Citation Nr: 21000323 Decision Date: 01/05/21 Archive Date: 01/05/21 DOCKET NO. 13-34 278A DATE: January 5, 2021 REMANDED Entitlement to an initial disability evaluation for degenerative joint disease of the left knee greater than 0 percent disabling from June 7, 2011, greater than 10 percent disabling from June 27, 2012, and greater than 30 percent from December 9, 2013 is remanded. Entitlement to an initial disability rating in excess of 10 percent from June 7, 2011, in excess of 10 percent from December 26, 2012, and in excess of 30 percent from June 4, 2015 is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1968 until August 1972, from September 1972 until September 1976, and from November 1983 until September 1988. The issues on appeal were most recently before the Board in October 2018. There has not been substantial compliance with the prior remand directives and the claims must be remanded again. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to an initial disability evaluation for degenerative joint disease of the left knee greater than 0 percent disabling from June 7, 2011, greater than 10 percent disabling from June 27, 2012, and greater than 30 percent from December 9, 2013 is remanded. 2. Entitlement to an initial disability rating in excess of 10 percent from June 7, 2011, in excess of 10 percent from December 26, 2012, and in excess of 30 percent from June 4, 2015 is remanded. The claims must be remanded again because the August 2019 VA examination obtained pursuant to the last remand is inadequate. The August 2019 VA medical examiner noted the history of the Veteran’s knee disabilities included his report they have worsened since onset. The examiner indicated the Veteran does not experience flares-ups of his condition. However, the Veteran did report flare-ups during previous examinations. He described the flare-ups as precipitated by poor weather and overexertion, resulting in increased functional loss. The August 2019 examination was not performed during a flare-up, but it does not appear that the examiner considered the Veteran’s report of the effect of flare-ups. On remand, a medical examination that addresses the Veteran’s report of flare-ups should be obtained. The matters are REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected bilateral knee disabilities. 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. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement 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). 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. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement 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). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.