Citation Nr: 21014017 Decision Date: 03/11/21 Archive Date: 03/11/21 DOCKET NO. 14-08 300 DATE: March 11, 2021 REMANDED Entitlement to a disability rating in excess of 30 percent for right knee total arthroplasty (previously rated as degenerative joint disease) is remanded. REASONS FOR REMAND The Veteran served on active duty for training purposes (ACDUTRA) with the United States Army Reserves from April to October 1962. That period is considered active military service, because service connection has been granted for a right knee disability incurred during that period. 38 U.S.C. § 101 (24); 38 C.F.R. § 3.6 (a). The Veteran also has additional service in the reserves including periods of ACDUTRA 14-15 days in length in December 1963, 1964, 1965, and 1966. He was discharged in March 1968. In March 2018, the Veteran and his spouse testified at a hearing before the undersigned Veterans Law Judge. A transcript of that hearing is of record. This matter has been advanced on the Board’s docket pursuant to 38 C.F.R. § 20.902 (c). This appeal has been before the Board on several prior occasions. Most recently, in July 2020, the Board remanded the Veteran’s increased rating claim for further development including obtaining updated VA treatment records, records from community-based pain management treatment provided through the VA Choice program, and a VA examination to determine the current severity of the Veteran’s disability. While the Board sincerely regrets the delay, there has not been substantial compliance with the Board’s prior remand directives, and another remand is now required. Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to a disability rating in excess of 30 percent for right knee total arthroplasty (previously rated as degenerative joint disease) is remanded. The Board cannot proceed to adjudication of the claim because there has not been substantial compliance with the directives contained in the Board’s July 2020 remand. The agency of original jurisdiction (AOJ) was directed to obtain all records of any pain management treatment conducted by a community care provider through the VA Choice program. An August 2020 VA medical record shows that a community care consult was completed in April 2020 and the Veteran was referred to Pain Institute of Southern Arizona. It does not appear that the AOJ has undertaken any efforts to obtain those records. The Veteran was afforded a VA knee examination in December 2020; unfortunately, the provided medical examination is inadequate. The examiner stated they reviewed records of pain management treatment conducted by a community care provider; however, those records have not been associated with the record and are not available for the Board’s review. The examiner also noted that pain and lack of endurance significantly limited the Veteran’s functional ability with repeated use over time and during flare-ups and that it could be described in terms of range of motion. However, the reported range of motion measurements after repeated use over time and during flare-ups were the same as the provided initial range of motion measurements. The Veteran reported severe right knee pain after standing or walking more than 20 to 30 minutes. On remand, the Veteran should be provided a new VA examination to evaluate the current severity of his right knee disability, after pertinent records related to pain management have been associated with the record. Because the Veteran continues to receive VA medical care, updated VA treatment records should also be obtained. See Bell v. Derwinski, 2 Vet. App. 611 (1992). The matters are REMANDED for the following action: 1. Obtain and associate with the Veteran’s e-folder all outstanding VA treatment records dated since January 2021. 2. Obtain and associate with the Veteran’s e-folder all records of any pain management treatment conducted by a community care provider, including but not limited to the Pain Institute of Southern Arizona, through the VA Choice program. If a release form is needed to obtain such records, one should be requested from the Veteran. Record all responses to such requests in the Veteran’s e-file. 3. After completion of the foregoing and any additionally indicated development, schedule the Veteran for an examination from an appropriate clinician to determine the current severity of his service-connected right knee total arthroplasty. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). In so doing, the examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). M.E. Larkin Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M.D. Collins, 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.