Citation Nr: 21066830 Decision Date: 11/02/21 Archive Date: 11/02/21 DOCKET NO. 18-30 725 DATE: November 2, 2021 REMANDED Entitlement to an initial rating in excess of 20 percent for thoracolumbar spine degenerative arthritis (back disorder) is remanded. Entitlement to an initial rating in excess of 10 percent for cervical spine degenerative arthritis (neck disorder) is remanded. Entitlement to an initial rating in excess of 10 percent for left knee patellar chondromalacia and degenerative joint disease (left knee disorder) is remanded. Entitlement to an initial rating in excess of 10 percent for right knee patellar chondromalacia and degenerative joint disease (right knee disorder) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1990 to January 1993, and from December 2000 to December 2013. In April 2021, the Veteran provided testimony before the Board of Veterans' Appeals (Board) and the undersigned Veterans Law Judge. The transcript of the hearing is associated with the Veteran's claims file. During the hearing, the Veteran reported that he currently was receiving treatment for his back and neck disorders at a chiropractor's office. The Veteran provided evidence that his back disorder would result in becoming bed ridden, he would experience sciatic pain in his left lower extremity, and he experienced bilateral radicular pain in his hands. In regard to the Veteran's bilateral knee disorder, the Veteran reported the use of knee braces due to knee instability and resulting falls. During the April 2021 hearing, the Veteran provided evidence of relevant private treatment records which are not associated with the record. The Veteran also provided evidence that his neck, back and knee disorders have worsened since the last VA examinations conducted over 3 years ago in August 2018. Accordingly, the Board finds that new examinations are necessary to determine the current severity of the service-connected neck, back and knee disorders. Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The matters are REMANDED for the following action: 1. Make efforts to obtain all outstanding medical records in accordance with the duties set forth in 38 C.F.R. § 3.159(c), to include private chiropractic records identified by the Veteran in the April 2021 Board hearing. 2. Schedule the Veteran for a VA spine examination by an appropriate clinician who has reviewed the claims file to determine the current severity of his service-connected neck and back disorders. The most current Disability Benefits Questionnaire must be employed, and all relevant findings indicated in that questionnaire must be addressed. Examinations must include joint testing for pain on both active and passive motion, and in weight-bearing and nonweight-bearing when appropriate. If it is not possible to provide a specific measurement 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). 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 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). The examiner should also address the presence of any cervical or lumbar radiculopathy/neuropathy associated with the Veteran's service-connected disorders. All opinions must be supported by a detailed rationale. 3. Schedule the Veteran for a VA knee examination by an appropriate clinician who has reviewed the claims file in conjunction with the examination. The most current Disability Benefits Questionnaire must be employed, and all relevant findings indicated in that questionnaire must be addressed. Examinations must include joint testing for pain on both active and passive motion, and in weight-bearing and nonweight-bearing when appropriate. If it is not possible to provide a specific measurement 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). 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 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). The examiner must assess any knee instability under the rating criteria in effect prior to February 7, 2021 as well as the revised rating criteria effective February 7, 2021. For example, the examiner should explain why the examiner classified the Veteran's knee instability as slight, moderate, or severe under the older rating criteria with citation to supporting evidence in the record including the Veteran's lay statements about the instability. The examiner must also consider: a) the extent of any sprain or ligament tear (and repair thereof), b) the use of prescribed assistive devices (e.g., a cane, crutches, or a walker), c) the need for bracing for ambulation, and d) the extent and degree of any current instability. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76463 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Code 5257). All opinions must be supported by a detailed rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. N. Quarles, 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.