Citation Nr: 22010286 Decision Date: 02/23/22 Archive Date: 02/23/22 DOCKET NO. 19-24 033 DATE: February 23, 2022 REMANDED Entitlement to an evaluation in excess of 30 percent for service-connected left knee total replacement is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1981 to March 1984. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2017 decision. The Veteran presented testimony before the Board in February 2022. He testified that his left knee has worsened in severity since his VA examination in 2017. Notably, he stated that he has limited, painful motion and difficulty bending and climbing stairs. He further indicated that he took medication first thing in the morning to alleviate pain and at the end of the day he could barely walk. The Veteran should be provided another VA examination to ascertain the current severity of his service-connected left knee disability. See Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994). The Board notes that the regulations pertaining to musculoskeletal disabilities were amended, effective February 7, 2021. See 85 Fed. Reg. 76453 (Nov. 30, 2020, as corrected). As such, on remand, the claim should be considered under both the old and amended criteria. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination to evaluate the current level of severity of the left knee disability on appeal. A copy of this remand, the claims folder and all pertinent treatment records should be made available to the examiner for review, and review of such records should be noted in any subsequent report. a) The examiner is asked specifically to provide range of motion testing (ROM) for the left knee for active motion, passive motion, in both weight-bearing, and nonweight-bearing, as well as for the opposing joint. b) In addition, the examiner must discuss pain for ROM movements on active, passive, and repetitive use testing. The examiner is asked to address the following questions: For all ROM testing, if pain is noted, the EXACT POINT at which pain is FIRST NOTED must be specified. (i) Are any ROM movements painful on active, passive, and repetitive use testing? If yes, identify whether active, passive, and repetitive use; and, identify the EXACT point where pain starts NOT JUST the endpoints of motion. (ii) If yes (there are painful movements), does the pain contribute to functional loss or additional limitation of ROM? Please further describe the functional loss or additional limitation of ROM, to include noting the EXACT point at which pain STARTS. (iii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. c) In addition, the examiner must discuss pain when used in weight-bearing or in nonweight-bearing. The examiner is asked to address the following questions: (i) Is there pain when the joint is used in weight-bearing or nonweight-bearing? If yes, identify whether weight-bearing or nonweight-bearing. If yes (there is pain when used in weight-bearing or nonweight-bearing), does the pain contribute to functional loss or additional limitation of ROM? Please further describe these limitations. (ii) If no (the pain does not contribute to functional loss or additional limitation of ROM), explain why the pain does not contribute. (d) The examiner must review the claims file and elicit information regarding the severity, frequency, and duration of all symptoms during flare-ups and repeated use over time, and the degree of functional loss during flare-ups and/or repeated used over time. If possible, the examiner must assess the additional functional impairment on repeated use or during flare-ups in terms of the degree of additional range of motion loss, using lay observations specifically elicited from the Veteran unless deemed to lack credibility or be inconsistent with other evidence such as test results. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. (e) The examiner should also comment on whether there is any form of ankylosis and if NOT, whether there is the functional equivalent thereof, due to the inability to perform normal working movements of the body, including as due to pain. 2. The RO must review the VA examiner's report to ensure compliance with each of the Board's remand directives; and, if necessary, take corrective action regarding any deficiencies. 3. Thereafter, the claim should be considered under both the old and amended regulations pertaining to musculoskeletal disabilities. The RO should be mindful of the fact that it may only apply the new rating criteria for the knee from the effective date of the change in the Diagnostic Code -February 7, 2012. If upon completion of the above action, the claim remains denied, the matter must be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. L. Wallin, 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.