Citation Nr: 21063456 Decision Date: 10/14/21 Archive Date: 10/14/21 DOCKET NO. 19-00 535A DATE: October 14, 2021 REMANDED Entitlement to a disability rating higher than 20 percent for left knee arthrotomies with ligamentous laxity, synovitis and atrophy, is remanded. Entitlement to a disability rating higher than 10 percent for left knee arthritis based on limitation of motion is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1969 to January 1973. In July 2021, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. 1. Entitlement to a disability rating higher than 20 percent for left knee arthrotomies with ligamentous laxity, synovitis and atrophy, is remanded. 2. Entitlement to a disability rating higher than 10 percent for left knee arthritis, based on limitation of motion, is remanded. The Veteran asserts that he is entitled to higher disability ratings than those currently assigned for his service-connected left knee disability. The Veteran was most recently afforded a VA examination in connection with his left knee disability in October 2019. At that time, flexion of the left knee was to 70 degrees and extension was to 0 degrees with no objective evidence of pain or additional loss of motion with repetitive movement. There was no ankylosis. There was no history of recurrent patellar subluxation or lateral instability, but there were frequent episodes of recurrent joint effusion with pain, locking and swelling, as well as meniscal tear. Stability testing revealed no abnormalities. At the July 2021 Board hearing, the Veteran testified that his left knee disability had worsened during 2020. He described what appears to be knee ankylosis, stating that he could no longer straighten or bend the knee, it was just stuck in the same position. The Veteran endorsed loss of balance and related requiring a cane and/or a walker at all times for ambulation. Reportedly, his doctor had recommended total knee replacement, but after examining the Veteran it was determined that the procedure was not indicated due, in pertinent part, to other comorbidities. Additionally, the Veteran's representative raised a claim for an increased rating for the left knee disability on an extraschedular basis. Private treatment records in January 2021, show that the Veteran complained of worsening left knee pain that would wake him from his sleep. Inspection of the knee revealed severe varus deformity, mild swelling, and no erythema. Palpation of the knee revealed severe effusion with warmth and bony osteophytes palpable. There was mild to moderate varus-valgus instability. Active range of motion of the left knee was 10 to 90 degrees. VA treatment records show that the Veteran was evaluated for knee replacement in April 2021, due to extreme pain. Examination of the knee showed a large sterile appearing effusion and reduced range of motion with extension to 10 degrees and flexion to 40 degrees, limited by pain and mechanical block. His left knee was determined to be ankylosed. VA's General Counsel has indicated that, when a claimant asserts that the severity of a disability has increased since the most recent rating examination, an additional examination is appropriate. VAOPGCPREC 11-95 (April 7, 1995); see also Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). In light of the Veteran's assertion that his left knee disability has increased in severity and as the medical evidence supports his contentions, a new examination to evaluate the severity of the Veteran's left knee disability is warranted. Finally, any outstanding VA and private treatment records should also be obtained and associated with the record. See 38 U.S.C. § 5103A(b). The matters are REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for the left knee disability on appeal, and complete and return an appropriate authorization form for each treatment provider identified (if any). After obtaining the completed release forms, request all identified pertinent medical records (if any). If possible, the Veteran should get these records and submit them himself to expedite the case (if any). 2. Schedule the Veteran for a VA examination to assess the current severity of his service-connected left knee disability, to include any functional effects. The Veteran's claims file should be made available to and reviewed by the examiner, and he or she must indicate whether such review was accomplished. (a) The examiner should determine the range of motion of the Veteran's left knee in degrees. Range of motion testing must include both passive and active motion, and in weight-bearing and nonweight-bearing conditions, and the range of the opposite undamaged joint. It should be indicated whether and at what point during the Veteran's range of motion he experiences any limitation of motion that is specifically attributable to pain. Further, the degree of additional range of motion loss or favorable or unfavorable ankylosis due to pain on use, weakened movement, excess fatigability, or incoordination should be indicated. If the Veteran endorses flare-ups of symptoms the examiner must comment on the functional limitations of the left knee during flare-ups, and the effect of pain on range of motion. If there is no flare-up at the time of the examination, the examiner is asked to opine on further functional limitations based on the Veteran's subjective complaints and history. (b) Indicate whether there is any ankylosis, and, if so, whether it is favorable or unfavorable and the angle at which the knee is held. (c) The examiner should state whether there is left knee instability that is best characterized as moderate or severe. (d) The examiner is specifically asked to provide: 1) whether the Veteran has had sprain, incomplete ligament tear, or repaired complete ligament tear related to his left knee disability; 2) whether the Veteran has had unrepaired or failed repair of complete ligament tear causing persistent instability related to the left knee disability; and 3) whether the Veteran requires prescription by a medical provider for either an assistive device (e.g., cane(s), crutch(es), walker) or bracing for ambulation due to his left knee disability. (e) The examiner is also asked to provide: 1) whether the Veteran has a diagnosed knee condition involving the patellofemoral complex with recurrent instability (with or without surgical repair); and 2) whether the Veteran requires a prescription from a medical provider for a brace, cane, or walker for the patellar instability. (f) The examiner should assess the impact of the Veteran's service connected left knee disability, on his activities of daily living, including his occupational functioning. All findings, conclusions, and the rationale for all opinions expressed should be provided in a report. Please note that an examiner's report that she/ he cannot provide and opinion without resort to mere speculation is inadequate unless the examiner provides a rationale for that statement. John J. Crowley Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Azizi, T. 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.