Citation Nr: 18159671 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 11-10 879 DATE: December 20, 2018 REMANDED Entitlement to a rating in excess of 10 percent for degenerative joint disease (DJD) of the left knee (limitation of motion) is remanded. Entitlement to a rating in excess of 10 percent, prior to January 19, 2016 for left knee anterior cruciate ligament (ACL) insufficiency (instability) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 to May 1983. In the October 2017 decision, the Board denied a rating in excess of 30 percent for left knee ACL insufficiency (instability) beginning January 19, 2016. The Veteran has not appealed this decision. Thus, the issue of entitlement to a rating in excess of 30 percent beginning January 19, 2016 for left knee ACL insufficiency (instability) is not before the Board at this time. In September 2015, January 2017 and October 2017, the Board remanded the claims for further development by the originating agency. The case has been returned to the Board for further appellate action. 1. Entitlement to a rating in excess of 10 percent for DJD of the left knee (limitation of motion) is remanded. 2. Entitlement to a rating in excess of 10 percent, prior to January 19, 2016, for left knee ACL insufficiency (instability) is remanded. The last VA examination for the Veteran’s service-connected left knee disabilities was provided in October 2017. In the November 2018 Appellant’s Post-Remand Brief, the Veteran’s representative argued that the last VA examination, which is over 12 months old and was conducted by an unqualified, non-physician examiner, is too old to adequately evaluate the Veteran’s left knee disabilities. See November 2018 Appellant’s Post-Remand Brief. Given the evidence of possible increased symptomatology, a new VA examination is warranted to determine the current severity of the service-connected DJD of the left knee (limitation of motion) and left knee ACL insufficiency (instability). Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994); VAOPGCPREC 11-95 (1995). The matters are REMANDED for the following action: 1. Updated treatment records should be obtained and added to the claims folder/efolder. 2. Following completion of the above, schedule the Veteran for a new VA examination with a Board-certified orthopedic surgeon, to determine the current severity of his service-connected DJD of the left knee and left knee ACL insufficiency. The claims folder, including a copy of this remand, should be made available to the examiner for review in connection with the examination and the examiner should acknowledge such review in the examination report or in an addendum. The examiner should indicate the nature and severity of all manifestations of the left knee disabilities. Any testing deemed necessary should be performed, including X-rays and appropriate range of motion studies. The examiner should specifically report the ranges of left knee flexion and extension in degrees on active motion, passive motion, weight-bearing and nonweight-bearing, as well as whether the left knee disabilities are manifested by weakened movement, excess fatigability, incoordination, flare-ups or pain. 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. If the examiner is unable to conduct the requested testing, or concludes the requested testing is not necessary, (s)he should clearly explain why that is so. Correia v. McDonald, 28 Vet. App. 158 (2016). If there is pain on motion, the examiner should report the point in the range of motion when the pain becomes apparent. The examiner should also report whether there is instability or subluxation and express an opinion as to the severity of such instability or subluxation. In addition, the examiner should indicate whether, and to what extent, the Veteran likely experiences functional loss due to pain and/or any other symptoms noted above during flare-ups and/or with repeated use; to the extent possible, the examiner should express any additional functional loss in terms of additional degrees of limited motion. 3. After completion of the above and any other development deemed necessary, readjudicate the Veteran's increased rating claims, based on the entirety of the evidence. If any benefit sought on appeal is not granted, the AOJ should issue a supplemental statement of the case and provide the appropriate opportunity to respond, before returning the case to the Board, if otherwise in order. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD F. Yankey, Counsel