Citation Nr: 21014013 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 15-11 281 DATE: March 11, 2021 REMANDED Entitlement to a disability rating higher than 10 percent for service-connected left knee osteoarthritis (based on limited flexion) is remanded. Entitlement to a disability rating higher than 10 percent for service-connected right knee osteoarthritis (based on limited flexion) is remanded. Entitlement to a compensable disability rating for service-connected left knee osteoarthritis (based on limited extension) is remanded. Entitlement to a compensable disability rating for service-connected right knee osteoarthritis (based on limited extension) is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1972 to September 1979 and from June 1984 to June 2010. The Board already twice has remanded these claims back to the local Regional Office (RO), i.e., Agency of Original Jurisdiction (AOJ) for further development and consideration – initially in June 2018 and more recently in September 2019. The more recent remand was to obtain an addendum medical opinion addressing deficiencies in an intervening April 2019 VA examination.   Specifically, the Board determined that VA examination was inadequate because it did not comply with the requirements of Sharp v. Shulkin, 29 Vet. App. 26 (2017). Consequently, supplemental medical opinions were obtained in November 2019 and August 2020. See Stegall v. West, 11 Vet. App. 268 (1998) (requiring the Board, as a matter of law, ensure compliance with prior remand directives). However, the Veteran contends that his service-connected bilateral knee disability has worsened appreciably – even since the April 2019 VA examination that he underwent following and as a result of the Board’s prior remand of these claims. See, e.g., November 2020 Veteran’s Representative Brief (Veteran contends that his bilateral knee condition has gotten severely worse to the point that it has impacted his home and work life). Mere passage of time, alone, is not reason to have a Veteran reexamined. See Palczewski v. Nicholson, 21 Vet. App. 174 (2007). Here, though, given the suggestion of worsening disability since the last medical evaluation, a new VA examination reassessing the severity of this service-connected bilateral knee disability is justified. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). Also, the Veteran continues to receive ongoing VA treatment for this disability. But, the most recent VA treatment records in the file on date up to August 2016. Therefore, all more recent VA treatment records also should be obtained and associated with the claims file so that they, too, may be considered. Accordingly, these claims are again REMANDED for the following still additional development and consideration: 1. Contact the Veteran and request authorization to obtain all outstanding records pertinent to his claims, including, but not limited to, his VA treatment records dating from August 2016 to the present, as well as any private treatment records following proper VA procedures (38 C.F.R. § 3.159(c)). Also, appropriately notify him and his representative if unable to obtain records identified with the required amount of information (38 C.F.R. § 3.159(e)). 2. After obtaining all additional treatment or other relevant records, schedule the Veteran for a VA examination to reassess the severity of his bilateral knee disability. A copy of this remand and all relevant medical and other records should be made available to the examiner for review. The examiner must review the pertinent evidence, including the Veteran’s lay assertions, and undertake all indicated testing and evaluation. All testing indicated by the current Disability Benefits Questionnaire (DBQ) format must be done or explanation provided as to why it could not be completed. The examiner should report all signs and symptoms necessary for rating the Veteran’s bilateral knee disability under the applicable rating criteria. To this end, the examiner should provide the range of motion of both knees in degrees. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing, if possible. If the examiner is unable to conduct the required testing, he or she should clearly discuss why in the report. The presence of objective evidence of pain, premature or excess fatigability, incoordination and weakness also should be noted, as should any additional disability (including additional limitation of motion) due to these factors. The examiner shall inquire as to periods of flare-up and note the frequency and duration of any such flare-ups.   Any additional impairment on use or in connection with flare-ups should be described in terms of the degree of additional range of motion loss. The examiner should specifically describe the severity, frequency, and duration of flare-ups, name the precipitating and alleviating factors, and estimate, per the Veteran, to what extent, if any, such flare-ups affect functional impairment. 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. Also, if there is knee instability, this, too, should be indicated and whether there is prescription for an assistive device such as a brace, cane or walker. Further, in reassessing the severity of the Veteran’s bilateral knee disability, the examiner is asked to address the extent to which the functional impairment caused by this disability impairs the Veteran’s ability to meet the demands of a substantially gainful job, whether sedentary or physical, and the timeframe in which such impairment arose.   It is essential the examiner provide explanation (rationale) for conclusions and opinions, preferably citing to clinical findings or other supporting evidence in the file or accepted medical authority. KEITH W. ALLEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Mukherjee 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.