Citation Nr: 21022468 Decision Date: 04/15/21 Archive Date: 04/15/21 DOCKET NO. 17-43 965 DATE: April 15, 2021 REMANDED Entitlement to a disability rating higher than 30 percent for left knee traumatic arthritis (“left knee disability”) is remanded. Entitlement to a disability rating higher than 10 percent for mild derangement of the left knee is remanded. REASONS FOR REMAND The Board recognizes that the Veteran is separately rated for mild derangement of the left knee, under Diagnostic Code 5257. As this is part and parcel of the increased rating claim for left knee disability the Board is taking jurisdiction over the issue and this is referenced in the title page. The Veteran testified at a hearing before a Decision Review Officer at the RO in January 2009 and before the undersigned Veterans Law Judge in a November 2018 Travel Board hearing. Transcripts of both hearings have been associated with the file. The Board remanded the matter in July 2019 for additional development. Although the Veteran was afforded a VA examination as the directives required, a review of the record shows that an additional remand is needed. As referenced above the Veteran is separately rated for mild derangement of the left knee. During the pendency of the appeal, the criteria for evaluating musculoskeletal disorders were revised, effective February 7, 2021. See Schedule for Rating Disabilities: Musculoskeletal System and Muscle Injuries, 85 Fed. Reg. 76453, 76464 (Nov. 30, 2020) (to be codified at 38 C.F.R. § 4.71a, Diagnostic Codes 5003, 5010, and 5257). As the criteria change specifically impacts the Veteran’s left knee and mild derangement disabilities the Board finds that another examination is required. In the most recent VA examination, dated November 2019, the VA examiner concluded that the Veteran did not then nor ever had a tear in the left knee. This is in stark contrast to several other records in the file. A March 2014 VA MRI note shows complete chronic ACL tear of the left knee. The February 2014 VA examination shows ACL meniscal tear, with a diagnosis date of 2006. Given that the new criteria under 5257 has been revised and ligament tear of the knee is determinative when assessing level of severity another examination is needed. Also, of note, a read of the record indicates that the Veteran’s left knee disability may be more severe than described in the most recent VA examination. During the hearing the Veteran provided testimony describing the severity of his left knee disability and flare-ups were discussed. VA treatment records illustrate clicking, popping, and locking of the knee as well as consideration for the need of a total knee replacement. See VA treatment records dated November 2013, October 2014, and October 2017. Despite the aforementioned, the November 2019 VA examiner stated that the Veteran denied flare-ups and there is nothing in that report to illustrate symptoms as severe as those in the VA treatment records. As such, the Board finds that an additional examination would be helpful in determining the current level of severity of the Veteran’s left knee disability. The matters are REMANDED for the following action: 1. The AOJ should schedule the Veteran for a VA examination by an appropriate clinician to determine the current severity of his service-connected left knee disability and his service-connected mild derangement of the left knee. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the rating criteria. To the extent possible the examiner should opine as to the level of severity of the Veteran’s left knee disabilities throughout the appeal period (from April 2013). The examiner is requested to note in his/her report that a full review of the Veteran’s electronic claims file was completed. The examiner is asked to test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner should attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the left knee disability alone and due to the mild derangement of the left knee alone, and discuss the effect of the Veteran’s left knee disabilities on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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 whether it is due to the examiner not having the knowledge or training. Specifically, the examiner should determine whether the Veteran has or has ever had, as of February 7, 2021, unrepaired or failed repair of complete ligament tear or sprain, incomplete ligament tear, or repaired complete ligament tear that causes persistent instability. H.M. WALKER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Talamantes, 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.