Citation Nr: 21028249 Decision Date: 05/10/21 Archive Date: 05/10/21 DOCKET NO. 17-03 060 DATE: May 10, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for right knee anterior cruciate ligament repair residuals with degenerative joint disease under 38 C.F.R. § 4.71a, Diagnostic Code 5260 is remanded. Entitlement to an initial rating in excess of 10 percent for right knee anterior cruciate ligament repair residuals under 38 C.F.R. § 4.71a, Diagnostic Code 5259 is remanded. Entitlement to an initial rating in excess of 10 percent for right knee anterior instability under 38 C.F.R. § 4.71a, Diagnostic Code 5257 is remanded. Entitlement to a compensable rating for right knee arthroscopic scar residuals is remanded. Entitlement to a compensable rating for right knee arthroscopic scar residuals with musculocutaneous nerve impairment is remanded. REASONS FOR REMAND The Veteran had active service from August 1983 to November 2013. 1. Entitlement to higher initial ratings for post operative right knee disability is remanded. The report of a November 2019 Department of Veterans Affairs (VA) knee examination states that the Veteran complained of worsening right knee impairment. On examination of the right knee, the Veteran exhibited a range of motion of 10 to 80 degrees with pain on flexion and extension; functional loss due to knee pain, weakness, stiffness, fatigue, and loss of endurance; and pain with weight bearing. The examiner commented that the "service connected right knee condition causes an abnormal gait" and "the Veteran reports difficulty with prolonged sitting, standing, ascending/descending stairs, walking, and driving and is unable to knee or squat." The nurse practitioner did not indicate the degree at which the Veteran experienced pain on motion of the right knee. In light of that deficiency, the Board finds that the functional loss associated with the service connected right knee disability is unclear and the examination report is of limited probative value. VA's duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). VA has recently amended that portion of 38 C.F.R. Part 4 which pertain to musculoskeletal disabilities. On February 7, 2021, the provisions of 38 C.F.R. § 4.71a, Diagnostic Codes 5003 and 5257 addressing degenerative arthritis and impairment of the knee were amended. 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 Codes 5010, 5257). Because of the cited deficiencies in the November 2019 VA knee examination and the recent amendment of the relevant diagnostic codes, the Board finds that further VA knee evaluation is needed. Clinical documentation dated after March 2020 is not of record. VA should obtain all relevant VA and private treatment records which could potentially be helpful in resolving the Veteran's claims. Murphy v. Derwinski, 1 Vet. App. 78 (1990); Bell v. Derwinski, 2 Vet. App. 611 (1992). 2. Entitlement to higher initial ratings for right knee arthroscopic scar residuals is remanded. The issues of higher initial ratings for right knee arthroscopic scar residuals are inextricably intertwined the issues being remanded and must also be remanded. These matters are REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated him for the service-connected post-operative right knee disability. Make two requests for the authorized records from all identified healthcare providers unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran's VA clinical documentation not already of record, including that pertaining to treatment after March 2020. 3. Schedule the Veteran for a VA knee examination conducted by a medical doctor to assist in determining the current nature and severity of post-operative right knee disability. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Provide ranges of motion for weight-bearing and nonweight-bearing and passive and active motion of both knees. The examiner should specifically indicate the degree at which the Veteran experiences pain on motion of the right knee. (b) State whether there is any additional loss of function of the right knee due to painful motion, weakened motion, excess motion, fatigability, incoordination, or on flare up. (c) State whether there is any recurrent lateral instability or subluxation of the right knee and, if so, the severity of any instability or subluxation. (d) Identify all post-operative right knee scars, the location of the scars, and whether any scars are symptomatic, painful, or unstable. (e) Provide an opinion as to the impact of the post-operative right knee disability on the Veteran's vocational pursuits. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. Andrew Ledman II 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.