Citation Nr: 18151219 Decision Date: 11/16/18 Archive Date: 11/16/18 DOCKET NO. 16-45 407 DATE: November 16, 2018 REMANDED Entitlement to a disability rating in excess of 10 percent for residuals of a left knee injury, status post-surgical repair, is remanded. Entitlement to a disability rating in excess of 10 percent for left knee instability, is remanded. Entitlement to a disability rating in excess of 20 percent for right knee strain is remanded. REASONS FOR REMAND The Veteran had active service from June 1980 to December 1981. These matters come to the Board on appeal from a March 2015 rating decision. 1. Entitlement to a disability rating in excess of 10 percent for residuals of a left knee injury, status post-surgical repair, is remanded. 2. Entitlement to a disability rating in excess of 20 percent for right knee strain is remanded. The Veteran attended a VA examination in May 2016 to determine the severity of her left and right knee disabilities. There, the examiner indicated that with regard to the impact of flare-ups and repetitive use over time, both caused functional loss bilaterally due to pain, fatigue and lack of endurance. With regard to both knees, the examiner stated that the examination was neither medically consistent or inconsistent with the Veteran’s statements describing functional loss during flare-ups and repetitive use over time. The examiner stated that he was unable to express functional loss in terms of range of motion, and his rationale was “no change on exam, medial and lateral pain limit walking and squatting.” The Board finds the May 2016 examination and opinion inadequate for decision making purposes. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). The Board is unclear what is meant by “no change on exam” as the Veteran was not examined after a period of repetitive use over time or during a flare-up. Further, the record does not reflect the examiner attempted to elicit sufficient information from the record or the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups or during repeated use with respect to the right knee and left knee. Sharp v. Shulkin, 29 Vet. App. 26, 29, 2017 U.S. App. Vet. LEXIS 1266 (Sept. 6, 2017). In addition, with regard to the Veteran’s right knee evaluation, the examiner noted that the Veteran had arthroscopic surgery in 2014. However, the record indicates that the Veteran had surgery on her right knee in March of 2015. The Board also notes that records relating to that surgery have not been obtained by the VA. An opinion based upon an inaccurate factual premise has no probative value. Reonal v. Brown, 5 Vet. App. 458, 461 (1993). As such, the Board must coordinate with the Veteran to obtain the treatment records for the 2015 right knee surgery, and an addendum opinion is necessary. 3. Entitlement to a disability rating in excess of 10 percent for left knee instability, is remanded. With regard to the issue of a higher rating for the Veteran’s left knee instability, the Board finds that the issue is inextricably intertwined with the issues remanded above. A new examination or opinion of the left knee has a high probability of yielding additional relevant evidence related to the level of instability. As such, adjudication of the matter will be deferred until completion of the action requested in the remand orders below. The matters are REMANDED for the following action: 1. In coordination with the Veteran, obtain the private treatment records that document the Veteran’s March 2015 knee surgery. If any records cannot be obtained after reasonable efforts have been made, notify the Veteran and allow her the opportunity to provide such records, as provided in 38 U.S.C. § 5103A (b)(2) and 38 C.F.R. § 3.159 (e). All attempts to obtain the records must be documented in the record. 2. Schedule the Veteran for a VA examination to determine the current nature and severity of the service-connected right and left knee disabilities at issue. Provide a copy of the record and a copy of this Remand to the examiner who conducted the May 2016 VA knee examinations, or, if that examiner is unavailable, to another suitably qualified examiner, for completion of an addendum opinion. The examiner must review the record, to include all evidence received since the last examination. The examiner must note such review. All indicated tests must be provided, to include active and passive range of motion findings, in degrees, on weight bearing and nonweight bearing, with pain. Upon review of the record and examination findings, the examiner must provide an opinion as to whether pain, weakness, fatigability or incoordination, associated with the Veteran’s left knee and right knee disabilities, significantly limits functional ability during flare-ups or during periods of repeated use, noting the degree of additional range of motion loss due to pain, weakness, fatigability or incoordination on repeated use or during flare-ups. If this is not feasible to determine without resort to speculation, the examiner must provide an explanation for why this is so, to include eliciting information from the record and/or the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups of the left knee and right knee disabilities. Additionally, the examiner must indicate whether any inability to furnish such an estimate is predicated on a lack of medical knowledge among the medical community at large, or insufficient knowledge by the individual examiner. A complete rationale for all conclusions reached and opinions expressed must be provided. 3. After undertaking any other development deemed appropriate, to include additional VA examinations if warranted based on any new evidence received, readjudicate the issues on appeal. If any benefit sought is not granted, furnish the Veteran with a supplemental   statement of the case and afford her an opportunity to respond before the record is returned to the Board for further review. U. R. POWELL Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Baker, Associate Counsel