Citation Nr: 21002881 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 13-23 363 DATE: January 19, 2021 ORDER The issue of a rating in excess of 10 percent for right knee arthritis effective July 15, 2010, is remanded. The issue of a rating in excess of 10 percent for left knee arthritis effective July 15, 2010, is remanded. The issue of a rating in excess of 10 percent for right knee instability effective July 15, 2010, is remanded. REASONS FOR REMAND The Veteran served in the U.S. Army from April 1979 to August 1992. The issue of a rating in excess of 10 percent for right knee arthritis effective July 15, 2010, is remanded. The issue of a rating in excess of 10 percent for left knee arthritis effective July 15, 2010, is remanded. The issue of a rating in excess of 10 percent for right knee instability effective July 15, 2010, is remanded. The matters are REMANDED for the following action: 1. BACKGROUND FOR THE RO ADJUDICATOR: This matter was remanded by the Board in July 2019 to obtain an adequate medical examination. The Veteran was examined in January 2020 but the examiner did not provide range of motion measurements for both knees in passive motion, and in weight-bearing and non-weightbearing. The examiner also noted “objective evidence of pain” with passive range of motion testing and when the joint is used when not bearing weight, but did not provide range of motion measurements. Correia v. McDonald, 28 Vet. App. 158 (2016). The remand directives follow. 3. Return the Veteran’s file to the VA examiner who conducted the January 2020 examination for an examination in accordance with VA rating protocols to determine the severity of the Veteran’s bilateral knee disabilities. If the January 2020 examiner is not available schedule the Veteran for an examination with a similarly qualified examiner. 4. In the Disability Benefits Questionnaire report of examination, in addition to all other data elicited as both knees, the examiner must also report active and passive motion and in weight-bearing and non-weight-bearing. Any additional range of motion loss should be described in degrees. If the examiner is unable to provide the requested opinion, he or she should clearly explain the basis for this decision. The examiner should review the Veteran’s entire file; however, his/her attention is drawn to the following: * In October 2011, the Veteran was afforded a VA examination. The Veteran endorsed symptoms of pain and stiffness in both knees and stated that he cannot walk long distances, ride a bike, or run but has no limitation in getting dressed. The Veteran’s range of motion measurements included right knee flexion to 120 degrees and no limitation on extension. Left knee range of motion measurements included flexion to 130 degrees and no limitation on extension. The Veteran indicated pain on movement in his right knee and pain on palpation in both knees. There was no limitation of muscle strength, no instability, subluxation, no shin splints, and no stress fractures or other tibial or fibular impairment. * In February 2012, the Veteran was afforded a VA examination. The Veteran reported that his knees sometimes swell and give way, but reported no locking, catching, subluxation, or dislocations. The Veteran’s range of motion measurements included right knee flexion to 130 degrees and no limitation on extension. The examiner did not include range of motion measurements for the left knee. There was no limitation of muscle strength, instability, subluxation, shin splints, and no stress fractures or other tibial or fibular impairment. * In July 2014, the Veteran was afforded a VA examination. The Veteran reported chronic anterior knee pain, stiffness, disturbance of locomotion, and swelling. The Veteran’s range of motion measurements included right knee flexion to 120 degrees and no limitation of extension. Left knee range of motion measurements included flexion to 120 degrees and no limitation of extension. There was no limitation of muscle strength, instability, subluxation, shin splints, and no stress fractures or other tibial or fibular impairment. * In June 2016 hearing testimony, the Veteran indicated that he has chronic knee pain in both knees. The Veteran also stated that the primary result of his disability was lack of mobility, pain, and the occasional collapsing of his right knee. The Veteran also stated that his right knee locks up approximately three to four times a year. The Veteran indicated that he only experiences pain in his left knee and stated that his left knee does not collapse. * In January 2017, the Veteran was afforded a VA examination. The Veteran indicated that cold weather, sitting, and driving worsen his knee pain, and his knees sometimes buckle. The examiner reported a diagnosis of shin splints but noted the shin splints were unrelated to the Veteran’s knee disabilities. The examiner also noted diagnoses for arthritis in both knees as well patellofemoral pain syndrome in the right knee. The examiner was unable to test range of motion in the right knee due to pain but range of motion measurements in the left knee included flexion to 120 degrees and extension of 0 to 120 degrees. The examiner noted tenderness on palpation, pain with weight bearing, and evidence of crepitus. The examiner also noted instability of station, disturbance of locomotion, and interference with sitting and standing. There was no muscle atrophy, ankylosis, recurrent subluxation, or recurrent effusion. The examiner also noted no anterior, posterior, medial, or lateral instability. * A February 2017 treatment note reports the Veteran has bilateral knee pain with long standing, walking, stairs, stiffness, knee subluxations, occasional buckling but no locking or falls. A March 2017 treatment note indicates the Veteran has degenerative joint disease and a range of motion from 0 to 120 in both knees. * In January 2020, the Veteran was afforded a VA examination. The Veteran was noted to have a diagnosis for right and left knee arthritis. The Veteran’s right knee initial range of motion measurements included flexion from 0 to 110 degrees and extension from 110 to 0 degrees. Range of motion in the left knee included flexion from 0 to 120 degrees and extension from 120 to 0 degrees. After repetitive use, the Veteran’s right knee range of motion measurements included flexion from 0 to 95 degrees and extension from 95 to 0 degrees. Repetitive range of motion in the left knee included flexion from 0 to 110 degrees and extension from 110 to 0 degrees. (Continued on the next page)   The Veteran reported flare-ups of bilateral knee pain occurring multiple times per day for several hours each day. Pain additionally limited the Veteran’s right knee range of motion to flexion of 0 to 90 degrees and extension of 90 to 0 degrees and left knee range of motion to flexion from 0 to 105 degrees and extension from 105 to 0 degrees. The additional functional loss was caused by pain, fatigue, and weakness. Limits on functional activity during flareups included difficulty with everyday activities such as climbing stairs, prolonged walking, sitting, standing, or bending, and impaired sleep. During flare-ups, the Veterans right knee range of motion measurements included flexion from 0 to 85 degrees and extension from 85 to 0 degrees and left knee range of motion measurements included flexion from 0 to 100 and 100 to 0. The examiner noted disturbance of locomotion, interference with sitting and interference with standing during flareups. The examiner also noted right knee instability and right knee popping and characterized the Veteran’s instability as “slight.” The examiner noted that the Veteran’s right knee instability and arthritis collectively cause limitations in running, kneeling, prolonged standing, prolonged walking and flare-ups require breaks and relief from weight-bearing. The examiner noted a history of shin splits but stated this was an acute condition which had resolved. 3. Thereafter, and after undertaking any additional development deemed necessary, readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative must be provided with a Supplemental Statement of the Case (SSOC) and be afforded reasonable opportunity to respond. The case should then be returned to the Board for further appellate review, if otherwise in order. Vito A. Clementi Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Wozniak, 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.