Citation Nr: 21011107 Decision Date: 02/26/21 Archive Date: 02/26/21 DOCKET NO. 17-12 667 DATE: February 26, 2021 REMANDED Entitlement to an initial compensable rating for right knee limitation of flexion is remanded. Entitlement to a disability rating in excess of 10 percent for right knee degenerative joint disease is remanded. Entitlement to a disability rating in excess of 10 percent for left knee chondromalacia is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1962 to March 1964 and from September 1964 to September 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2014 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In April 2019, the Veteran testified at a central office hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that proceeding has been associated with the record. This case was previously before the Board in May 2019, when the issues on appeal were remanded for additional evidentiary development. In accordance with the remand directives, the Veteran was afforded a VA examination in January 2020. This case has been advanced on the docket pursuant to 38 C.F.R. § 20.900. Entitlement to increased ratings for right knee limitation of flexion, right knee degenerative joint disease, and left knee chondromalacia are remanded. The Veteran is seeking increased disability ratings for his service-connected right knee degenerative joint disease, right knee limitation of extension, and left knee chondromalacia. Specifically, the Veteran contends that his disabilities are more severe than reflected by his currently assigned disability ratings. The Veteran further asserts that his January 2020 VA examination was inadequate. See January 2021 Appellate Brief. Based on a review of the claims file, the Board finds that additional development is needed prior to adjudication of the claims. In accordance with the May 2019 Board remand, the Veteran was afforded a VA examination in January 2020. The VA examiner noted diagnoses of left knee chondromalacia and right knee total knee replacement. The Veteran reported bilateral knee stiffness, occasional swelling, difficulty walking, and occasional giving way. He further reported that his bilateral knee disabilities impact his ability to perform occupational functioning and ordinary activity, described as an inability to work, difficulty moving, driving, and walking. The Veteran endorsed flare-ups of both knees. The Veteran reported that his right knee flare-ups are sometimes severe and last until he takes weight off the knee, all precipitated by walking, getting up, and standing. The Veteran reported that his left knee flare-ups occur every day, are severe, and last until he takes weight off his knee, precipitated by walking, getting up, and standing. The Veteran also endorsed functional loss, described as difficulty walking and standing due to pain. Range of motion testing revealed right knee flexion from 0 to 135 degrees with normal extension and left knee flexion from 0 to 135 degrees with normal extension. Bilaterally, pain was noted on examination resulting in functional loss and pain with weight bearing. There was objective evidence of pain on palpation for the right knee but not for the left knee. There was no evidence of crepitus for either knee. The Veteran was able to perform repetitive-use testing for both knees with additional loss of function after three repetitions. The right knee functional loss included pain, fatigue, weakness, and lack of endurance, resulting in range of motion from 0 to 130 degrees. The left knee functional loss included pain, fatigue, weakness, lack of endurance, and incoordination, resulting in range of motion from 0 to 125 degrees. Right knee flare-ups result in pain, fatigue, weakness, and lack of endurance, resulting in range of motion from 0 to 120 degrees. Left knee flare-ups result in pain, fatigue, weakness, and lack of endurance, resulting in range of motion from 0 to 110 degrees. Bilaterally, the Veteran’s additional knee symptoms include less movement than normal due to ankyloses, adhesions, etc., instability of station, disturbances of locomotion, interference with standing, and pain on standing and walking. Muscle strength is 4/5 bilaterally with no muscle atrophy. There is no evidence of ankylosis for either the right or left knee. There is no evidence of recurrent subluxation or lateral instability. The VA examiner reported no meniscus condition for either knee but noted the Veteran’s 2013 total left knee replacement with residuals including scar and limitation of motion. The Veteran reported constant use of a walker for stability, balance, and ambulation. The VA examiner concluded that the Veteran’s bilateral knee disabilities do not impact his ability to perform any type of occupational task. The Veteran’s representative asserts that the January 2020 VA examination is inadequate for rating purposes. See January 2021 Appellate Brief. Specifically, the January 2020 VA examiner noted that pain, weakness, fatiguability, and incoordination limit the Veteran’s functional ability with flare-ups and repeated use over time. However, the Veteran’s representative points out that the VA examiner also reported that the Veteran’s bilateral knee disabilities do not impact his ability to work. The VA examiner further relied on findings from an inadequate previous VA examination. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). The Veteran’s representative requests a remand for an adequate VA examination. See January 2021 Appellate Brief. As such, the Board finds that remand is warranted for an adequate VA examination. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to determine the current nature and severity of his bilateral knee disabilities. The record, to include a copy of this Remand, must be made available to and be reviewed by the examiner, and the examination report should note that review. All testing deemed necessary to rate the bilateral knee disabilities under the criteria of the VA rating schedule must be conducted and the results reported in detail. The examiner should test the range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing, for the bilateral knees. The examiner should comment as to the extent of any instability, painful motion, functional loss due to pain, excess fatigability, weakness, and additional disability during flare-ups, expressed as additional range of motion loss, if possible. 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 elicit from the Veteran a complete history of any flare-ups of his bilateral knee disabilities. In so doing, the examiner should inquire as to the frequency, duration, characteristics, severity, and functional loss during periods of flare-ups of the Veteran’s bilateral knee disabilities. The examiner should describe the additional loss in degrees or percentage. The examiner must also report whether or not the Veteran’s bilateral knee disabilities impact his ability to perform any type of occupational task. In rendering the above requested opinion, the examiner should derive his or her estimate from relevant sources within the claims file, including private treatment records and lay statements of the Veteran. If the examiner is unable to do so, the examiner should indicate that all procurable data was considered (i.e., the information regarding frequency, duration, characteristics, severity, and/or functional loss related to such flare-ups elicited from the Veteran), but any member of the medical community at large could not provide such an opinion without resorting to speculation. It is insufficient to conclude that the requested opinion cannot be rendered without resorting to speculation based solely on the fact that the VA examination was not performed during a period of flare-up.  A rationale for all opinions must be provided. 2. If the benefit sought on appeal remains denied, furnish to the Veteran and his representative an appropriate SSOC that includes clear reasons and bases for all determinations, and afford them the appropriate time period for response before the claims file is returned to the Board for further appellate consideration. KRISTI L. GUNN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. C. Slaughter, 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.