Citation Nr: 21015249 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 12-34 953 DATE: March 17, 2021 REMANDED Entitlement to a compensable rating in excess of 10 percent for patellofemoral syndrome and tricompartmental degenerative joint disease of the left knee is remanded. Entitlement to an initial rating in excess of 10 percent for service-connected left knee patellofemoral pain syndrome on an extraschedular basis is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1981 through September 1981, and from March 2003 through August 2004. This matter comes before the Board of Veterans’ Appeals (Board) on appeal of a March 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Atlanta, Georgia. In the rating decision, the Veteran was found service connected for left knee patellofemoral pain syndrome and tricompartmental joint disease with an evaluation of 10 percent effective August 17, 2004. The Veteran timely appealed that decision. After a January 2017 hearing (the transcript is of record), the Board, in June 2018, denied the Veteran’s claim for entitlement in excess of 10 percent. The Veteran appealed the June 2019 decision to the U.S. Court of Appeals for Veterans Claims (CAVC). In a June 2019 joint motion for remand, the CAVC remanded the Board’s denial of entitlement to a higher initial rating for further development and readjudication. In December 2019, the Board, again, denied entitlement to a higher initial rating and remanded entitlement to an initial rating in excess of 10 percent on an extraschedular basis. The Veteran appealed the Board’s December 2019 decision to the CAVC. In an October 2020 joint motion for remand, the CAVC remanded the Board’s denial of entitlement to a higher initial rating for further development and readjudication. Also, in October 2020, the RO denied entitlement to an initial rating in excess of 10 percent for the service-connected left knee patellofemoral pain syndrome on an extraschedular basis. Additionally, the issue of entitlement on an extraschedular basis was denied by the Director in October 2020. Both issues are now before the Board for adjudication. 1. Entitlement to a compensable rating in excess of 10 percent for patellofemoral syndrome and tricompartmental degenerative joint disease of the left knee is remanded. 2. Entitlement to an initial rating in excess of 10 percent for service-connected left knee patellofemoral pain syndrome on an extraschedular basis is remanded. Unfortunately, remand is again required for the Veteran’s claims of entitlement to an increased rating for his left knee disability to obtain an adequate examination. For disabilities evaluated on the basis of limitation of motion, VA is required to apply the provisions of 38 C.F.R. §§ 4.40, 4.45, pertaining to functional impairment. In applying these regulations VA should obtain examinations in which the examiner determines whether the disability is manifested by weakened movement, excess fatigability, incoordination, pain, or flare ups. These determinations are, if feasible, to be expressed in terms of the degree of additional range-of-motion loss due to any weakened movement, excess fatigability, incoordination, flare-ups, or pain. The examiner must also determine the point, if any, at which such factors cause functional impairment. Mitchell v. Shinseki, 25 Vet. App. 32, 44 (2011); DeLuca v. Brown, 8 Vet. App. 202 (1995); 38 C.F.R. § 4.59. Also, VA examinations for musculoskeletal conditions must include joint testing for pain on both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; Correia v. McDonald, 28 Vet. App. 158 (2016). While the record contains contemporaneous VA examinations regarding the Veteran’s patellofemoral syndrome and tricompartmental degenerative joint disease of the left knee, the examinations do not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158, 168 (2016) pursuant to the CAVC remand. Specifically, the examinations do not contain pain on weight-bearing testing. A remand is required to obtain a medical opinion as to whether the knee disability causes the inability to perform normal working movement of the body with normal exclusion, strength, speed, coordination and endurance. The issue of entitlement on an extraschedular basis is inextricably intertwined with the issue of entitlement on a schedular basis such that this issue is also remanded. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected connected left knee patellofemoral pain syndrome. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 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). 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to an initial rating in excess of 10 percent for service-connected left knee patellofemoral pain syndrome on an extraschedular basis. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112. Thomas H. O’Shay Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Hamilton, 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.