Citation Nr: 22018133 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 19-09 683 DATE: March 28, 2022 REMANDED Entitlement to a rating in excess of 10 percent for the period prior to January 14, 2021, and in excess of 40 percent for limitation of extension, 20 percent for limitation of flexion, and 10 percent for instability for the period from January 14, 2021, onward, for right knee strain is remanded. Entitlement to a rating in excess of 10 percent for the period prior to January 14, 2021, and in excess of 30 percent for limitation of extension, 20 percent for limitation of flexion, and 10 percent for instability for the period from January 14, 2021, onward, for left knee strain is remanded. REASONS FOR REMAND The Veteran served on active duty from January to February 2003. He served in the U.S. Army. The Board thanks the Veteran for his service to our country. The Veteran testified before the undersigned at a Board videoconference hearing in May 2020. A transcript of the hearing is of record. In a December 2021 rating decision, the agency of original jurisdiction assigned ratings of 20 percent for limitation of flexion of each knee as well as separate ratings of 40 percent and 30 percent for limitation of extension of the right and left knees and 10 percent for instability of each knee. 1. Entitlement to a rating in excess of 10 percent for the period prior to January 14, 2021, and a combined rating of 60 percent (40 percent for limitation of extension, 20 percent for limitation of flexion, and 10 percent for instability) for the period from January 14, 2021, onward, for right knee strain is remanded. 2. Entitlement to a rating in excess of 10 percent for the period prior to January 14, 2021, and a combined rating of 50 percent (30 percent for limitation of extension, 20 percent for limitation of flexion, and 10 percent for instability) for the period from January 14, 2021, onward, for left knee strain is remanded. A remand is necessary as an addendum opinion as to the Veteran's functional limitations while discounting the ameliorative effects of medication is necessary. During the period on appeal, multiple VA examination reports showed pain on flexion and/or extension of both knees. In an August 2018 VA examination report, the Veteran reported taking Motrin twice daily and Tramadol daily and in a January 2019 VA examination report, he reported taking Ibuprofen and Tramadol once daily. At the May 2020 hearing, he testified taking a higher dosage of medication to treat his pain and receiving injections for knee pain since approximately 2019. In an April 2021 note, he reported receiving steroid injections a year before which helped drastically. Accordingly, a remand is necessary to assess the severity of his left and right knee disabilities while discounting the ameliorative effects of medication. The matters are REMANDED for the following action: 1. Please secure for the record copies of complete updated clinical records (any not already of record) of all VA and non-VA treatment the Veteran has received for the disabilities on appeal. Please ask the Veteran to provide the releases necessary for VA to secure private treatment records. 2. After the action requested in paragraph 1 above is complete, please refer the claims to a clinician for addendum opinions as to the severity of the left and right knee disabilities. The Veteran's claims-file must be made available to and reviewed by the clinician. (a.) The clinician is specifically requested to indicate the severity of the right knee disability during the period on appeal when discounting the ameliorative effects of medication, including range of motion. (b.) The clinician is specifically requested to indicate the severity of the left knee disability during the period on appeal when discounting the ameliorative effects of medication, including range of motion. (c.) Please opine as to whether symptoms of the Veteran's service connected left knee strain may be distinguished from left knee arthritis or any other left knee disorders and, if so, which are manifestations of the service connected left knee strain. ONLY IF the clinician determines that an examination is necessary for the addendum opinion, the Veteran should be scheduled for an appropriate VA examination to determine the severity of the disorder. The clinician must explain the rationale for all opinions in detail, citing to supporting clinical data and/or medical literature, as appropriate. The clinician should take into consideration that the Veteran is competent to report in service and post-service symptom experiences; other witnesses are competent to report observable symptoms. If the clinician cannot provide an opinion without resorting to speculation, the clinician should provide an explanation as to why this is so and note what, if any, additional evidence would permit such an opinion to be made. The Board is not permitted to accept a rationale that the clinician or examiner is unable to offer an opinion without resort to speculation based on an aversion to offering an opinion on issues not directly observed. M. C. GRAHAM Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Vashaw, Associate 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.