Citation Nr: 20036719 Decision Date: 05/28/20 Archive Date: 05/28/20 DOCKET NO. 18-52 607 DATE: May 28, 2020 REMANDED Entitlement to a rating higher than 10 percent for left knee patellofemoral syndrome with ACL sprain is remanded. Entitlement to service connection for left ankle condition is remanded. Entitlement to service connection for right ankle condition is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from August 1995 to August 2015. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2016 and September 2018 rating decisions of the Department of Veterans Affairs (VA) Regional Office (RO). REASONS FOR REMAND 1. Entitlement to an increased rating in excess of 10 percent disabling for left knee patellofemoral syndrome with ACL sprain is remanded. The Veteran underwent a VA examination in September 2015 which diagnosed patellofemoral pain syndrome in his knees bilaterally. At that time, he reported intermittent mild pain with prolonged sitting and standing, with the right knee being worse than the left knee. In his Notice of Disagreement, he reported that this left knee is in constant pain and has painful motion, but the VA examiner did not document it. The Veteran underwent an MRI in February 2016 for the left knee which showed ACL degeneration with meniscal contusion but no meniscal tear. In May 2016, VA treatment records note the Veteran began physical therapy for his bilateral knee pain, but he continued to have complaints of knee pain. Private treatment records submitted in May 2019 show the Veteran complained of continuous bilateral knee pain from walking or trying to run, however, range of motion was not tested. He described his pain as throbbing, wrenching, unbearable and dreadful. The Board finds that the Veteran’s complaints of continuous left knee pain demonstrate that the severity of the Veteran’s left knee disability has worsened. Given these allegations of worsening symptoms, and the fact that range of motion has not been tested since the September 2015 VA examination, an updated VA examination is necessary before addressing the appeal. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). 2. Entitlement to service connection for a left and right ankle condition is remanded. The Veteran contends that the ankle problems he noted in his separation examination are causing pain currently. His service treatment records (STRs) document general pain in the back, knees and other areas. He also noted foot trouble and swollen or painful joints in the separation examination. The September 2015 VA examiner determined that, despite intermittent popping sensations, the Veteran did not have a diagnosis of any ankle conditions. The examiner also noted that there was no functional impact from the Veteran’s ankle. However, the Veteran had continued complaints of ankle pain September 2017, and requested orthopedic braces for his ankles. See September 2017 VA treatment records. Pain that results in functional impairment may be considered a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Given the Veteran’s continued reports of pain requiring orthopedic braces, the Board finds that the functional impairment from his bilateral ankle pain should be reassessed. Accordingly, a remand is necessary. The matters are REMANDED for the following action: 1. Obtain any updated VA and private medical records pertaining to the Veteran’s knee and ankle disabilities. 2. Schedule the Veteran for an examination of the current severity of his left knee disability. The examiner should identify any symptoms and functional impairments due to the Veteran’s left knee symptoms. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner should state the reason why. Further, 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. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner should state the reason why. 3. Schedule the Veteran for an examination by an appropriate clinician to determine the etiology of the Veteran's bilateral ankle pain. The record must be made available to the examiner and the examiner should indicate in his/her report whether the record was reviewed. The examiner should provide a full description of the disabilities and report all signs and symptoms. Based on a review of the record and any examination findings, the examiner should address the following: (a.) Identify all current diagnoses of the bilateral ankles. If the Veteran is only diagnosed with left or right ankle pain (without identified underlying disability), the examiner must determine whether such pain results in any functional impairment. The examiner must address the Veteran’s request for ankle braces and whether there is ankle instability. The examiner should also elicit from the Veteran a history of his bilateral ankle pain, which was noted on discharge. (b.) As to each diagnosed ankle disability (or if left or right ankle pain results in functional impairment but no diagnosis), indicate whether it is at least as likely as not that the disability began during active duty or is otherwise related to any in-service event or injury. The examiner must address the Veteran's lay contentions, as well as provide a complete rationale for all opinions expressed and conclusions reached.   4. After completing the above actions, the claim on appeal should be re-adjudicated based on the entirety of the evidence. If the claim remains denied, the Veteran and his representative should be issued a supplemental statement of the case. MARTHA R. LUBOCH Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board B. Jaigirdar, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.