Citation Nr: 21065213 Decision Date: 10/25/21 Archive Date: 10/25/21 DOCKET NO. 18-03 852 DATE: October 25, 2021 REMANDED Entitlement to an evaluation in excess of 10 percent for left knee tendonitis with degenerative changes is remanded. Entitlement to an evaluation in excess of 10 percent for right knee tendonitis with degenerative changes is remanded. Entitlement to an evaluation in excess of 10 percent for degenerative changes of the thoracic spine is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Coast Guard from February 1981 to February 2001. These matters come before the Board of Veterans Appeals (Board) on appeal from an August 2014 decision by a Department of Veterans Affairs (VA) Regional Office (RO). These matters were previously denied by the Board in March 2020. The Veteran appealed to the United States Court of Appeals for Veterans Claims (Court). In January 2021, the Court issued an Order granting a Joint Motion for Remand, vacating and remanding the Board's March 2020 decision. The Court found that the VA examinations on record evaluating the severity of the Veteran's back and knee disabilities were inadequate. Specifically, the April 2014 VA examinations did not provide the complete range of motion (ROM) measurements, and the April 2019 examinations noted functional loss after repeated use over time without describing this additional functional loss in terms of ROM (or adequately explaining why additional functional loss could not be explained in terms of limitation of ROM). Following this decision, the Board remanded these matters in May 2021 to obtain new VA examinations. Unfortunately, the Board finds that a second remand is necessary, as the VA examinations obtained in June 2021 have essentially the same deficiencies as the April 2019 examinations. See Correia v. McDonald, 28 Vet. App. 158, 169-170 (2016); Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The June 2021 knee examination report notes pain on both flexion and extension of the knees, and that pain results in functional loss, but does not note where in the ROM pain begins. The examination report is also contradictory regarding additional functional loss after repeated use; the examiner states that procured evidence suggests additional functional loss after repeated use due to pain and weakness, but when asked to describe the additional loss in terms of ROM, the examiner gives the same numbers as shown on the initial ROM measurement. The June 2021 back examination notes pain on all forms of motion, but again, does not note where in the ROM pain begins. The examiner states that there is additional functional loss after repeated use over time, due to pain, but when asked to describe the additional loss in terms of ROM, the examiner gives the same numbers as shown on the initial ROM measurement. While it is possible that the Veteran does not suffer additional functional loss upon repeated use over time, the examination reports are ambiguous, and clarification is needed. The matters are REMANDED for the following action: 1. Obtain new examinations of the Veteran's knees and back from an appropriate VA clinician. The Veteran's entire claims file (including a copy of this remand) must be made available to the examiner for review, and the examiner must certify in the addendum opinion report that the claims file has been reviewed. The examiner must perform full range of motion testing. The joints involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing. The examiner should describe any pain, weakened movement, excess fatigability, instability, and incoordination present. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, the examiner should clearly explain why. The examiner must clearly identify where in the arc of motion the Veteran begins to experience pain, regardless of whether the examiner ultimately finds that said pain results in functional loss. The examiner should also state whether the examination is taking place during a flare-up and/or after repeated use over time. If not, the examiner should ask the Veteran to describe any flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an estimate, in degrees, any additional limitation of motion caused by functional loss during a flare-up or after repeated use over time. If the Veteran does not suffer additional limitation of motion after repeated use over time or during flare-ups, the examiner should state so explicitly. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether this is because of a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Shermila Sundquist 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.