Citation Nr: 21074921 Decision Date: 12/16/21 Archive Date: 12/16/21 DOCKET NO. 15-14 328 DATE: December 16, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for a right knee disability is remanded. Entitlement to an initial rating in excess of 10 percent for a right ankle disability is remanded. Entitlement to a rating in excess of 10 percent for a left ankle disability is remanded. Entitlement to a compensable rating prior to March 11, 2021, and a rating in excess of 10 percent thereafter, for a right foot disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from July 1992 to July 1996 and from October 2001 to October 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from October 2014 and December 2014 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). In June 2018, the Veteran testified during a Board hearing before the undersigned Veterans Law Judge. In April 2019, October 2019, and most recently in August 2020, the Board remanded the appeal for further development. The Board regrets additional delay, but unfortunately, another remand is required. Pursuant to the Board's August 2020 remand directives, the Veteran was afforded VA examinations in March 2021. However, the Board requested an addendum opinion not an actual examination to address the Veteran's previous reports of flare-ups. Specifically, the Board asked the examiner: considering the Veteran's reported history during the August 2013, April 2014, August 2014, December 2016, January 2018, and December 2018 VA examinations, please also provide an opinion describing functional impairment of the Veteran's right knee, right foot and bilateral ankles due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. If the examiner is unable to provide such an opinion without resorting to speculation, the examiner must provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician's Guide to estimate, "per [the] veteran," what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. Although VA examinations were conducted in March 2021, the examiner did not review the above-cited evidence and provide an addendum opinion in conformity with the same. Thus, a remand for an addendum opinion is now needed to ensure substantial compliance with the Board's August 2020 remand instructions. Stegall v. West, 11 Vet. App. 268 (1998). The Board understands this case has been remanded a number of times, but without compliance with its prior directives it has no choice but continue to do so until an adequate opinion addressing the Board's directives is secured. Updated treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. Then obtain an opinion from a VA examiner other than the July 2019, December 2019, and March 2021 examiners. The entire claims file should be made available to and be reviewed by the examiner. Please note that only an opinion is needed in this case and the Veteran should NOT be scheduled for another examination. The examiner must consider the Veteran's reported flare-up history during the August 2013, April 2014, August 2014, December 2016, January 2018, December 2018, December 2019, and March 2021 VA examination reports. After reviewing this history as outlined in these reports, please provide an opinion describing functional impairment of the Veteran's right knee, right foot and bilateral ankles due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. If the examiner is unable to provide such an opinion without resorting to speculation, the examiner must provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician's Guide to estimate, "per [the] veteran," what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.) If the examiner fails to consider the above-cited flare-up history, the Board will continue to remand this case until it secures an adequate opinion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Asante, Ruby 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.