Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral syndrome is remanded.

Citation Nr: 26001452 Decision Date: 01/30/26 Archive Date: 01/30/26 DOCKET NO. 11-22 115 DATE: January 30, 2026 REMANDED Entitlement to an initial rating in excess of 10 percent for right knee patellofemoral syndrome is remanded. Entitlement to an initial evaluation in excess of 10 percent prior to August 12, 2013, an evaluation in excess of 20 percent from October 1, 2013 to October 26, 2016, an evaluation in excess of 20 percent from December 1, 2016 to September 20, 2017, and an evaluation in excess of 30 percent from November 1, 2018 for left knee replacement (previously rated as degenerative joint disease (DJD) of the left knee with degenerative medial meniscus and synovitis of all three compartments (previously characterized as left knee chondromalacia patella)) is remanded. REASONS FOR REMAND The Veteran served on active duty from December 12, 2008 to December 14, 2008, and from February 2009 to December 2009. This matter is before the Board of Veterans' Appeals (Board) on appeal from a June 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In August 2017, a hearing was held before the undersigned. A transcript of the hearing is of record. In April 2018, the Board issued a decision, in pertinent part, granting a separate 10 percent rating for right knee patellofemoral syndrome based on limitation of extension and denying a higher rating for right knee patellofemoral syndrome. The Veteran appealed the Board's decision to the United States Court of Appeals for Veterans Claims (Court). The Board decision also remanded the issue of an increased rating for left knee replacement. In a January 2019 order, the Court vacated the April 2018 decision, in relevant part, as it pertained to the denial of an increased rating for right knee patellofemoral syndrome and remanded the matter to the Board for further proceedings consistent with a Joint Motion for Partial Remand (JMPR). The issue of entitlement to an increased rating for the left knee was again before the Board in April 2020 when it was remanded for further development. All issues were previously before the Board in April 2022, December 2022, August 2023, April 2024, September 2024, and May 2025 when they were remanded for further development. The Board acknowledges that this claim has been remanded numerous times since the issuance of the JMPR. Unfortunately, because there was not substantial compliance with the Board's previous remand directives and another remand is needed. Stegall v. West, 11 Vet. App. 268 (1998). The May 2025 remand directed that the Veteran be afforded a VA examination to determine the current severity of the service-connected right knee patellofemoral syndrome and left knee replacement. The remand specifically indicated that the AOJ provide the Veteran with at least three weeks' written notice of the date, time, and location of the examination. If the Veteran did not report for the examination, then the claims file was to be forwarded to a qualified VA clinician for an addendum medical opinion, as the previous January 2025 retrospective opinion was inadequate. The record reflects that on June 4, 2025, the Veteran was sent a letter indicating that an examination was requested and that she would soon be advised of the date, time, and place of the examination. Records indicate that on June 16, 2025, it was noted that the Veteran failed to appear for the examinations. On June 23, 2025, the Veteran was sent another letter indicating that an examination was requested and that she would soon be advised of the date, time, and place of the examination. Records indicate that on July 11, 2025, the examination was cancelled because they were unable to contact the Veteran. Records from the facility where the examination was scheduled indicated that the examination was scheduled for July 7, 2025. It does not appear that examinations were scheduled with three weeks' written notice to the Veteran of the date, time, and place. In addition, the Veteran sent a correspondence in August 2025, where she asked to have the examination rescheduled to at least three weeks out and to be scheduled with a female provider. Also, despite the Veteran not having appeared for an examination, no addendum medical opinion was obtained as directed in the May 2025 remand. Consequently, while the Board sincerely regrets the additional delay in adjudicating this matter, another remand consistent with the directives herein is again necessary pursuant to Stegall v. West, 11 Vet. App. 268, 271 (1998). The matters are REMANDED for the following action: 1. Obtain the Veteran's VA treatment records for the period from October 2019 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of the service-connected right knee patellofemoral syndrome and left knee replacement. **Provide the Veteran with at least three weeks written notice of the date, time, and location of the examination and schedule the examination with a female clinician as requested by the Veteran.** a) The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran's disabilities under the rating criteria. In so doing, the examiner must test the Veteran's active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. b) The examiner is also asked to provide a retrospective opinion regarding the frequency, severity, and duration of flare ups of the Veteran's right knee disability. In so doing, the clinician is asked to describe the Veteran's additional functional loss, expressed in terms of additional limitation of motion (in degrees), if any, experienced during flare-ups and after repeated use over time for the entire period on appeal (beginning in January 2010), based on other evidence of record and the Veteran's statements. In responding to these questions, the examiner must ensure that any measurements provided, or functional impairment discussed, including based on impairment due to flare-ups and after repeated use over time, do not consider the ameliorative effects of any medication the Veteran takes or receives for her knees. In other words, the findings should be made using the Veteran's baseline level of disability without consideration of the relief afforded by medication or the beneficial effects of medication. If it is not possible to provide a specific measurement 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. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. If the Veteran does not report for the examination, then the Veteran's claims file should be forwarded to a qualified VA clinician for an addendum medical opinion. The clinician must be given the entire claims file for review. The clinician is asked to provide a retrospective opinion regarding the frequency, severity, and duration of flare ups of the Veteran's right knee disability. In so doing, the clinician is asked to describe the Veteran's additional functional loss, expressed in terms of additional limitation of motion (in degrees), if any, experienced during flare-ups and after repeated use over time for the entire period on appeal (beginning in January 2010), based on other evidence of record and the Veteran's statements. In responding to these questions, the examiner must ensure that any measurements provided, or functional impairment discussed, including based on impairment due to flare-ups and after repeated use over time, do not consider the ameliorative effects of any medication the Veteran takes or receives for her knees. In other words, the findings should be made using the Veteran's baseline level of disability without consideration of the relief afforded by medication or the beneficial effects of medication. If it is not possible to provide a specific measurement 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. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Yoon, 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.