Citation Nr: 18148887
Decision Date: 11/08/18	Archive Date: 11/08/18

DOCKET NO. 15-06 743A
DATE:	November 8, 2018
REMANDED
Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded.
REASONS FOR REMAND
The Veteran had active service in the United States Marine Corps from August 1988 through June 1992.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). 
In May 2018, the Veteran was afforded a video conference hearing before the undersigned Veterans Law Judge (VLJ).  During the hearing, the VLJ engaged in a colloquy with the Veteran toward substantiation of the claims.  Bryant v. Shinseki, 23 Vet. App. 488, 496-97 (2010).  A hearing transcript is in the record.
1. Entitlement to an initial rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded.
In the May 2018 hearing, the Veteran’s representative discussed alternative rating codes relative to the Veteran’s left knee.  Remand is necessary to afford the Veteran a VA examination regarding the alternative rating codes.  See McLendon v. Nicholson, 20 Vet. App. 79 (2006); Bell v. Derwinski, 2 Vet. App. 611 (1992).  See also Butts v. Brown, 5 Vet. App. 532 (1993) (holding that the assignment of a diagnostic code is “completely dependent on the facts of a particular case” and the Board can choose the diagnostic code to apply so long as it is supported by reasons and evidence).
The matter is REMANDED for the following action:
1. Request the Veteran provide any service treatment records he possesses or identify and secure any relevant private medical records that are not in the claims file.  If the Veteran identifies private records, following the securing of the appropriate waivers, make all appropriate attempts to locate such records and to associate them with the claims file.  If the Veteran has no further evidence to submit, or, if after exhaustive efforts have been made, no records can be identified, so annotate the record.
2. Obtain any outstanding VA medical records and associate them with the claims file.
3. Schedule the Veteran for an appropriate VA examination to determine the nature of his left knee disability.  The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner.  All appropriate tests, studies, and consultations should be accomplished and all clinical findings should be reported in detail.  An explanation should be given for all opinions and conclusions rendered.
Based upon a review of the relevant evidence of record, history provided by the Veteran, and sound medical principles, the VA examiner should provide the following opinion:
(a.) Identify whether the Veteran now has, or has had at any time since July 30, 2013: 
1.	Impairment of the femur near the left knee, such that there is malunion with slight knee or hip disability; malunion with moderate knee or hip disability; malunion with marked knee or hip disability; fracture of surgical neck of, with false joint; fracture of shaft or anatomical neck with nonunion, without loose motion, weightbearing preserved with aid of brace; or fracture of shaft or anatomical neck with nonunion, with loose motion (spiral or oblique fracture);
2.	Ankylosis of the left knee in a favorable angle in full extension, or in slight flexion between 0 degrees and 10 degrees; in flexion between 10 degrees and 20 degrees, in flexion between 20 degrees and 45 degrees; or extremely unfavorable, in flexion at an angle of 45 degrees or more.
3.	Recurrent subluxation or lateral instability of the left knee (slight, moderate, or severe); 
4.	Semilunar dislocation of cartilage in the left knee with frequent episodes of locking, pain, and effusion; 
5.	Semilunar removal of cartilage in the left knee; 
6.	Limitation of flexion of the left knee limited to 60, 45, 30, or 15 degrees;
7.	Limitation of extension of the left knee limited to 5, 10, 15, 20, 30, or 45 degrees;
8.	Impairment of tibia and/or fibula in the left knee with malunion of slight knee or ankle, moderate knee or ankle disability, or marked knee or ankle disability; or nonunion of, with loose motion, requiring brace; 
9.	Genu recurvatum in the left knee (acquired, traumatic, with weakness and insecurity in weight-bearing objectively demonstrated);
10.	Burn scars or scars due to other causes not of the head, face, or neck, that are deep and nonlinear (near the left knee): area or areas of 6 square inches (39 square centimeters), but less than 12 square inches (77 square centimeters); area or areas of at least 12 square inches (77 square centimeters), but less than 72 square inches (465 square centimeters); area or areas of 72 square inches (465 square centimeters), but less than 144 square inches (929 square centimeters); or area or areas of 144 square inches (929 square centimeters) or greater;
11.	Burn scars or scars due to other causes not of the head, face, or neck, that are superficial and nonlinear (near the left knee) that are an area or areas of 144 square inches (929 square centimeters) or greater.
12.	Unstable or painful scars (near the left knee): one or two; three or four; or five or more.
The examiner must review the entire record in conjunction with rendering the requested opinions.  In addition to any records that are generated because of this Remand, the VA examiner’s attention is drawn to the following:
•	December 2013 VA Examination.  See “C&P Exam,” received December 16, 2013.
•	February 2015 Department of Orthopedic Surgery Consult indicting a diagnosis of moderate degenerative changes of the left knee with valgus deformity.  See “Medical Treatment Record – Non-Government Facility,” received March 10, 2015.
•	March 2016 VA Examination.  See both “C&P Exam” documents, received March 10, 2016.
•	December 2016 Twin Cities Orthopedics-Otsego Report indicating a diagnosis of left knee significant arthrosis.  See “Medical Treatment Record – Non-Government Facility,” received December 30, 2016, page 16 of 21.
•	May 2018 Transcript of Hearing indicating the Veteran should be assessed for impairment of the femur and lateral instability.  See “Hearing Transcript,” received May 14, 2018, page 6 of 15. 
The examiner must do appropriate clinical testing to determine if there is support for the Veteran’s contentions.
A thorough explanation must be provided for the opinions rendered.  If the examiner cannot provide the requested opinions without resorting to speculation, s/he should expressly indicate this and provide supporting rationale as to why the opinions cannot be made without resorting to speculation. 
The examiner is advised that by law, the mere statement that the claims folder was reviewed and/or the examiner has expertise is not sufficient to find the examination/opinion sufficient. 
 
Vito A. Clementi
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	S. McLendon, Associate Counsel