12-34 039
12-34 039
| Board of Vet. App. | Nov 30, 2017Background
- Veteran (Marine Corps, 1987–1990) appealed VA RO rating decisions concerning bilateral knee disability; travel Board hearing held March 2015.
- Service-connected diagnoses: right and left knee patellofemoral syndrome, each rated 10% for painful motion; claimed additional separate compensable disability for recurrent patellar subluxation and higher ratings for patellofemoral syndrome.
- Medical records (2011–2016) include imaging showing mild bilateral patellar subluxation, repeated PT notes of hypermobile patella, reports of popping/dislocation sensations, orthopedic consult noting degenerative cartilage/chondromalacia, and use of braces/cane.
- VA examiners (2012, 2014, 2016) inconsistently recorded history of patellar subluxation; 2016 exam documented limited ROM, pain with weight-bearing, flare-ups, inability to complete repetitive testing, and edema/crepitus but omitted some required detail on pain in active/passive and non-weight-bearing testing.
- Board found preponderance of evidence supports bilateral recurrent patellar subluxation and granted separate compensable evaluations for recurrent subluxation of each knee, but remanded the increased-evaluation claims for patellofemoral syndrome for further development due to inadequate/contradictory exam information.
Issues
| Issue | Plaintiff's Argument | Defendant's Argument | Held |
|---|---|---|---|
| 1. Entitlement to >10% for right knee patellofemoral syndrome | Right knee causes greater functional loss, flare-ups, and limits ROM beyond current rating | VA relied on existing exams; no demonstration of criteria for higher rating | REMANDED for new VA exam/opinion (development needed) |
| 2. Entitlement to >10% for left knee patellofemoral syndrome | Left knee causes greater functional loss/flare-ups warranting higher rating | VA contends current record doesn’t meet higher criteria | REMANDED for new VA exam/opinion (development needed) |
| 3. Separate compensable evaluation for other impairment — right knee (recurrent patellar subluxation) | Recurrent subluxation is additional, non-overlapping symptomatology meriting separate rating | VA examiners had sometimes denied history of subluxation despite imaging and lay reports | GRANTED — separate evaluation for recurrent right patellar subluxation awarded |
| 4. Separate compensable evaluation for other impairment — left knee (recurrent patellar subluxation) | Same as right knee: objective imaging and symptoms support separate pathology | VA examiners’ conclusions conflicted with imaging and PT findings | GRANTED — separate evaluation for recurrent left patellar subluxation awarded |
Key Cases Cited
- Scott v. McDonald, 789 F.3d 1375 (Fed. Cir.) (filings must be liberally read but Board need not address unraised procedural arguments)
- Dickens v. McDonald, 814 F.3d 1359 (Fed. Cir.) (Scott applied to duty-to-assist arguments)
- Bryant v. Shinseki, 23 Vet. App. 488 (Vet. App.) (requirements for Board hearing officers)
- Esteban v. Brown, 6 Vet. App. 259 (Vet. App.) (separate ratings allowed where symptomatology is non-duplicative)
- Barr v. Nicholson, 21 Vet. App. 303 (Vet. App.) (VA must ensure adequacy of exams/opinions it obtains)
- Stefl v. Nicholson, 21 Vet. App. 120 (Vet. App.) (examination adequacy requires consideration of prior medical history and sufficient detail for Board evaluation)
- Correia v. McDonald, 28 Vet. App. 158 (Vet. App.) (requirements for musculoskeletal examinations, including weight-bearing/non-weight-bearing testing)
- Sharp v. Shulkin, 29 Vet. App. 26 (Vet. App.) (examiners may base flare-up opinions on estimates informed by lay statements)
- Stegall v. West, 11 Vet. App. 268 (Vet. App.) (AOJ must ensure compliance with Board remand directives)