Citation Nr: 18149023 Decision Date: 11/08/18 Archive Date: 11/08/18 DOCKET NO. 18-08 932 DATE: November 8, 2018 REMANDED Entitlement to an initial rating in excess of 10 percent for a left knee disability is remanded. Entitlement to an initial rating in excess of 10 percent for asthma is remanded REASONS FOR REMAND The Veteran served on active duty in the U.S. Army from September 1986 to March 1987 and in the U.S. Marine Corps from May 1989 to March 2016. This matter is before the Board of Veterans' Appeals (Board) on appeal of a June 2016 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). 1. Entitlement to an initial rating in excess of 10 percent for a left knee disability The Veteran’s February 2018 VA Form 9 includes her assertion that her knee has worsened since a December 2015 VA examination was provided. She stated she was receiving suction cup therapy and contemplating additional surgery. Given that the Veteran’s statement indicates the service-connected left knee disability may have worsened since her last VA examination, a new examination is warranted on remand. See Snuffer v. Gober, 10 Vet. App. 400 (1997). 2. Entitlement to an initial rating in excess of 10 percent for asthma The Veteran claims entitlement to an initial rating in excess of 10 percent for asthma. A December 2015 VA respiratory conditions examination was provided to evaluate her asthma. The examiner noted a diagnosis of asthma from 1991. He indicated the Veteran used inhalation bronchodilator therapy on an intermittent basis and did not use anti-inflammatory medications or any other inhaled medications. The Veteran’s February 2018 VA Form 9 includes her statement that she uses “two different asthma inhalers.” December 2015 records document prescriptions for multiple asthma medications, including medications which may be anti-inflammatory. One medication is prescribed for daily use. Private treatment records from April 2016 and April 2018 document continuing prescriptions for a daily use asthma medication and prescriptions for medications which may be anti-inflammatory. The December 2015 VA respiratory conditions examination may be factually inaccurate. It is insufficient to determine the claim. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). A new VA examination is warranted. The matter is REMANDED for the following action: 1. Ask the Veteran to complete a VA Form 21-4142 for any medical provider or facility which may have records related to her claims. Make two requests for the authorized records from any provider or facility identified, unless it is clear after the first request that a second request would be futile. 2. Obtain the Veteran’s VA treatment records, if any, for the period from December 2015 to present. 3. Schedule the Veteran for a VA examination to determine the current nature and severity of her left knee disability. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The examiner should identify all left knee pathology found to be present. The examiner should conduct all indicated tests and studies, to include range of motion studies. The left knee should be tested in both active and passive motion, in weight-bearing and non-weight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 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 should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups she experiences, if any, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment she experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should 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). (Continued on the next page)   4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of her service-connected asthma. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. To the extent possible, the examiner should identify any symptoms and functional impairments due to asthma alone and discuss the effect of the Veteran’s service-connected asthma on any occupational functioning and activities of daily living. M. HYLAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Jeanne Celtnieks, Associate Counsel