Citation Nr: 21009057 Decision Date: 02/18/21 Archive Date: 02/18/21 DOCKET NO. 15-33 681 DATE: February 18, 2021 REMANDED Entitlement to a rating higher than 10 percent for a left knee disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1987 to January 1988. In September 2019, the Board remanded this claim back to the local regional office (RO), i.e., back to the Agency of Original Jurisdiction (AOJ), as well as a claim for service connection for a stomach disorder, to obtain all outstanding relevant treatment records and for VA examinations reassessing the severity of the Veteran’s left knee disorder and for a medical nexus opinion regarding the etiology of his additionally claimed stomach disorder. Following an October 2019 VA examination, on remand, the RO granted service connection for the stomach disorder, specifically, for duodenitis with gastroparesis. If the Veteran disagrees with the initial rating and/or effective date assigned for this now service-connected disability, he must separately appeal these “downstream” issues. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997).  Regarding the remaining claim for a rating higher than 10 percent for the left knee disorder that is still on appeal, the Board unfortunately finds that still more development of this claim is required. Significantly, a February 2020 VA orthopedic treatment note indicates that a then recent MRI had revealed the Veteran has a chronic anterior cruciate ligament (ACL) tear and chronic degenerative tear of the medial meniscus of his left knee, neither of which are reflected in the report of the VA examination he underwent following the Board’s prior remand of this claim. The Veteran also consequently is awaiting left knee arthroscopic surgery, which has been postponed due to the COVID-19 pandemic. This evidence tends to suggest that his left knee disability has worsened appreciably – even since the October 2019 VA examination that he underwent following the Board’s prior remand of this claim. Thus, he at least seemingly needs to be examined again. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007). In addition, during the October 2019 VA examination, the Veteran indicated that he regularly wore a brace and constantly used a cane. The new criteria for rating disabilities of the musculoskeletal system took effect on February 7, 2021. Under the revised criteria, the Veteran may be eligible for assignment of a separate diagnostic code for recurrent subluxation or instability of his left knee. However, additional medical comment is needed to assist in making this determination. Accordingly, this claim is again REMANDED for the following still additional development and consideration: Schedule the Veteran for another VA examination again reassessing the severity of his left knee disorder. A copy of this remand and all relevant medical records should be made available to the examiner for review. The examiner must review the pertinent evidence, including the Veteran’s lay assertions, and undertake all indicated testing and evaluation needed to address all relevant rating criteria. The examiner should report all signs and symptoms necessary for rating the Veteran’s left knee disorder under the applicable rating criteria. To this end, the examiner should provide the range of motion in degrees of the left knee. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing, if possible. If the examiner is unable to conduct the required testing, he or she should clearly discuss why in the report. The presence of objective evidence of pain, premature or excess fatigability, incoordination and weakness also should be noted, as should any additional disability (including additional limitation of motion) due to these factors. The examiner shall inquire as to periods of flare-up and note the frequency and duration of any such flare-ups. Any additional impairment on use or in connection with flare-ups should be described in terms of the degree of additional range of motion loss. The examiner should specifically describe the severity, frequency, and duration of flare-ups; name the precipitating and alleviating factors; and estimate, per the Veteran, to what extent, if any, such flare-ups affect functional impairment. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so.   The evaluating clinician should also discuss whether the Veteran experiences recurrent subluxation or instability and, if so, to what extent. In addition, the examiner should indicate whether the Veteran’s use of a cane and brace is medically prescribed. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Mukherjee 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.