Citation Nr: 18140199 Decision Date: 10/02/18 Archive Date: 10/02/18 DOCKET NO. 10-30 066 DATE: October 2, 2018 REMANDED Entitlement to a rating in excess of 10 percent for limitation of motion of the left knee is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1972 to October 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In February 2015, the Veteran testified before the undersigned at a Board hearing in Winston-Salem, North Carolina. A transcript of that hearing has been associated with the virtual file and reviewed. This case was previously before the Board in July 2015, at which time it was remanded for further development. In June 2017, the Board denied a rating in excess of 10 percent based on limitation of the left knee, but assigned a separate 10 percent rating for the left knee based on instability. The Veteran appealed the Board’s June 2017 decision to the United States Court of Appeals for Veterans Claims (Court). In May 2018 the Court issued an order granting a Joint Motion for Partial Remand (JMPR), and vacated the decision to the extent it denied a rating in excess of 10 percent based on limitation of motion of the left knee. The parties explicitly acknowledged that the Veteran was not challenging the denial of a rating in excess of 10 percent for left knee instability and the Court dismissed that issue. The Board acknowledges that in June 2017 it also remanded the claims of entitlement to an increased rating for a back disability and total disability based on individual unemployability (TDIU). Those claims are currently being developed by the Agency of Original Jurisdiction (AOJ) in compliance with the June 2017 Remand directives and are not before the Board at this time. Entitlement to a rating in excess of 10 percent for limitation of motion of the left knee is remanded. A July 2016 VA examination is inadequate because the Board is unable to determine whether the examiner’s inability to offer an opinion as to whether pain, fatigue, weakness, and/or instability significantly limit range of motion of the left knee during flare-ups and/or after repetitive use over time is due to a deficiency in the examiner, as opposed to in the knowledge of the medical community more generally. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017); see also June 2017 Joint Motion for Partial Remand. The matter is REMANDED for the following actions: 1. Obtain the Veteran’s VA treatment records for the period from October 2016 to the present. 2. After completing directive #1, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability. Range of motion should be reported, including whether and the extent to which such motion is affected by pain, weakness, fatigue, lack of endurance, incoordination or other symptoms resulting in functional loss. (a.) Based upon a review of the medical records, lay statements submitted in support of the claim, and/or statements elicited from the Veteran during the examination, state whether the Veteran experiences flare ups of his service-connected left knee disability, and how he or she characterizes the additional functional loss during a flare. (b.) If the Veteran describes experiencing flare ups, identify the: o frequency; o duration; o precipitating factors; and o alleviating factors. (c.) Based upon the information elicited as a result of the foregoing, please assess the extent of any additional functional loss during flare-ups and describe it in terms of degrees of range of motion. (d.) To the extent possible, the examiner should identify any symptoms and functional impairments due to the left knee disability alone and discuss the effect of the Veteran’s left knee disability on any occupational functioning and activities of daily living. If the examiner cannot provide the requested calculation without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner’s lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J.A. Gelber, Associate Counsel