Citation Nr: 21027737 Decision Date: 05/06/21 Archive Date: 05/06/21 DOCKET NO. 16-11 464 DATE: May 6, 2021 REMANDED Entitlement to an evaluation in excess of 20 percent for residuals of right knee anterior cruciate ligament (ACL) reconstruction is remanded. Entitlement to an evaluation in excess of 10 percent for residuals of right knee ACL reconstruction limitation of extension is remanded. Entitlement to an increased evaluation for residuals of right knee ACL reconstruction limitation of flexion, currently rated as 10 percent disabling prior to September 25, 2017, and as noncompensable thereafter, to include whether the reduction from 10 percent to a noncompensable evaluation was proper, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1992 to August 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from August 2013 rating decision. In the August 2013 rating decision, the Regional Office (RO) continued a 20 percent evaluation for the service-connected residuals of right knee ACL reconstruction under 38 C.F.R. § 4.71a, Diagnostic Code 5257. In a February 2016 rating decision, the RO assigned a separate 10 percent evaluation for right knee flexion under 38 C.F.R. § 4.61, Diagnostic Code 5260. In a September 2017 rating decision, the RO continued a 20 percent evaluation for the service-connected residuals of right knee ACL. The RO also assigned a separate evaluation for right knee limitation of extension effective from September 25, 2017 under Diagnostic Code 5261. In addition, the RO decreased the evaluation for right knee limitation of flexion from 10 percent to a noncompensable evaluation effective from September 25, 2017. In May 2019, the Board remanded the case for further development. In so doing, the Board characterized an issue on appeal as entitlement to increased evaluations for right knee limitation of flexion, to include whether the reduction from 10 percent to 0 percent was proper. Unfortunately, the Board finds that a November 2019 VA examination does not substantially comply with the Board's remand instructions. Stegall v. West, 11 Vet. App. 268 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim). In this regard, although the examiner noted that the Veteran exhibited pain on passive motion and nonweight-bearing, she did not provide an estimate of range of motion lost in terms of degrees. Moreover, the examiner did not provide a retrospective opinion regarding the Veteran's range of motion and functional impairment for the February 2016 and September 2017 VA examination, as directed by the Board. Therefore, although the Board sincerely regrets the delay, a remand is necessary to obtain an additional examination. In the November 2019 VA examination report, the examiner noted that a September 2017 MRI report showed impressions of lateral subluxation and tilt of the patella with narrowing of the patellofemoral articulation; a horizontal tear of the anterior horn medial meniscus; a horizontal tear posterior horn lateral meniscus; distal quadriceps and patellar tendinosis; and small joint effusion. The Board notes that the rating criteria for knee subluxation and instability were amended effective February 7, 2021. 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). Therefore, a remand is also necessary to ensure that the examinations findings fully address the revised rating criteria for Diagnostic Code 5257. Lastly, the Board notes that the most recent VA medical records currently associated with the claims file are dated in November 2019. On remand, the Agency of Original Jurisdiction (AOJ) should also obtain any outstanding VA medical records. The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. 2. Schedule the Veteran for an examination to determine the severity of his service-connected right knee residuals of an ACL reconstruction. (a) The examiner should report all signs and symptoms necessary for evaluation of the Veteran's right knee disability under the rating criteria. In particular, the examiner should provide range of motion test results (in degrees) for both of the Veteran's knees and describe the effects of pain on active and passive motion, in weight-bearing and nonweight-bearing, or explain why any such information cannot be provided. (b) The examiner should describe whether pain significantly limits functional ability when the joint is used repeatedly over a period of time or during flare-ups (if reported), and indicate range of motion. IF THE EXAMINATION DOES NOT TAKE PLACE DURING A FLARE, THE EXAMINER MUST GLEAN INFORMATION REGARDING THE FLARES' SEVERITY, FREQUENCY, DURATION, AND FUNCTIONAL LOSS MANIFESTATIONS FROM THE VETERAN, MEDICAL RECORDS, AND OTHER AVAILABLE SOURCES. EFFORTS TO OBTAIN SUCH INFORMATION MUST BE DOCUMENTED. If there is no pain and/or no limitation of function, such facts must be noted in the report. (c) The examiner should also report whether there is subluxation, lateral instability, or patellar instability involving the patellofemoral complex of the right knee, and if present, provide an opinion as to its frequency and severity. The examiner should specify (a) whether any instability is due to unrepaired or failed repair of complete ligament tear, an incomplete ligament tear, a complete ligament tear, and/or a repaired complete ligament tear; and (b) whether the Veteran has been prescribed an assistive device and/or bracing for ambulation by a medical provider due to his knee instability. (d) The examiner is asked to provide a retrospective opinion to estimate the degree of range of motion for passive motion, weight-bearing, and non-weight-bearing for the other VA examinations conducted during the appeal period. See, e.g., February 2016, September 2017, and November 2019 VA examinations. (e) The examiner is also asked to provide a retrospective opinion to estimate, if possible, the additional impairment (in terms of range of motion) due to pain based the evidence of record and the Veteran's statements for the February 2016 VA examination. All opinions must be supported by detailed rationale. If the opinion cannot be provided without resort to speculation, the examiner should explain why, and state whether the inability is due to the absence of evidence or limits of scientific/medical knowledge. A. S. CARACCIOLO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Wulff, 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.