Citation Nr: 21064766 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 15-26 773 DATE: October 21, 2021 REMANDED The issue of entitlement to an initial disability rating in excess of 10 percent for left knee strain is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1985 to August 1985, January 1986 to January 1990, December 1990 to September 1991, and from September 1991 to October 1992. This matter comes to the Board of Veterans' Appeals (Board) on appeal from a December 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Philadelphia, Pennsylvania. The Veteran testified at a hearing before the undersigned Veterans Law Judge (VLJ) via videoconference in November 2018 and a transcript of the hearing has been associated with the claims file. This matter was previously before the Board in April 2021 at which time it was remanded for further development. Entitlement to an initial disability rating in excess of 10 percent for left knee strain is remanded. The Veteran contends that his left knee disability is more severe than as reflected by the rating currently assigned. Specifically, the Veteran contends that he experiences flare-ups causing pain, swelling, and knee buckling and resulting in inability to run or stand for long periods of time and difficulty climbing and descending stairs. In this regard, the April 2021 Board remand directives specifically asked the examiner to render an opinion regarding the functional effects of flare-ups of the Veteran's service-connected left knee strain. In a June 2021 addendum, an examiner acknowledged the Veteran's reports of variable left knee pain, occasional buckling, and swelling, but indicated that these reports were in contrast to prior examinations, VBMS medical treatment records, repeated physical examinations, and x-ray and MRI evaluations; which are overall silent for an ongoing history of and objective findings consistent with recurring flare-ups, knee joint effusion or locking, and/or clinical exacerbation with repetitive use over time. The examiner therefore concluded that the medical opinions requested in the Board remand were rendered moot. The Board finds the June 2021 VA addendum inadequate to decide the Veteran's claim for increase. The June 2021 VA addendum essentially repeated the same rationale found inadequate by the Board in its previous remand. See April 2021 Board Remand. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (holding that when VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). Therefore, the Board finds that an additional attempt should be made on remand to obtain an addendum opinion addressing the functional effects of flare-ups of the Veteran's service-connected left knee strain. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: 1. Request that the Veteran provide or authorize VA to obtain records of his relevant treatment that have not yet been associated with the claims file, and associate with the claims file any outstanding VA treatment records. 2. Forward a copy of this remand to a qualified examiner (a different examiner than the June 2021 examiner) for the purpose of obtaining an opinion based on file review. (a.) State whether it is at least as likely as not (50 percent probability or greater) that during a flare up range of motion is additionally limited to 30 degrees (for flexion) (the measurement required for the next higher rating). Please explain why or why not. Please estimate functional loss that occurred during flare-ups, using information procured from relevant sources of record in addition to examination reports, including lay statements from Veteran. The Veteran testified during the November 2018 Board hearing that he experiences flare-ups about once a month. Symptoms of flare-ups include pain, swelling, and knee buckling. The Veteran further testified that he cannot run or stand for long periods of time; and he has difficulty climbing and descending stairs. The flare-ups require rest, elevation, and medication for alleviation. (b.) State whether it is at least as likely as not (50 percent probability or greater) that repetitive use over time additionally limits motion to 30 degrees or less (for flexion) or 10 degrees or more (for extension). Please explain why or why not. (c.) State whether it is at least as likely as not (50 percent probability or greater) that during a flare up the disability is manifested by effusion and/or locking. If the examiner cannot provide the requested opinions without resorting to speculation, he/she should explain why an opinion cannot be provided (e.g. lack of sufficient information/evidence in this case, or a lack of knowledge among the medical community at large, and not the insufficient knowledge of the individual examiner). If the inability to provide an opinion without resorting to speculation is due to a deficiency in the record (additional facts are required), the AOJ should develop the claim to the extent it is necessary to cure any such deficiency. If the inability to provide an opinion is due to the examiner's lack of requisite knowledge or training, then the AOJ should obtain an opinion from a medical professional who has the knowledge and training needed to render such an opinion. S.C. Krembs Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Smith-Jennings, 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.