Citation Nr: 21074152 Decision Date: 12/14/21 Archive Date: 12/14/21 DOCKET NO. 16-40 377 DATE: December 14, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for service-connected right knee disability based on limitation of flexion is remanded. Entitlement to an initial compensable rating for service-connected right knee disability based on limitation of extension is remanded. Entitlement to an initial rating in excess of 10 percent prior to August 5, 2021, and in excess of 20 percent thereafter for service-connected right knee disability based on instability is remanded. REASONS FOR REMAND The Veteran had active military service from August 1963 to August 1965. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a May 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). By way of background, in September 2017, March 2018, April 2020, December 2020, and April 2021 the Board remanded the appeal for further evidentiary development. 1. Entitlement to an initial rating in excess of 10 percent for service-connected right knee disability based on limitation of flexion is remanded. 2. Entitlement to an initial compensable rating for service-connected right knee disability based on limitation of extension is remanded. 3. Entitlement to initial higher ratings for service-connected right knee disability based on instability is remanded. At the outset, the Veteran filed a claim of entitlement to service connection for a right knee disability in November 2009. In a May 2013 rating decision, the RO granted service connection for his right knee disability and assigned a 10 percent rating. A review of the records shows that the Veteran was afforded VA examinations in March 2013, November 2015, November 2017, May 2018, June 2019, September 2019, July 2020, December 2020, August 2021, with an addendum in May 2019, August 2021, and September 2021. For the following reasons, the August 2021 VA examination, August 2021 addendum, and September 2021 addendum reports are flawed. In the August 2021 VA examination report, the examiner wrote that the Veteran's flexion was to 50 degrees and his extension was to 50 degrees with evidence of pain on flexion and extension. There was evidence of pain on weight bearing, active motion, and passive motion. There was objective evidence of crepitus. There was no objective evidence of localized tenderness or pain on palpation of the joint or associated soft tissue. He was able to perform repetitive-use testing with at least three repetitions. The examiner indicated that there was additional loss of function or range of motion after three repetitions and that the Veteran's flexion was to 50 degrees and that his extension was to 0 degrees after three repetitions. The examiner estimated that during flare ups the Veteran's flexion would be limited to 50 degrees and his extension would be limited to 0 degrees. There was no evidence of muscle atrophy or ankylosis. The examiner noted that due to the Veteran's right knee disability it has caused him difficulties working in a power plant for 15 years and reiterated the Veteran's prior statement of functional limitation (i.e., pain after standing for a few minutes, pain after walking with a cane after few steps, pain with lifting and/or carrying few pounds, pain with getting in and out of vehicle, unable to climb stairs due to right knee pain, pain with dressing and bathing, and difficulty with climbing in bathtub). In the August 2021 addendum, the same examiner from the August 2021 VA examination, stated that the Veteran's initial range of motion, additional range of motion during reserved, repeated use, and flare ups the Veteran should be "50 de[g]rees extension & extension limited to 0 degree." In the September 2021 addendum, the examiner from the August 2021 examination wrote that the "rework in" August 2021 "appears to have a typo and, then the examiner appeared to indicate that the Veteran's knee flexion was to 0 degrees and that his knee extension was to 50 degrees. An October 2021 OTC addendum report shows the examiner from the August 2021 was requested to "verify ALL range of motion testing reported on examination. Rework results are inconsistent." Thereafter, October 2021 OTC addendum report list the Board's August 2021 VA remand directives. Although the examiner from the August 2021 VA examination signed the October 2021 OTC addendum, the report does not show that the examiner provided any response to the inquiries or clarified her prior findings. Unfortunately, another remand is warranted to schedule the Veteran for a VA examination, as the August 2021 VA examination report with the addendum opinions are unclear and internally inconsistent; additionally, the August 2021 VA examination report with the addendum opinions do not provide sufficient findings to evaluate the severity of the Veteran's right knee disability. Based on the foregoing, the Board finds that a remand is warranted to provide the Veteran with an adequate VA examination. Once VA undertakes to provide an examination, it is obligated to ensure that the examination is adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination to evaluate the current severity of his right knee disability from a different examiner than the examiner that conducted the August 2021 VA examination. Furnish the Veteran's claims file, including a copy of this remand, to the examiner. The examiner should obtain a detailed clinical history from the Veteran. All pertinent pathology found on examination should be noted in the report of the evaluation. Any testing deemed necessary should be performed. (a) The examination must record the results of range of motion testing for pain on BOTH active and passive motion AND in weight-bearing and non-weight-bearing. (b) The examiner must address whether the Veteran has residual weakness, pain, or limitation of motion of his right knee, or chronic residuals consisting of severe painful motion or weakness of his right knee. (c) The examiner must also express an opinion concerning whether there would be additional functional impairment on repeated use or during flare-ups. The examiner should assess the additional functional impairment on repeated use or during flare-ups in terms of the degree of additional range of motion loss. If this is not feasible to determine without resort to speculation, the examiner should provide an explanation for why this is so. (d) Finally, the examiner should discuss the impact, if any, as well as a full description of the effects, that the Veteran's right knee disability has on his occupational functioning, and whether or not his right knee disability impacts his ability to perform ordinary activities of daily living. Please include more than a reiteration of the Veteran's statements as to his functional limitations. Ashley Castillo Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P. Noh, 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.