Citation Nr: 18139962 Decision Date: 10/01/18 Archive Date: 10/01/18 DOCKET NO. 16-15 449 DATE: October 1, 2018 REMANDED The claim of entitlement to a compensable disability rating for right knee chondromalacia is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from February 1997 to February 2000. The Veteran is a Gulf War Era Veteran. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a July 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. The appeal is REMANDED to the Agency of Original Jurisdiction. VA will notify the Veteran if further action is required. Entitlement to a compensable disability rating for right knee chondromalacia is remanded. The VA must provide an examination when the evidence shows: (1) A current disability; (2) an in-service event, injury, or disease; (3) some indication that the claimed disability may be associated with the established event, injury, or disease, and (4) insufficient competent evidence of record for the VA to make a decision. See McLendon v. Nicholson, 20 Vet. App. 79 (2006). Once VA decides that it is appropriate to provide a VA examination, it must be an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). VA’s duty to assist includes providing a thorough and contemporaneous medical examination, especially where it is necessary to determine the current level of severity of a disability. Peters v. Brown, 6 Vet. App. 540, 542 (1994). The Board notes that the Veteran was last afforded a VA examination to assess the severity of his right knee chondromalacia in July 2014. The VA examiner performed range of motion testing of the right knee, reporting that there was no difference in range of motion measurements between active and passive range of motion. The examiner further noted that there was no objective evidence of painful range of motion. Repetitive testing did not limit the Veteran’s range of motion. The examiner stated that the Veteran did not report flare-ups. Later in the evaluation, the examiner stated: “As the [V]eteran is not having a flare up today, it would only be speculative to report additional range of motion [sic] loss and whether pain, weakness, fatigability, or incoordination could significantly limit functional ability during flare-ups, or when the joint is used repeatedly over a period of time.” The Board finds this evaluation inadequate for a number of reasons. First, the examination was internally inconsistent. The examiner stated that the Veteran did not report any flare-ups. However, later in the examination, he stated that it would be merely speculative to opine as to the specific range of motion loss or other limits present during a flare-up, implying that the Veteran does experience flare-ups. Moreover, to be considered adequate, an examiner must fully explain why a finding must be purely speculative, and not merely assert such as a conclusory finding. See Jones v. Shinseki, 23 Vet. App. 382 (2010). The Board, additionally, finds that this decision is inadequate as it did not consider the effects of weight-bearing and nonweight-bearing on the pain and quality of motion of the right knee, nor were specific range of motion measurements of the left knee considered. To be considered adequate, all of the aforementioned measures should be considered in an examination to address disability ratings, including assertion of an increase thereof. 38 C.F.R. § 4.59 (2017); Correia v. McDonald, 28 Vet. App. 158 (2016). Given the above, the Board finds that the Veteran’s July 2014 VA examination is inadequate to adjudicate this claim and finds that a new VA examination should be scheduled upon remand. Moreover, since the July 2014 examination, the record reflects that the Veteran’s right knee may have increased in severity. Specifically, in September 2014, a magnetic resonance imaging scan was performed on the right knee by the VA. This scan revealed that the Veteran’s right knee had a torn medial meniscus and medial compartment osteoarthritis. The July 2014 VA examination found that the Veteran had no meniscal involvement of the right knee and that there was no radiographic evidence that indicated right knee osteoarthritis. The Board notes that a new examination is appropriate when there is evidence of an increase in severity since the last examination. Therefore, the Veteran should be afforded another examination on remand. See 38 C.F.R. § 3.159 (2017); see also Barr, 21 Vet. App. at 312; Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007); Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). The matter is REMANDED for the following action: 1. Appropriate efforts should be made to obtain and associate with this case file any outstanding VA medical records and all outstanding private treatment records, with all necessary assistance from the Veteran. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file, and if, after making reasonable efforts to obtain named records, they are not able to be secured, provide the required notice and opportunity to respond to the Veteran and his representative. 2. The Veteran should be scheduled for a VA examination before an appropriate examiner to determine the current severity of his service-connected right knee disability. The Veteran's claims file and a copy of this remand should be provided to the examiner and the examination report should reflect that these items were reviewed. The examiner is asked to perform all indicated tests and studies and to provide an opinion as to the following: (a.) The examiner should make specific findings as to whether, during the examination, there is objective evidence of pain on motion, weakness, excess fatigability, or incoordination associated with the use of the right knee. If pain on motion is observed, the examiner should indicate the point at which pain begins. In addition, the examiner should indicate whether, and to what extent, the Veteran experiences functional loss of the right knee due to pain or any of the other symptoms listed above during flare-ups or with repeated use. To the extent possible, the examiner should express any additional functional loss in terms of additional degrees of limited motion. (b.) Additionally, the examiner must test the range of motion in active motion, passive motion, and (where appropriate) weight-bearing and nonweight-bearing settings for both knees. 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 must clearly explain why that is so. A full rationale must be provided for any opinion offered. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). Jones, 23 Vet. App. at 382. B. MULLINS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. E. Trotter, Associate Counsel