Citation Nr: 18147086 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 15-03 597 DATE: November 2, 2018 REMANDED Entitlement to a rating for internal derangement of the left knee in excess of 10 percent from April 30, 2014 through November 5, 2015 and a rating in excess of 20 percent from November 5, 2015 through January 26, 2016 is remanded. Entitlement to a rating for degenerative joint disease of the left knee in excess of 10 percent from April 30, 2014 through January 26, 2016 is remanded. Entitlement to a rating in excess of 30 percent for the residuals of a left total knee replacement from March 1, 2017 is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1961 through January 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 of the Department of Veterans Affairs (VA) Regional Office (RO). A service-connected knee disability can be assessed separate ratings under multiple diagnostic codes, provided that the same symptoms are not evaluated under different diagnostic codes. 38 C.F.R. § 4.14; Lyles v. Shulkin, 29 Vet. App. 107. Here, the Veteran’s left knee was service connected in 2008 with a rating of 10 percent for internal derangement under diagnostic code 5003-5257, and a rating of 10 percent for degenerative joint disease under diagnostic code 5261. In April 2014, the Veteran filed a claim for increased ratings for his left knee. Subsequently, the Veteran’s internal derangement of the left knee was increased to 20 percent in November 2015. Also in January 2016, following a left total knee arthroplasty, the Veteran’s internal derangement was evaluated under diagnostic code 5055 for total knee replacement. The Veteran was awarded a temporary total disability rating until March 2017, when the Veteran’s left total knee arthroplasty was rated at 30 percent. As 100 percent is the highest possible rating, the period during which the Veteran was awarded total disability will not be evaluated. Accordingly, the periods on appeal are as reflected on the title page. Here, the Veteran’s most recent VA examination was in March 2017. During the examination, the Veteran reported that he is unable to pick up leaves from his back yard, must sit due to fatigued legs; must lean on the counter while shaving; has difficulty walking while shopping; has a continuous irritating pain to the knee; and has pain with prolonged sitting, standing and walking. The Veteran also reported that due to his knee disability he is no longer able to golf. The Veteran was noted to have tenderness or pain on palpation, with no evidence of crepitus. See March 2017 C&P Exam. This examination occurred just six weeks after the Veteran’s January 2017 revision of his left total knee replacement. Accordingly, this examination may not offer an accurate depiction of the current severity of the Veteran’s left knee disability. Further, the examiner did not offer an opinion as to whether the Veteran’s pain, weakness and fatigability result in functional loss. Although the Veteran was noted to have no pain on examination, the Veteran reported symptoms of pain and fatigability. The examiner must consider both the Veteran’s lay statements and the objective evidence to assess whether the Veteran has a functional loss as a result of his disability. Accordingly, to evaluate the current severity of the Veteran’s left knee disability, a new examination is warranted. Additionally, the record contains no evidence of treatment records beyond March 2017. To assess the current severity of the Veteran’s left knee disability, all outstanding treatment records should be obtained. These matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records from March 2017 to present, and afford the Veteran the opportunity to identify or submit any private treatment records. (Continued on the next page)   2. Thereafter, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability including left knee arthroplasty and left knee degenerative joint disease. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to pain, fatigability and weakness alone and discuss the effect of the Veteran’s left knee replacement on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). S. HENEKS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Wimbish, Associate Counsel