Citation Nr: 18158420 Decision Date: 12/14/18 Archive Date: 12/14/18 DOCKET NO. 16-31 251 DATE: December 14, 2018 REMANDED Entitlement to an initial rating higher than 10 percent for chronic right knee degenerative joint disease (DJD) status post arthroscopic chondroplasty of the right medial femoral condyle from February 22, 1990, to October 31, 2007, is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1981 to February 1990. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2015 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In a June 2008 rating decision, the RO awarded service connection for right knee DJD, rated as 10 percent disabling; and right knee limitation of extension rated as 10 percent disabling, both effective from October 31, 2007. The Veteran appealed the effective date and initial rating. In December 2009, the RO denied the Veteran’s claim for an earlier effective date for the grant of service connection for chronic right knee DJD and right knee limitation of extension. In June 2010, the RO increased the initial rating for chronic right knee DJD to 20 percent, effective October 31, 2007; and continued the 10 percent disability rating for right knee limitation of extension. In February 2014, the RO increased the Veteran’s right knee limitation of extension to 30 percent disabling, effective June 5, 2013; and continued the Veteran’s 20 percent rating for chronic right knee DJD. In December 2014, the Board remanded the Veteran’s claim for an earlier effective date for chronic right knee DJD and right knee limitation of extension for additional development. In February 2015, the RO awarded service connection for chronic right knee DJD, rated as 10 percent disabling, effective from February 22, 1990 to October 31, 2007. The Veteran timely appealed this assigned initial rating, and this period of time is the only issue before the Board on this appeal. 1. Entitlement to an initial rating higher than 10 percent for chronic right knee DJD status post arthroscopic chondroplasty of the right medial femoral condyle from February 22, 1990, to October 31, 2007, is remanded. The Veteran contends that his service-connected right knee DJD should be rated higher than 10 percent disabling from February 22, 1990, to October 31, 2007. The Board notes that STRs include several entries describing the Veteran’s right knee disability, including range of motion, pain, effusion, crepitus, and edema. However, the Board finds that there is little evidence that can be used to adequately assess the severity of the service-connected right knee DJD during the time period for which a higher initial rating is sought on this appeal. There is no lay or medical evidence dated between the relevant dates. Moreover, while there is some evidence in the Veteran’s statements that he experienced flare-ups, there is no opinion estimating what, if any, additional limitation of motion the Veteran experienced due to flare-ups or repeated use over time. See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) (finding orthopedic examination inadequate with regard to flare-ups where the examination was the basis for a denial of a higher disability rating). Thus, the Board finds that a retrospective medical opinion addressing the severity of the Veteran’s service-connected right knee DJD upon his activities of daily living during the period from approximately February 1990 through October 2007, would aid in the resolution of the claim for increased rating. See Chotta v. Peake, 22 Vet. App. 80 (2008) (explaining that a retrospective medical opinion must be sought in circumstances such as those in this case). This opinion will have to consider evidence from outside the relevant time period and draw inferences from it. The matter is REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician regarding the severity of the Veteran’s right knee DJD during the period from February 1990 through October 2007. Based on any examination findings and the Veteran’s documented medical history and lay assertions, to include the Veteran’s STRs starting in February 1989, the clinician should identify the nature and severity of any symptoms associated with the service-connected right knee DJD during the period from February 1990 through October 2007 and, if possible, indicate whether and at what point between February 1990 through October 2007 the Veteran’s right knee disability increased in severity. This opinion will have to review lay and medical evidence from outside this time period and draw inferences from it as to what the symptoms were during the relevant time period. To the extent possible, the clinician should estimate the ranges of active motion and passive motion of the right knee and indicate whether there was any pain with weight-bearing and without weight-bearing. The clinician should also provide any 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 clinician should identify any symptoms and functional impairments due to the right knee DJD alone and discuss the effect of the Veteran’s 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 clinician 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). The Board appreciates the difficulties in answering the above questions. However, given the unique facts of the case as well the Court’s decisions, which are binding on the Board, it must attempt to answer these questions with the assistance of an appropriate health care professional. Jonathan Hager Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Leifert, Associate Counsel