Citation Nr: 21040631 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 16-40 527A DATE: July 6, 2021 REMANDED Entitlement to a rating in excess of 10 percent for right knee strain with degenerative arthritis is remanded. Entitlement to a rating in excess of 20 percent prior to December 18, 2011, and a rating in excess of 40 percent on and after December 18, 2011, for loss of use of the right foot with complete paralysis of the lateral popliteal nerve, foot drop, reflex sympathetic dystrophy, cavovarus and equinus contracture, ankle strain residuals, triple arthrodesis, and tendo-Achilles lengthening is remanded. Entitlement to a compensable rating prior to April 30, 2012, and in excess of 20 percent on and after for post-operative right foot dorsal, lateral, posterior, and anterior scar residuals is remanded. REASONS FOR REMAND The Veteran had active service from July 1981 to September 1981. 1. Entitlement to a rating in excess of 10 percent for right knee strain with degenerative arthritis is remanded. The report of a July 2020 knee examination conducted for the Department of Veterans Affairs (VA) states that the Veteran complained of severe right knee pain which was exacerbated by activity including walking and standing. On examination of the right knee, the Veteran exhibited a range of motion of 0 to 79 degrees; severe joint line pain; and pain with weight bearing and non weight bearing. The examiner commented that the "Veteran is unable to stand or walk for extended periods, no steep slopes or uneven terrain, no run/jump, limited climbing stairs but no ladders, no heavy lifting (nothing more than 20 lbs.), no bending/squatting/kneeling/crawling due to right knee strain with degenerative arthritis." The physician did not identify the degree at which the reported right knee pain was exhibited. Given that deficiency, the Board of Veterans' Appeals (Board) finds that the July 2020 examination report is of limited probative value. The Board observes that the Secretary of 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 Code 5003 addressing degenerative arthritis 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 Code 5003). 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 (1991). When VA obtain an evaluation, the evaluation must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). Therefore, the Board finds that further VA right knee evaluation is needed. Clinical documentation dated after May 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 a rating in excess of 20 percent prior to December 18, 2011, and a rating in excess of 40 percent on and after December 18, 2011, for loss of use of the right foot with complete paralysis of the lateral popliteal nerve, foot drop, reflex sympathetic dystrophy, cavovarus and equinus contracture, ankle strain residuals, triple arthrodesis, and tendo-Achilles lengthening and a compensable rating prior to April 30, 2012, and in excess of 20 percent on and after for post-operative right foot dorsal, lateral, posterior, and anterior scar residuals is remanded. The combined rating for disabilities of an extremity shall not exceed the rating for the amputation at the elective level, were amputation to be performed. For example, the combined ratings for disabilities below the knee shall not exceed the 40 percent evaluation, Diagnostic Code 5165. This 40 percent rating may be further combined with evaluation for disabilities above the knee but not to exceed the above the knee amputation elective level. Painful neuroma of a stump after amputation shall be assigned the evaluation for the elective site of reamputation. 38 C.F.R. § 4.68. In light of 38 C.F.R. § 4.68, the Board finds that the issues of increased ratings for the service connected right ankle, right foot, and scar disabilities are inextricably intertwined with issue of an increased rating for the service connected right knee being remanded and must also be remanded. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for each private healthcare provider who has treated the service-connected right knee, right ankle, right foot, and scar disabilities. 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 any VA treatment records not of record, to include those pertaining to treatment after May 2020. 3. Schedule the Veteran for a VA knee examination to assist in determining the nature and severity of the service connected 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 non weight bearing and passive and active motion of the right knee. The examiner should indicate the degree at which the Veteran experiences pain on motion of the right knee. (b) State whether there is any additional loss of right knee function due to painful motion, weakened motion, excess motion, fatigability, incoordination, or on flare up. (c) State whether there is any recurrent subluxation or lateral instability of the right knee and, if so, opine as to the severity. J. T. HUTCHESON Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Roya Bahrami, 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.