Citation Nr: 21076498 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 13-23 854 DATE: December 27, 2021 REMANDED Entitlement to an evaluation in excess of 10 percent for degenerative changes of the left knee is remanded. Entitlement to an evaluation in excess of 10 percent for rheumatoid arthritis of the left hip is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1989 to October 1989. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In March 2017, the Veteran testified at a hearing before the undersigned. This matter was previously remanded by the Board in August 2017, December 2019, and April and September 2021. The case has been returned to the Board at this time for further appellate review. 1. Entitlement to an evaluation in excess of 10 percent for degenerative change of the left knee is remanded. 2. Entitlement to an evaluation in excess of 10 percent for rheumatoid arthritis of the left hip is remanded. The Veteran was afforded VA examinations in October 2021 which the Board finds to be inadequate because they are internally inconsistent without any explanation for the examiner's contrary findings. First, the VA examiner noted that, during acute pain flares involving the Veteran's left knee and left hip, the Veteran has difficulty with activities that involve prolonged sitting, standing, walking, using stairs, and squatting activities with the left knee and left hip. Later, however, the VA examiner stated that the procured evidence does not suggest pain, fatigability, weakness, lack of endurance, or incoordination which significantly limits functional ability with flare-ups of the Veteran's left knee and left hip. Without any further explanation from the VA examiner, these findings appear to contradict each other. Thus, remand for a new VA examination is warranted. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination (or telehealth interview, if an in-person examination is not feasible), preferably with a clinician who has not previously examined the Veteran, to determine the current nature and severity of her service-connected left knee and left hip disabilities. After reviewing the entire claims file, the selected examiner should conduct all indicated tests and studies, to include range of motion testing. The joints involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups she experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment she 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 opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up and after repeated use over time. 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 the need to speculate is caused by 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). The examiner is advised that the Veteran is competent to report her symptoms and history, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so; however, the Veteran's history of symptoms capable of lay observation cannot be dismissed solely on the basis that they are not recorded in contemporaneous treatment records. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elias, Associate 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.