the Veteran’s mother indicated that although the symptoms and troubles of the disease had been manageable over the past years, they had truly become the main focus and hindrances over his daily life. More specifically, the Veteran had gone from working on a daily basis to only being able to work when his symptoms were less heightened. She noted that to some, this might be normal, but for the Veteran, who had been a hard worker his entire life, this was truly abnormal. Symptoms that were prevalent in his daily life included, but were not limited to, fatigue, fever, nausea, poor appetite, and stomach pains. He even had constant complaints of muscle and joint pain. She noted that taking these symptoms into consideration, the Veteran had even begun to struggle with daily tasks both mentally and socially. For example, it was hard for him to enjoy his family time at home due to being sick, and it was even more of a struggle for him to complete certain tasks at work solely based on the fact that these symptoms were consuming his daily life. In his January 2017 substantive appeal, the Veteran indicated that he was losing weight, felt nauseated and fatigued, and reported that his quality of life was diminished. At the time of an April 2017 VA examination, the Veteran was again diagnosed with Hepatitis C. Continuous medication was not required for the condition. The Veteran was noted to have daily fatigue, malaise, anorexia, nausea, vomiting, weight loss (base line 190 pounds/current weight 135 pounds) with weight loss sustained for more than three months. The Veteran was reported to have had incapacitating episodes for six weeks or more in the past 12 months. There were no findings of cirrhosis of the liver. The Veteran’s liver condition was not noted to impact his ability to work. In an addendum opinion, the examiner indicated that it was less likely than not that the Veteran’s current gastrointestinal complaints, including weight loss, were related to his hepatitis C. She noted that the Veteran had been diagnosed with gastritis, gastroparesis, GERD. She observed that he had had gastroparesis for years and lost 45 lbs. this year due to vomiting often. She noted that he smoked cigarettes over 37 years and was smoking crack cocaine until 2 years ago. She stated that this was not related to his Hepatitis C condition. In an April 2017 letter, the Veteran’s spouse indicated that the Veteran had had this condition for twenty years, but for the past two years, she had witnessed his health rapidly decline. She noted that he was having constant debilitating symptoms such as chronic fatigue, vomiting, right upper quadrant pain, muscle and joint pain, cramping, decreased appetite, arthritis, gastrointestinal dysfunction, and malaise. She indicated that due to the symptoms, he had lost a substantial amount of weight and he was beginning to look more undernourished and unhealthy. She noted that having these incapacitating episodes and chronic debilitating symptoms had continued to affect him mentally, physically, spiritually, and emotionally. She stated that he was struggling every day to get out of bed, perform daily tasks and to be able to function normally. She indicated that the Veteran was having constant feelings of discomfort, illness, and lack of feeling healthy or happy due to the substantial amount of symptoms he was experiencing daily. In an April 2017 statement, the Veteran’s son indicated that stomach pain, cramps, vomiting, and malaise were just some of the many symptoms the Veteran suffered from on a daily basis. He indicated that these symptoms had caused the Veteran’s quality of life to decrease tremendously, which included fatigue, no appetite, and not wanting to go in public due to these symptoms. Time Period Prior To April 10, 2017 Following a review of all the evidence, lay and medical, and resolving reasonable doubt in favor of the Veteran, the Board finds that that criteria for a 60 percent disability evaluation have been more closely approximated during the entire appeal period. During this time period, the Veteran was found to have daily fatigue, malaise, nausea, and anorexia. There was also a substantial weight loss, as defined by VA regulations, as the Veteran’s weight loss versus his baseline weight was more than 20 percent for over a 3 month period. The examiner specifically indicated that the weight loss was related to the Veteran’s service-connected hepatitis in the May 2014 report. Although the Veteran was noted to only have intermittent vomiting and no hepatomegaly, and there were no reports of incapacitating episodes (with symptoms such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain) having a total duration of at least six weeks during the past 12-month period; the overall criteria necessary for a 60 percent evaluation, to include substantial weight loss, as defined by regulation, indicates that the criteria for a 60 percent evaluation were more closely approximated. Hence, the criteria for a 60 percent evaluation were met from the date of the Veteran’s original request for an increased evaluation. The criteria for a 100 percent schedular evaluation have not been met at any time during the appeal period. The medical evidence of record does not demonstrate that the Veteran has had near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). The April 2017 VA examiner, while reporting an increase in symptomatology versus the results of the May 2014 VA examination, did not report findings of near-constant debilitating symptoms (such as fatigue, malaise, nausea, vomiting, anorexia, arthralgia, and right upper quadrant pain). The VA examiner specifically indicated that the Veteran had daily fatigue, malaise, anorexia, nausea, vomiting, as well as weight loss (base line 190 pounds/current weight 135 pounds), with weight loss sustained for more than three months. He did not check the available boxes of near-constant and debilitating for any of the above symptoms. VA treatment records also do not contain any findings of near constant or debilitating symptoms for daily fatigue, malaise, anorexia, nausea, or vomiting. While the Board is sympathetic to the statements from the Veteran and his family, and has considered their assertions when assessing the severity of Veteran's Hepatitis C, which they are certainly competent to provide, see, e.g. Layno v. Brown, 6 Vet. App. 465, 470 (1994) and Grottveit v. Brown, 5 Vet. App. 91, 93 (1993), the criteria needed to support a higher rating require medical findings that are within the province of trained medical professionals. See Jones v. Brown, 7 Vet. App. 134 (1994). As such, the lay assertions are not considered more persuasive than the objective medical findings, which, as indicated above, do not support assignment of an evaluation in excess of 60 percent pursuant to the applicable criteria at any point pertinent to the current claim on appeal. REASONS FOR REMAND Increased Rating for Left Knee As it relates to the claim for an increased evaluation for a left knee disorder, the Board notes that the Veteran underwent additional surgery on his left total knee replacement in November 2017. As a result of the surgery, the Veteran was assigned a 100 percent temporary total disability evaluation from November 27, 2017, until March 1, 2018, with a 30 percent disability evaluation being assigned thereafter. Unfortunately, the Veteran has not undergone an additional VA examination following the surgery to determine the current severity of the service-connected left knee disorder. VA is obligated to afford a veteran a contemporaneous examination where there is evidence of an increase in the severity of the disability. VAOPGCPREC 11-95 (1995). Furthermore, the Court has held that 38 C.F.R. § 4.59 (2016) creates a requirement that certain range of motion testing be conducted whenever possible in cases of joint disabilities. Correia v. McDonald, 21 Vet. App. 158 (2016). Specifically, the Court concluded that the final sentence of 38 C.F.R. § 4.59 required testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with the range of the opposite undamaged joint. Id. A review of the evidence of record reveals that prior examinations regarding the Veteran's service-connected left knee fail to fully comply with the Court's holding in Correia. As such, remand is required to obtain an adequate examination regarding the Veteran's service-connected left knee. See Id.; see also Barr, 21 Vet. App. 303. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain all outstanding VA and/or private treatment records related to the Veteran's outstanding claim. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified. 2. Schedule the Veteran for a current VA examination to determine the severity, manifestations, and effects of his service-connected left knee disability. The examiner must review the claims file in conjunction with the examination. The examiner must specifically test and report the Veteran's range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing, for both right and left knees. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should report the ranges of knee motion in degrees. The examiner should further report whether the left knee disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare ups. Such inquiry should not be limited to muscles or nerves. These determinations should be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, pain or flare-ups. The examiner should also report whether there is lateral instability or recurrent subluxation, and if present, the severity of such symptoms. The examiner should also comment on the necessity of the use of a brace. The examiner must also comment on whether there is severe painful motion or weakness in the left lower extremity. Additionally, the examiner should clearly document any functional impairment as a result of the Veteran's service-connected left knee disability. 3. Review the claims file. If any development is incomplete, including if the examination report does not contain sufficient information to respond to the questions posed, to include the Court's holding in Correia as it relates to the left knee, take corrective action before readjudication. See Stegall v. West, 11 Vet. App. 268 (1998). K. PARAKKAL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T.S.Kelly, Counsel