11-21 152, 11-21 152

Veteran served on active duty from June 1968 to April 1972 and appealed VA RO decisions continuing 10% ratings for chondromalacia of each knee.
Board previously remanded claims and in April 2015 awarded separate 10% ratings for left and right knee lateral instability; ratings in excess of 10% for chondromalacia and instability remain on appeal.
Veteran had a VA knee examination in March 2016 documenting ROM: right 0–110°, left 0–120°, with pain on flexion, groaning, and pain with weight bearing; examiner noted additional limitation after repetitive testing but did not quantify degree where pain began.
Examiner declined to provide degree-based estimates for additional ROM loss during pain or flare-ups, calling such estimates speculative, and did not fully address Veteran’s reports of limitations during flare-ups.
Board found the March 2016 examination inadequate under Mitchell because it failed to express additional limitation (from pain, weakened movement, fatigability, incoordination, or flare-ups) in degrees and did not adequately reconcile patient-reported flare-up limitations.
Board remanded for a new VA examination to record exact ROM, specify degree at which pain begins, quantify additional ROM loss from pain/flare-ups in degrees, document Veteran’s flare-up statements and reasons to reject them if any, and to re-adjudicate instability issues at the RO.

Issue	Plaintiff's Argument	Defendant's Argument	Held
Whether ratings in excess of 10% are warranted for right knee chondromalacia	Veteran asserts greater functional loss from pain and flare-ups warrants higher rating	RO relied on March 2016 exam which did not quantify flare-up limitations and denied increased rating	Remanded for a new, adequate exam quantifying ROM and flare-up effects in degrees
Whether ratings in excess of 10% are warranted for left knee chondromalacia	Same as right knee	Same as right knee	Remanded for a new, adequate exam quantifying ROM and flare-up effects in degrees
Whether ratings in excess of 10% are warranted for right knee lateral instability	Veteran seeks higher rating based on functional loss	RO did not readjudicate instability after development	Remanded for RO readjudication and supplementation if benefits remain denied
Whether ratings in excess of 10% are warranted for left knee lateral instability	Same as right instability	Same as right instability	Remanded for RO readjudication and supplementation if benefits remain denied

Mitchell v. Shinseki, 25 Vet. App. 32 (2011) (examination must address additional ROM loss from pain, weakness, fatigability, incoordination, and flare‑ups and quantify in degrees when possible)
Kutscherousky v. West, 12 Vet. App. 369 (1999) (veteran may submit additional evidence and argument after remand)