Citation Nr: 21030380 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 18-06 015 DATE: May 18, 2021 REMANDED The issue of entitlement to an increased rating for a left knee disability, currently rated as 10 percent disabling based on limitation of flexion, is remanded. The issue of entitlement to an increased rating for a right knee disability, currently rated as 10 percent disabling based on limitation of flexion, is remanded. REASONS FOR REMAND The Veteran served on active duty from April 2003 to April 2007. This matter is before the Board following his appeal of a March 2016 rating decision, which denied compensable ratings for left and right knee disabilities. In a March 2019 rating decision, the RO granted 10 percent ratings for the left and right knee, effective October 14, 2015. As those grants did not represent a total grant of the benefits sought on appeal, those claims remain before the Board. AB v. Brown, 6 Vet. App. 35 (1993). In October 2019, the Veteran testified before the undersigned Veterans Law Judge; a transcript of the hearing is of record. The Board then remanded this matter in January 2020. Unfortunately, the Board finds that additional remand is necessary prior to adjudicating the Veteran's bilateral knee increased rating claims. In this regard, although the Veteran was afforded a VA examination in March 2020 pursuant to the prior remand, evidence received since that examination either calls into question the adequacy of the examination or supports a worsening. Specifically, in May 2020, the Veteran reported popping in his knees, and in July 2020, he reported worsening bilateral knee pain that affected his balance and the way he walked. He also reported feeling as though his knee will give out when he walks. Those symptoms were not reported during the March 2020 examination and suggest a worsening or change in the Veteran's condition. Additionally, the Board notes that the March 2020 examiner did not complete Section 3D of the examination report regarding flare ups, presumably because the Veteran denied flare-ups of his knee condition to the examiner. Nevertheless, because the Veteran testified in October 2019 that he does experience flare-ups of his knee disabilities, including on a daily basis at times, the Board finds that clarification is needed regarding what the Veteran considers to be a flare-up of his knee disabilities, and how the examiner defines a flare up. Finally, VA treatment notes in November 2019 and July 2020 indicate that the Veteran was to undergo additional imaging of the knees, and the Veteran wrote to in August 2020 that he had an upcoming MRI appointment for both knees and would therefore have additional evidence to submit. However, no additional reports of knee imaging have been submitted. Therefore, remand is necessary to obtain any outstanding relevant records. The matters are REMANDED for the following action: 1. Obtain updated relevant treatment records, to include any MRI reports related to the knees occurring since November 2019. 2. Then, schedule the Veteran for a VA examination to assess the current nature and severity of his service-connected left and right knee disabilities. Range of motion should be reported, including whether and the extent to which such motion is affected by pain, weakness, fatigue, lack of endurance, incoordination or other symptoms resulting in functional loss. (a) Based upon a review of the medical records, lay statements submitted in support of the claim, and/or statements elicited from the Veteran during the examination, state whether the Veteran experiences flare ups of his service-connected knee disabilities, and how he characterizes the additional functional loss during a flare. Please note the Veteran testified in October 2019 that he experiences flare-ups on a daily basis. If the examiner concludes that the Veteran does not experience flare ups, explain why not with consideration of the Veteran's testimony. (b) If the Veteran describes experiencing flare ups, identify the (1) frequency; (2) duration; (3) precipitating factors; and (4) alleviating factors. (c) Based upon the information elicited as a result of the foregoing, state whether it is at least as likely as not (50 percent probability or greater) that during a flare up range of motion is additionally limited to 30 degrees of flexion or 10 degrees of extension. Please explain why or why not. (d) Based upon the information elicited as a result of the foregoing, state whether it is at least as likely as not (50 percent probability or greater) that repetitive use over time additionally limits motion to 30 degrees or less (for flexion) or 10 degrees or more (for extension). Please explain why or why not. (e) Based upon the information elicited as a result of the foregoing, state whether it is at least as likely as not (50 percent probability or greater) that during a flare up the disability is manifested by effusion and/or locking. (f) Address the Veteran's reports of popping in his knees and feeling as though his knee will give way, and describe any functional impact caused by those symptoms, to include whether those symptoms cause any disturbance in locomotion or interfere with sitting, standing, and weight-bearing. If the examiner cannot provide the requested opinions without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). S. C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Fagan 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.