Citation Nr: 21066757 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 14-38 899 DATE: November 2, 2021 REMANDED Entitlement to a rating in excess of 20 percent for left knee patellofemoral syndrome is remanded. Entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome is remanded. REASONS FOR REMAND The Veteran had active service from August 1990 to August 1992. The underlying appeal arises from a November 2010 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which denied increased ratings for the Veteran's left and right knee patellofemoral syndromes. The matters were previously denied by the Board of Veterans Appeals (Board) in September 2020, and the Veteran appealed to the Court of Appeals for Veterans Claims (Court). The matters have been vacated and remanded to the Board pursuant to a June 2021 Joint Motion for Partial Remand (JMPR) and Order of the Court. 1. Entitlement to a rating in excess of 20 percent for left knee patellofemoral syndrome is remanded. 2. Entitlement to a rating in excess of 10 percent for right knee patellofemoral syndrome is remanded. The Veteran contends her knee conditions warrant increased ratings, specifically, an additional separate rating under the relevant diagnostic code for instability of the knees. See 38 C.F.R. § 4.14, Diagnostic Code 5257. The Veteran's left and right knee conditions will be addressed together in the below discussion. The Veteran has undergone several VA examinations in connection with her bilateral knee claimin September 2010, April 2012, and June 2018. The Court found only the September 2010 examination inadequate. During that examination, the Veteran reported that her right knee "locked" on occasion, and that her left knee had a "catching" sensation, but no locking. She reported subjective symptoms in both knees of "giving way," pain, and "weakness," but no deformity, instability, incoordination, or episodes of dislocation or subluxation. The examiner's objective findings included weakness in both knees, but indicated no instability of either knee. The Court found that the September 2010 VA examiner provided an insufficient medical explanation regarding the conclusion that the Veteran did not have joint instability. Specifically, the Court emphasized that the examiner indicated the Veteran did not have knee instability, even though she had reported symptoms of "giving way" and "weakness." The JMPR states that the examiner, in providing her medical explanation, "did not qualify the difference between 'instability,' and 'giving way' and 'weakness,' given their similarity." The Court accordingly has ordered the Board to direct the VA conduct a new examination of appellant's knee conditions and, if still applicable, to clarify the distinction between "instability," "giving way" and "weakness" in providing a reasoned medical explanation, consistent with Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The Board acknowledges that over 10 years have elapsed since the September 2010 examination at issue, and that a new examiner may be unable to ascertain what the 2010 VA examiner or the Veteran meant or understood through their choice of terminology. The Board also acknowledges that the diagnostic criteria for rating the knees have changed during the pendency of the Veteran's appeal, including the diagnostic criteria for instability of the knee, 38 C.F.R. § 4.71, Diagnostic Code 5257. Nevertheless, the Board requests that, on remand, the new examiner review the September 2010 examination and, in providing a reasoned medical opinion, address the 2010 examination findings and differentiate (if still applicable) the terminology noted above, in light of the diagnostic criteria in effect at the time. The examiner should explain the necessary criteria to support a finding of instability and provide a medical rationale as to whether symptoms of "giving way" and "weakness" do or do not equate to "instability" of a knee. The examiner may wish to include an explanation of joint stability testing that was or would have been conducted and the evidence of record at the time. The examiner must also conduct a complete examination and evaluation of the current condition of the Veteran's knees, opine whether they meet the criteria for instability under the relevant diagnostic criteria, and provide a reasoned medical opinion for any conclusions reached. The matters are REMANDED for the following action: 1. Schedule the Veteran for a new VA knee disorders examination with an appropriate clinician to determine the current severity of her service-connected left and right knee disabilities. A complete examination of each knee must be conducted. (a.) Prior to conducting the examination, the clinician should be provided with, and review, the Veteran's entire claims file, including a copy of this remand and the Court's JMPR. (b.) In consideration of the Court's emphasis on instability, the examiner must determine whether the Veteran has knee instability, and if so, note the severity. The examiner must carefully consider the Veteran's lay statements and reported symptomatology when evaluating the stability of the knees. The examiner is reminded that the Veteran is competent to subjectively describe sensations in her knees. Any indicated joint stability testing must be performed, and the findings detailed in the examination report. (c.) The examiner must review and address the findings of the 2010 VA examination of the knees, and, if still applicable, clarify the distinction between "instability," "giving way," and "weakness" as those terms are understood and evaluated with respect to knee disabilities. JENNIFER HWA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Medley, 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.