Citation Nr: 21061440 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 16-35 337A DATE: October 4, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for the service-connected right knee patellofemoral pain syndrome is remanded. Entitlement to an initial rating in excess of 10 percent for the service-connected left knee patellofemoral pain syndrome is remanded. REASONS FOR REMAND The Veteran had active service from September 1961 to August 1966. In October 2019, he testified at a hearing before the undersigned Veterans Law Judge (VLJ). In October 2020, the Board of Veterans' Appeals (Board) remanded these claims for further evidentiary development. The Veteran most recently underwent a VA examination of his knees in May 2021 to ascertain the severity of his bilateral knee disability. However, the examination report leaves some necessary questions unanswered. As to the Veteran's lay reports (including at the Board hearing) of having been told he had a right knee meniscus tear, the Board notes that a January 26, 2016, MRI report shows that a differential diagnosis was made regarding his right knee meniscus of "differential including degenerative changes versus small tear." Clarification is needed as to whether this impression is indicative of a possible meniscus tear, and, if not, an explanation is needed. If an MRI is needed to answer this question, an in-person examination of the Veteran with relevant MRI testing should also be performed. Also, clarification is needed as to the examiner's findings regarding subluxation and instability of the Veteran's knees. The May 2021 VA examiner noted that neither of the Veteran's knees had recurrent subluxation or persistent instability. However, the 2016 bilateral knee MRI findings note "superolaterally subluxed patella" bilaterally. Accordingly, an explanation is needed as to why this is not indicative of recurrent subluxation. As to the May 2021 VA examiner's findings of no persistent instability and no recurrent patellar instability in the Veteran's knees, the examiner must address the Veteran's lay reports of using bilateral knee braces and must explain the significance, if any, of his use of these assistive devices if he does not have instability issues in his knees. Finally, the examiner noted in the examination report that the Veteran did not require a prescription by a medical provider of braces for ambulation. However, the Veteran's VA treatment records include both a November 19, 2018, treatment note in which the "plan" included sending the Veteran to prosthetics for a bilateral medial unloader knee braceand also a March 27, 2019, prosthetics note indicating that the Veteran was fitted for bilateral knee orthotics and also noting that he brought braces. An explanation is needed as to why these records do not indicate a prescription of bilateral knee braces for ambulation. Accordingly, these matters are REMANDED for the following action: Obtain an addendum opinion from the same examiner who provided the May 2021 VA knee examination, if possible. If the May 2021 VA examiner is unavailable, this opinion request should be forwarded to another appropriate VA examiner. If an opinion cannot be provided without an examination with additional testing, including MRIs, one should be provided. Upon review of the Veteran's claims file, including a copy of this Remand, the Veteran's October 2019 Board hearing testimony, and the Veteran's complete VA treatment records, the examiner is asked to provide clarification on the Veteran's bilateral knee meniscal conditions, including any associated subluxation, instability, and prescribed assistive devices pertinent to these joints. In doing so, the examiner should: (a.) Discuss the January 26, 2016, bilateral knee MRI report, in light of the Veteran's assertions that he was told he had right knee meniscal tears, and should address whether the notation of the right knee "differential including degenerative changes versus small tear" is indicative of a right knee meniscal tear. (b.) Discuss the bilateral knee findings in the 2016 MRI report of "superolaterally subluxed patella" of both of the Veteran's knees and address whether this notation is indicative of the Veteran's having recurrent subluxation in his knees. (c.) Discuss the Veteran's Board testimony regarding his use of assistive devices and explain whether such devices are needed for lateral and/or patellar instability. In addressing the Veteran's bilateral knee instability, the examiner should also consider his lay statements about instability symptoms he has experienced in his knees, regardless of findings on instability objective testing on prior in-person examinations. (d.) Discuss the November 19, 2018, and March 27, 2019, VA treatment records detailed above which indicate that the Veteran was fitted for knee braces with VA and explain whether this indicates that the Veteran requires a prescription by a medical provider for knee braces for ambulation. If it is not possible to provide a specific answer to the above items without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). A rationale for all requested opinions shall be provided. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination, if needed, may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Davidoski, 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.