Citation Nr: 21014520 Decision Date: 03/12/21 Archive Date: 03/12/21 DOCKET NO. 06-01 256 DATE: March 12, 2021 REMANDED Entitlement to an initial disability rating for degenerative joint disease (DJD) with patellar ligament derangement of the left knee, greater than 10 percent before October 10, 2018, and greater than 20 percent thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1968 to July 1970 with service in the Republic of Vietnam from July 1969 to July 1970. The Veteran appeared before a Veterans Law Judge (VLJ) from the Board of Veterans’ Appeals (Board) in hearings in December 2009 and October 2014 to present testimony regarding the knee disability on appeal. The Veteran was informed in an April 2016 notification letter that the presiding VLJ from the hearings was not able to participate in the decision in this case. The Veteran declined the opportunity to request a new hearing and the appeal has proceeded accordingly. There is a lengthy procedural history in this case, much of which was previously recounted in the Board’s September 2019 decision that denied the Veteran’s appeal for an increased initial rating for his service-connected left knee disability. That history need not be repeated here. Following the September 2019 denial of the claim, the Veteran pursued his appeal to the United State Court of Appeals for Veterans Claims (Court). In May 2020, pursuant to a joint motion for remand, both VA and the appellant agreed that the Board’s September 2019 denial of the claim should be set aside and remanded for further evidentiary development. The Board now returns this case to the agency of original jurisdiction (AOJ) for the completion of that evidentiary development. Entitlement to an initial disability rating greater than 10 percent for DJD with patellar ligament derangement of the left knee before October 10, 2018, and greater than 20 percent thereafter, is remanded. Once VA undertakes the effort to provide a medical examination, even if not statutorily obligated to do so, it must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, it has been determined that the VA examinations conducted for the left knee from October 2016 to October 2018 did not adequately address all necessary elements to decide the present claim. See Sharp v. Shulkin, 29 Vet. App. 26 (2018); Correia v. McDonald, 28 Vet. App. 158 (2016). Accordingly, given these deficiencies and to comply with the Court’s remand order, the Board must request a retrospective medical opinion that addresses each needed element for the entirety of the period on appeal. The matters are REMANDED for the following action: Schedule the Veteran for an examination to determine the severity of his service-connected left knee DJD with patellar ligament derangement. To the extent possible, the impairment resulting from the service-connected left knee disability should be distinguished from any impairment resulting from any nonservice-connected disabilities such as gout. If it is not possible to distinguish such limitations, then all left knee impairments must be attributed to the service-connected disability. The examiner should provide a full description of the left knee 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. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups from DJD with patellar ligament derangement, and the degree of functional loss during those flare-ups. Due to the nature of the present appeal, and the order of the Court, a retrospective medical opinion is necessary. In other words, the examiner is asked to describe not only the current severity of the Veteran’s left knee disability, but also to reconstruct a history of that impairment to the best of his or her ability for the period since November 30, 2006. It will be of particular usefulness to the Board if the examiner is able to identify the approximate date or timeframe at which any distinctive worsening of the Veteran’s impairment is determinable, particularly as manifested by limitation of flexion, limitation of extension, or lateral instability. Stated another way, the examiner is asked to identify the approximate date, if any, since November 30, 2006 at which the Veteran’s left knee exhibits: (1) flexion shown or estimated to be limited to 45 degrees or less (including during flare-ups), (2) extension shown or estimated to be limited to 15 degrees or more (including during flare-ups), (3) recurrent lateral instability of the left knee joint shown or estimated to be present, and the degree of severity of that impairment should then be identified (slight, moderate, or severe) or (after February 7, 2021: sprain, incomplete ligament tear, or complete ligament tear causing persistent instability); any medically prescribed cane, crutches, or walker used for this condition or bracing for ambulation should also be identified, (4) patellar instability involving the patellofemoral complex (quadriceps tendon, patella, and the patellar tendon) with recurrent instability shown or estimated to be present (with or without history of surgical repair); any medically prescribed brace, cane or walker used for this condition should be identified. (Continued on the next page)   For any of the above determinations, where 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 degree of limitation 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). K. J. ALIBRANDO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. McDonald, 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.