Citation Nr: 21066309 Decision Date: 10/29/21 Archive Date: 10/29/21 DOCKET NO. 17-37 614 DATE: October 29, 2021 REMANDED Entitlement to a rating in excess of 10 percent for service-connected right ankle arthritis is remanded. Entitlement to a rating in excess of 10 percent since June 7, 2017 for service-connected left ankle arthritis is remanded. REASONS FOR REMAND This matter comes before the Board of Veterans' Appeals (Board) on appeal from a rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). This appeal was remanded in December 2019 and March 2021 for further development. 1. Entitlement to an initial rating in excess of 10 percent for service-connected right ankle arthritis is remanded. 2. Entitlement to an initial rating in excess of 10 percent since June 7, 2017 for service-connected left ankle arthritis is remanded. The Veteran contends that he is entitled to higher evaluations for his right and left knee disabilities. See NOD (May 2014); Form 9 (July 2017); Hearing Transcript (September 2019). The Board finds that remand is required to obtain adequate addendum opinions. The Board is obligated by law to ensure that the RO complies with its directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). RO compliance with remand directives is not optional or discretionary and the Board errs as a matter of law when it fails to ensure remand compliance. Stegall, 11 Vet. App. at 271. In increased evaluation claims, VA examinations for musculoskeletal conditions must include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. 38 C.F.R. § 4.59; Correia v. McDonald, 28 Vet. App. 158 (2016). Although a VA examination is not inadequate merely because the examiner states they cannot reach a conclusion without resort to speculation, it is considered inadequate where the examiner fails to articulate a reasoned explanation of that conclusion. Jones v. Shinseki, 23 Vet. App. 382, 391 (2010). In March 2021, the Board remanded the issues on appeal, finding that the 2013 and 2017 VA ankle examinations did not provide passive range of motion findings or indicate whether there was additional lost range of motion due to pain on weight-bearing. See BVA Decision (March 2021). The Board thus remanded for retrospective opinions based on the evidence of record and the Veteran's lay statements. See BVA Decision (March 2021). On remand, a June 2021 VA examination was conducted that addressed the current functioning of the ankles. See C&P Exam (June 2021). Addendum opinions were obtained in August and September 2021 that addressed the 2013 and 2017 VA examinations. See C&P Exam (August 2021); C&P Exam (September 2021). The examiner stated that it was not possible to state beyond mere speculation a retrospective range of motion measurement because the examiner was not present the day of the examination. The examiner reiterated that there was no medical professional who would be able to provide this information without simply speculating. See C&P Exam (August 2021); C&P Exam (September 2021). The examiner appears to be providing an opinion that retrospective range of motion findings can never be estimated. The examiner did not, however, provide an actual supporting explanation for this finding as they did not indicate why such an estimate could not be based on lay statements from the Veteran and available objective evidence. Accordingly, remand is required for an addendum opinion that does so. The matters are REMANDED for the following action: 1. Provide the Veteran with an appropriate examination to determine the severity of the service-connected bilateral ankles at the 2013 and 2017 VA examinations. The entire claims file must be made available to and be reviewed by the examiner. If an examination is deemed necessary, one must be provided. (a.) Provide an addendum retrospective opinion to supplement the April 2013 VA ankle examination that estimates the amount in degrees of range of motion lost due to pain in both weightbearing and non-weight bearing positions, and on both active and passive motion based on the evidence of record and the Veteran's statements. (b.) Provide an addendum retrospective opinion to supplement the June 2017 VA ankle examination that estimates the amount in degrees of range of motion lost due to pain in both weightbearing and non-weight bearing positions, and on both active and passive motion based on the evidence of record and the Veteran's statements. (c.) 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). 2. Ensure that the medical opinion obtained includes a complete rationale for the conclusions reached. The medical opinion must support the conclusions reached with an analysis that is adequate for the Board to consider and weigh against other evidence of record; medical opinions must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. If an opinion cannot be expressed without resort to speculation, ensure that the clinician so indicates and discusses why an opinion is not possible, to include whether there is additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. 3. Readjudicate. C.A. SKOW Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.M., 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.