Citation Nr: 18146366 Decision Date: 10/31/18 Archive Date: 10/31/18 DOCKET NO. 12-05 445 DATE: October 31, 2018 REMANDED Entitlement to an increased rating for residuals of left knee arthroscopy surgery, rated as 10 percent disabling prior to October 6, 2015; 20 percent disabling prior to October 6, 2017; and 30 percent thereafter (excluding periods of a temporary total rating, during which time a 100 percent evaluation is in effect) is remanded. Entitlement to an increased rating for left knee arthritis with limitation of flexion, rated as 10 percent disabling prior to October 6, 2017 and 20 percent thereafter is remanded. REASONS FOR REMAND The Veteran had active military service from May 1987 to January 1992. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. This appeal was before the Board in August 2017 at which time it was remanded for additional evidentiary development. As detailed below, additional remand is required. 1. Entitlement to an increased rating for residuals of left knee arthroscopy surgery, rated as 10 percent disabling prior to October 6, 2015; 20 percent disabling prior to October 6, 2017; and 30 percent thereafter is remanded. 2. Entitlement to an increased rating for left knee arthritis with limitation of flexion, rated as 10 percent disabling prior to October 6, 2017 and 20 percent thereafter is remanded. The Board observes that during VA examinations conducted in October 2015 and August 2016, the Veteran reported flare-ups of his left knee disabilities. However, the examiners did not estimate the additional limitation imposed by the flare-ups. Most recently, the Veteran was provided a VA examination in October 2017 where he again reported flare-ups of his left knee disabilities. The examiner initially indicated that the examination was conducted during a flare-up. He noted that pain, significantly limited functional ability with flare-ups. However, the examiner indicated that he was unable to describe such limitation in terms of range of motion as the Veteran was not examined during a flare-up. The Board finds that the VA examinations are inadequate to adjudicate the Veteran’s claims on appeal. In Sharp v. Shulkin, 29 Vet. App. 26, 33-34 (2017), the Court stated that the examiner should estimate a veteran’s functional loss due to flare-ups based on all the evidence of record-including the lay information or sufficiently explain why the examiner cannot do so. In this case, neither the October 2015 nor the 2016 VA examiners estimated functional loss due to flare-ups. While the October 2017 VA examiner indicated that the VA examination was conducted during a left knee flare-up, he subsequently reported that the examination was not conducted during a flare-up and therefore, did not provide an opinion regarding functional limitation during flare-ups. In light of the foregoing, an addendum opinion must be obtained on remand. The matters are REMANDED for the following action: 1. Forward the claims file to an appropriate clinician to obtain a retrospective medical opinion addressing the ranges of motion and additional functional impairment of the Veteran’s left knee disabilities during the October 2015, August 2016, and October 2017 VA examinations. An additional VA examination may be provided if deemed necessary. Specifically, the clinician must estimate any functional loss expressed in additional degrees of limited motion of the left knee during flare-ups and repeated use over time noted during the October 2015, August 2016, and October 2017 VA examinations. If the clinician cannot provide the above-requested opinion without resorting to speculation, he or she should state whether all procurable medical evidence had been considered, to specifically include the Veteran’s description as to the severity, frequency, duration of the flare-ups and his description as to the extent of functional loss during a flare-up and after repetitive use over time; whether the inability is due to the limits of medical community or the limits of the examiner’s medical knowledge; and whether there is additional evidence, which if obtained, would permit the opinion to be provided. (Continued on the next page)   A clear explanation for the VA medical opinion is required, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot respond without resorting to speculation, it should be explained why a response would be speculative. ERIC S. LEBOFF Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Jones, Counsel