Citation Nr: 18147930 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-44 139 DATE: November 6, 2018 ORDER Entitlement to a compensable rating for left knee strain is granted. REMANDED Entitlement to service connection for gastroesophageal reflux disease is remanded. FINDING OF FACT The Veteran has full range of motion of the left knee with no instability or subluxation, but evidence of pain. CONCLUSION OF LAW A 10 percent rating, but not greater, for medial collateral ligament strain of the left knee is not warranted. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.59, 4.71a, Diagnostic Codes 5260, 5261. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1978 to January 2004. These matters are before the Board of Veterans' Appeals (the Board) on appeal from a September 2012 rating decision. A compensable rating for left knee strain is granted. On July 2012 VA examination of the knees, the Veteran stated that he has 4/10 pain and sometimes stiffness about three times a month if he exercises heavily. He reported that his symptoms resolve with over-the-counter medication after 12 hours. An examination found that range of motion was from 0-140 degrees, with no objective evidence of pain. He was able to perform repetitive use testing with no functional loss or change in the range of motion. The Veteran did not have tenderness or pain to palpation. Muscle strength testing was 5/5. Joint stability tests were all normal. There was no history of recurrent subluxation or dislocation. There was mild left knee crepitus. The diagnosis was medial collateral ligament strain of the left knee. The Veteran was examined by the VA in May 2016. He reported increasing pain, swelling and locking of the left knee. He stated that he had difficulty climbing stairs. It was noted that he used a knee brace and Motrin. He denied flare-ups of pain. An examination showed that range of motion was 0-140 degrees, without pain. He was able to perform repetitive use testing with no additional functional loss or limitation of motion after three repetitions. Muscle strength testing was 5/5. There was no muscle atrophy, history or recurrent subluxation, lateral instability or recurrent effusion. The diagnosis was left knee medial collateral ligament strain. Disability ratings are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Separate diagnostic codes identify the various disabilities. Disabilities must be reviewed in relation to their history. 38 C.F.R. § 4.1. Reasonable doubt regarding the degree of disability is to be resolved in favor of the claimant, 38 C.F.R. § 4.3. Functional impairment is to be assessed on the basis of lack of usefulness, and the effects of the disability upon the person’s ordinary activity, 38 C.F.R. § 4.10. See Schafrath v. Derwinski, 1 Vet. App. 589 (1991). When the appeal is from the initial rating assigned with an award of service connection, separate ratings can be assigned for separate periods of time based on the facts found – a practice known as “staged” ratings. Fenderson v. West, 12 Vet. App. 119 (1999). Under Code 5260, a 30 percent rating is to be assigned when flexion of a knee is limited to 15 degrees; a 20 percent rating when flexion is limited to 30 degrees, and a 10 percent rating when flexion is limited to 45 degrees. 38 C.F.R. § 4.71a. Under Code 5261, a 50 percent rating is to be assigned when extension of the leg is limited at 45 degrees; a 40 percent rating when extension is limited at 30 degrees; a 30 percent rating when extension is limited at 20 degrees; a 20 percent rating when extension is limited at 15 degrees; and a 10 percent rating when extension is limited at 10 degrees. 38 C.F.R. § 4.71a. Under Code 5257 a 30 percent rating is to be assigned for other knee disability manifested by recurrent subluxation or instability when severe; a 20 percent rating when moderate; and 10 percent when slight. 38 C.F.R. § 4.71a. Normal range of motion of the knee is 0 degrees of extension and 140 degrees of flexion. See 38 C.F.R. § 4.71a, Plate II. Separate ratings may also be assigned for compensable limitations of flexion and extension, each, as well as for subluxation or instability. See VAOPGCPREC 23-97 (July 1, 1997); VAOPGCPREC 9-2004. In addition to separate ratings being assignable for arthritis with limitation of motion and for instability, separate ratings may also be assigned for compensable limitations of flexion and extension, each. VAOPGCPREC 9-2004. The Veteran asserts that a higher rating is warranted for his left knee disability. The Veteran was afforded VA examinations to assess his knee disabilities in July 2012 and again in May 2016. To warrant a 10 percent rating under Diagnostic Codes 5260-5261 for his knee disability, the evidence must show flexion limited to 45 degrees or extension limited to 10 degrees. Both examinations found that the Veteran has full range of motion of the left knee with no evidence of pain. Such findings do not support a compensable rating for the left knee disability based on limitation of motion. Furthermore, subluxation or instability of the left knee is not shown. The examinations show that the left knee joint is stable. There is no basis, therefore, for a compensable rating based on instability. Regarding functional impairment and pain as addressed under 38 C.F.R. §§ 4.10, 4.40 and 4.45, 4.59, no VA examination has found additional limitation of motion following repetitive motion. The Veteran has reported that his knee is painful while exams have demonstrated an absence of pain. The Board concludes that it is as likely as not that there is painful motion at times and in resolving all doubt in the Veteran’s behalf finds that a 10 percent rating, but not greater, is warranted. REASONS FOR REMAND Service connection for gastroesophageal reflux disease is remanded. The Veteran's service treatment records show that he was seen on several occasions for gastrointestinal complaints. It was noted that he had gastritis and/or gastroenteritis. A September 2003 report of medical history shows that the Veteran denied having or having ever had frequent indigestion or heartburn. The report of his retirement examination is not of record. It was noted in August 2010 that the Veteran was found to have gastritis and duodenitis on upper endoscopy the previous month. On July 2012 VA examination, the Veteran stated that he developed increased symptoms in 2010 and that testing at that time found gastroesophageal reflux disease. The VA examiner opined that it was less likely than not that that the Veteran's gastroesophageal reflux disease was related to the episodes in service. In March 2018, a service department physician noted that the Veteran had a more than 30-year history of gastroesophageal reflux disease, and had been treated for the condition by primary care providers and in the gastroenterology clinic. The Veteran submitted a statement noting that the physician had based his opinion on a review of the record. The matter is REMANDED for the following action: 1. Contact the appropriate service department as well as the Veteran to obtain the report of the September 2003 retirement examination. 2. Arrange for a VA gastroenterology examination of the Veteran to ascertain the nature and etiology of gastroesophageal reflux disease. The examiner should review the record and provide an opinion as to whether it is at least as likely as not (a 50 percent or higher probability) that the Veteran’s gastroesophageal reflux disease is related to service. The examiner must consider the March 2018 statement that the Veteran has a 30-year   history of gastroesophageal reflux disease. The examiner must include rationale with all opinions. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD James R. Siegel, Counsel