Citation Nr: 18153547 Decision Date: 11/28/18 Archive Date: 11/27/18 DOCKET NO. 08-11 019 DATE: November 28, 2018 REMANDED Entitlement to an initial rating in excess of 10 percent for a service-connected left knee disability is remanded. Entitlement to an initial rating in excess of 10 percent prior to February 24, 2014, and in excess of 20 percent thereafter for a service-connected left ankle disability also is remanded. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for a service-connected left knee disability is remanded. The Veteran is seeking an increased initial rating for his service-connected left knee disability. The Veteran’s claim was previously before the Board in May 2017 when it was remanded in order to obtain a new VA examination which included range of motion testing in both active and passive motion. In response to the May 2017 Board remand the Veteran was provided with a June 2017 VA examination. The examiner noted pain was increased with prolonged weightbearing. Left knee range of motion findings were taken and flexion was found to be 10 to 70 degrees with extension at 70 to 10 degrees. The examiner noted the Veteran was unable to complete the repetitive use test due to pain. In addition, a July 2017 addendum opinion was obtained which noted the Veteran experienced left knee pain with active and passive range of motion and during weightbearing and non-weightbearing. A February 2018 addendum opinion was also obtained. The opinion provider concluded that while the Veteran’s knee symptoms were increased during weightbearing and non-weightbearing it did not result in any difference in range of motion after repetitive use or during flare ups. The Board finds the July 2017 VA examination and subsequent addendum opinions to be inadequate. The May 2017 Board remand specifically asked that the examiner take range of motion findings in active and passive motion. However, the July 2017 VA examination only contains on set of range of motion findings. In addition, the July 2017 VA examiner noted that the Veteran was unable to perform range of motion testing following the repetitive use test, however, the February 2018 addendum opinion provider concluded that the Veteran’s range of motion was not limited following repetitive use. It is unclear how the opinion provider was unable to come to this conclusion without range of motion findings. Moreover, the examiner failed to provide sufficient information regarding the severity, frequency, and duration of the Veteran’s flare-ups. As such, the Veteran’s claim must be remanded in order to obtain an additional complete VA examination. In addition, the Veteran continues to receive treatment at a VA medical center. As such, any and all outstanding VA treatment records must be obtained on remand. 2. Entitlement to an initial rating in excess of 10 percent prior to February 24, 2014, and in excess of 20 percent thereafter for a service-connected left ankle disability is remanded. The Veteran is seeking an increased rating for his service-connected left ankle disability. The Veteran’s claim was previously before the Board in May 2017 when it was remanded in order to obtain a new VA examination which included range of motion testing in both active and passive motion. In response to the May 2017 Board remand a June 2017 VA examination was obtained. The examiner noted the Veteran had increased pain with weightbearing. Range of motion findings were noted to be 0 to 15 dorsal flexion and 0 to 30 for plantar flexion. The examiner noted that pain was noted during the examination but that it did not cause functional loss. The Veteran was unable to complete the repetitive use range of motion test due to pain. The examiner noted that the Veteran’s left ankle pain caused functional loss. The examiner concluded that the Veteran’s left ankle disability does did not limit her ability to perform any employment task. A December 2017 VA addendum opinion was obtained and noted that the Veteran experienced left ankle pain with active and passive range of motion and during weightbearing and non-weightbearing. The Board finds the May 2017 VA examination and December 2017 VA addendum opinion to be inadequate. The June 2017 VA examiner contradicted herself several times indicating throughout the examination that the Veteran’s left ankle pain both did and did not cause functional loss. In addition, the May 2017 Board remand specifically asked that the examiner take range of motion findings in active and passive motion. However, the July 2017 VA examination only contains on set of range of motion findings. Moreover, the examiner failed to provide sufficient information regarding the severity, frequency, and duration of the Veteran’s flare-ups. As such, the Veteran’s claim must be remanded in order to obtain an additional complete VA examination. In addition, the Veteran continues to receive treatment at a VA medical center. As such, any and all outstanding VA treatment records must be obtained on remand. The matters are REMANDED for the following action: 1. Attempt to obtain and associate with the claims file any and all outstanding VA treatment records. 2. Schedule the Veteran for an examination of the current severity of his service-connected left knee disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments and discuss the effect of the Veteran’s left knee disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. Schedule the Veteran for an examination of the current severity of his service-connected left ankle disability. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments and discuss the effect of the Veteran’s left ankle disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD C. Biggins, Associate Counsel