Citation Nr: 21030435 Decision Date: 05/18/21 Archive Date: 05/18/21 DOCKET NO. 17-39 550 DATE: May 18, 2021 REMANDED Entitlement to increase in the staged (20 percent prior to September 12, 2017, and 50 percent from that date) ratings assigned for a (now post-total knee replacement (TKR)) left knee disability, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from February 1992 to May 1998. This matter is before the Board of Veterans' Appeals (Board) on appeal from an October 2015 rating decision, which granted service connection for left knee anterior cruciate ligament (ACL) reconstruction and meniscectomy with osteoarthritis (under Diagnostic Code (Code) 5261), and continued a 10 percent rating for left knee anterior instability (under Code 5257)). In May 2016, the Board remanded the matter for issuance of a Statement of the Case (SOC) pursuant to Manlincon v. West, 12 Vet. App. 238 (1999). An interim (September 2018) rating decision increased the rating for left ACL reconstruction and meniscectomy with osteoarthritis from 10 to 40 percent, effective September 12, 2017. In September 2019, a hearing was held before the undersigned in Washington, D.C; a transcript is in the Veteran's record. In September 2020, the case was remanded for additional development. An interim (December 2020) rating decision, inter alia, assigned a total (schedular post-TKR) rating from October 19, 2020 to December 1, 2021. Therefore, that period is not for consideration. Entitlement to increase in the combined staged rating assigned for a (now post-TKR) left knee disability The Board remanded this matter in September 2020 to obtain outstanding pertinent private treatment records, particularly those from Hampton Roads Orthopaedics Spine & Sports Medicine group (HROSM), which had suggested a left TKR may be necessary. The Board also noted that the most recent examination to assess the severity of the left knee disability was in March 2020, and directed that if records obtained on remand suggested or showed a worsening since March 2020, another examination would be necessary. In late-October 2020, the Veteran's representative notified VA that the Veteran underwent left TKR surgery on October 19, 2020; he submitted the surgical report and one follow-up treatment record from November 2020. This is evidence of a material change in the condition of his left knee disability, necessitating reexamination. 38 C.F.R. § 3.327. Notably, the records currently associated with the file show he was scheduled for additional follow-up visits at HROSM, and was referred for physical therapy at Glasson Sports Medicine. See November 6, 2020 VA treatment record. Follow-up records from HROSM and PT records from Glasson Sports Medicine have not been sought (or submitted by the Veteran), and should be secured (with the Veteran's assistance in providing authorizations for such) on, as they may shed additional light on the status of the left knee disability, particularly post-surgery. The matter is REMANDED for the following: 1. Secure for the record complete, updated and outstanding (any not already in the record) clinical records of all VA evaluations or treatment the Veteran has received for his left knee disability, including any non-VA treatment records scanned into Vista. 2. Also ask the Veteran to provide identifying information (and authorizations for VA to obtain records) of all private evaluations or treatment he has received for his left knee disability (records of which are not already in the record), including specifically records from HROSM and Glasson Sports Medicine. If a private provider does not respond to an AOJ request for identified records sought, the Veteran must be so notified, and reminded that ultimately it is his responsibility to ensure that pertinent private treatment records are received. Obtain all records identified. 3. When the development requested above is completed, arrange for an orthopedic examination of the Veteran to assess the nature and severity of is now post-TKR left knee disability. The Veteran's record (to include this remand and all records received pursuant to the development sought above) must be reviewed by the examiner in conjunction with the examination. All findings should be described in detail. The findings must include range of motion studies for findings of functional limitations due to pain on both active and passive motion and in weight-bearing and non-weight-bearing. [If the left knee cannot be tested on "weight-bearing," the examiner must explain why that is so.] Considering the Veteran's reported history, describe any functional impairment of the Veteran's left knee due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. If such opinion cannot be provided without resort to mere speculation, indicate whether the need to speculate is caused by a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), by a deficiency in the record or the examiner (additional facts are required [if so indicating what further information is needed], or the examiner lacks requisite knowledge or training). Specifically indicate whether the left knee is ankylosed, and if so, identify the position of ankylosis; whether there is limitation of extension, and if so at what degree of extension; and whether there is malunion or nonunion of the tibia and fibula. Also opine whether the Veteran has severe painful motion or weakness in the left lower extremity, and comment on the nature and extent of the impact the knee disability has on occupational functioning. All opinions should include a detailed explanation of rationale, with citation to supporting clinical findings and medical principles (as deemed appropriate). GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Dupont, 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.