Citation Nr: 18150053 Decision Date: 11/14/18 Archive Date: 11/14/18 DOCKET NO. 16-27 805 DATE: November 14, 2018 REMANDED Entitlement to a disability rating in excess of 10 percent for right knee limitation of extension, prior to May 1, 2017. REASONS FOR REMAND The Veteran had active service from September 1981 to January 1985. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2013 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO) in Waco, Texas, that denied entitlement to a disability rating in excess of 30 percent for right knee degenerative joint disease under Diagnostic Code (DC) 5257 and awarded a separate 10 percent rating for right knee limitation of extension under DC 5261, effective February 7, 2013. On his June 2016 VA Form 9, the Veteran indicated he was only appealing the issue of entitlement to a higher evaluation for limitation of extension of his right knee. On May 1, 2017, the Veteran underwent a total right knee replacement. Accordingly, the RO recharacterized his disability as right knee, status post total knee arthroplasty, and awarded him a 100 percent temporary total rating under 38 C.F.R. § 4.30 from May 1, 2017, to June 30, 2017, followed by a 100 percent schedular rating from July 1, 2017, to June 30, 2018, and a 60 percent rating from July 1, 2018, forward under DC 5055. A 60 percent rating under DC 5055 is the maximum rating available following the expiration of the one-year period after implantation of a knee prosthesis. As such, the issue had been phrased accordingly on the title page. A retrospective medical opinion is necessary to capture the severity of the Veteran's left knee limitation of motion from February 2013 to May 2017. See Chotta v. Peake, 22 Vet. App. 80 (2008) (when there is an absence of medical evidence during a certain period of time, a retroactive medical evaluation may be warranted). Sharp requires VA examiners to obtain information from the Veteran as to the severity, frequency, and duration of flare-ups, as well as precipitating and alleviating factors, and the extent of functional impairment. It also requires that VA examiners estimate the additional loss of range of motion during a flare-up based on all procurable information from the record, as well as the Veteran’s own statements. If an estimate cannot be provided without resorting to speculation, it must be clear whether this is due to a lack of knowledge among the medical community at large, or insufficient knowledge of the specific examiner. The Board notes a September 2014 examination report noted the Veteran did not report any flare-ups, but also commented the Veteran reported constant pain. For repeated use, the examiner commented, “additional pain on use but no additional loss of ROM.” Consequently, no additional loss of motion measurements were provided in the report for flare-ups or repeated use. On remand, a longitudinal review of the lay and medical evidence should be accomplished in providing an opinion, as described below. The matter is REMANDED for the following action: Arrange for an appropriate VA examiner to review the Veteran’s file. The examiner should provide a retrospective opinion, as best as can be ascertained from the Veteran's self-reports as well as from clinical records and other evidence, for the time period from February 2013 to May 2017. With respect to the Veteran’s right knee, the examiner is asked to provide an opinion estimating any additional degrees of limited motion (flexion and extension) 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). The examiner should provide a complete rationale for all opinions expressed. P. M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Denton, Buck