Citation Nr: 22015407 Decision Date: 03/17/22 Archive Date: 03/17/22 DOCKET NO. 16-01 924 DATE: March 17, 2022 REMANDED Entitlement to an initial rating in excess of 10 percent for a right knee disability manifested by limitation of flexion is remanded. Entitlement to an initial compensable rating for a right knee disability manifested by limitation of extension is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1988 to July 1996. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which granted service connection for a right knee strain and assigned a noncompensable rating, effective August 11, 2008. In January 2015, the Board remanded the appeal for further development. In a May 2015 rating decision, the RO increased the rating for the Veteran's right knee limited flexion rating to 10 percent, effective May 2, 2015. In October 2014 and January 2019, the Veteran testified during Board hearings before the undersigned Veterans Law Judge. In November 2019, the Board again remanded the appeal for further development. In an October 2020 rating decision, the RO extended the 10 percent rating for right knee strain with limitation of flexion to August 11, 2008 and granted service connection for right knee strain with limitation of extension and assigned a noncompensable rating, effective October 6, 2020. In a May 2021 Appellate Brief, the Veteran's representative argued that the effective date for both flexion and extension should cover the entirety of the applicable appeal period, or from August 11, 2008. The Board agreed in its July 2021 remand. In a November 2021 rating decision, the RO implemented an effective date of August 11, 2008, for right knee strain with limitation of extension. The Board regrets additional delay, but another remand is necessary to afford the Veteran an examination that considers the recent amended regulatory criteria addressing knee disabilities and adequately addresses the Veteran's reported episodic flare-ups. See June 2009 VA examination report. Any outstanding records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for an examination to determine the current nature and severity of his right knee disability. The claims file should be made available to and be reviewed by the examiner. All findings should be reported in detail. (a). The examiner should conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested for pain (1) on active motion, (2) on passive motion, (3) in weight-bearing, (4) in nonweight-bearing, and (5) with range of motion of the opposite undamaged joint. For each range of motion study conducted, the examiner must state where in the range of motion the Veteran reports that he begins to experience pain. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (b). Please also provide an opinion describing functional impairment of the Veteran's right knee disability due to flare-ups or when the joint is used repeatedly over a period of time, 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. Please do not state the Veteran does not endorse flare-ups, as he has done so during the appeal period. See June 2009 VA examination report. If the examiner is unable to provide such an opinion without resort to speculation, the examiner must provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician's Guide to estimate, "per [the] veteran," what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. It is not necessary for the examiner to provide an exact measurement of range of motion when describing functional loss, and an estimate is appropriate if measurements cannot be taken. (c.) Please comment on whether the Veteran's right knee disability has been manifested by ankylosis at any point since August 2008, specifically considering the contradictory findings in this regard in the May 2015 VA examination report. If the Veteran does not have ankylosis, please thoroughly explain why not. If there is ankylosis, the examiner should comment on its nature and severity. A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g. lack of sufficient information/evidence, the limits of medical knowledge, etc.). S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.