Citation Nr: 21021177 Decision Date: 04/12/21 Archive Date: 04/12/21 DOCKET NO. 14-20 051 DATE: April 12, 2021 REMANDED Entitlement to a disability rating in excess of 10 percent for service-connected gout with patellofemoral chondromalacia of the left knee is remanded. Entitlement to a disability rating in excess of 10 percent for service-connected gout with patellofemoral chondromalacia of the right knee is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1987 to July 2007. These matters come before the Board of Veterans’ Appeals (Board) on appeal from a November 2012 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously before the Board in August 2020. The Board remanded the issues on appeal for a new VA examination. However, as discussed below, the Board finds that remand is necessary for further development. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Entitlement to a disability rating in excess of 10 percent for service-connected gout with patellofemoral chondromalacia of the left knee is remanded. Entitlement to a disability rating in excess of 10 percent for service-connected gout with patellofemoral chondromalacia of the right knee is remanded. The Veteran seeks a disability rating in excess of 10 percent for his service-connected gout with patellofemoral chondromalacia of the bilateral knees. Specifically, the Veteran contends that he experiences flare ups of his gout in both knees, experiences severe pain, and has visited the emergency room on a regular basis for treatment due to gout attacks. See February 2012, August 2012, September 2012 Statements in Support of Claim; December 2012 Notice of Disagreement (NOD); May 2014 Correspondence. The Veteran was afforded an initial VA examination in August 2012. However, the Board previously determined the August 2012 VA examination did not comply with the requirements in Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). See June 2018 Board Remand. In addition, the Veteran had indicated that his service-connected bilateral knee disability had worsened since the August 2012 VA examination. Snuffer v. Gober, 10 Vet. App. 400 (1997); Caffrey v. Brown, 6 Vet. App. 377 (1994) In August 2020, the Board determined the record failed to demonstrate the Veteran was properly notified of a scheduled VA examination and the record established good cause for the Veteran missing the scheduled VA examination. As noted, the Board remanded the issues on appeal to afford the Veteran with an opportunity to attend a new VA examination. The Veteran was afforded a VA examination in October 2020. However, the Board finds that the October 2020 VA examination inadequately addresses the Board’s prior remand directives. See Stegall, 11 Vet. App. at 271. Specifically, the VA examiner did not provide an opinion as to whether the functional impairment due to flare ups and the range of motion measurements for active motion, passive motion, weight-bearing, and non-weight-bearing for both knees could be estimated for the prior VA examination conducted in August 2012. See October 2020 VA examination. The Board requested that the examiner clearly explain if he or she is unable to provide a retrospective opinion as to these findings. Additionally, the VA examiner did not address whether the Veteran’s gout of the bilateral knees were productive of one or two exacerbations a year in a well-established diagnosis; manifest by symptom combinations productive of definitive impairment of health objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year; manifest by weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods; or constitutional manifestations associated with active joint involvement that are totally incapacitating. Id. As noted, the Veteran reported flare ups of his gout and provided private and VA treatment records that demonstrate emergency room visits for treatment of his bilateral knees. See February 2012, August 2012, September 2012 Statements in Support of Claim; December 2012 Notice of Disagreement (NOD); August 2013 and April 2014 private treatment records; May 2014 Correspondence; March 2019 VA treatment records. The VA examiner stated medical review was negative for consistent evidence showing gout negatively impacts the knee joints. See October 2020 VA examination. However, the VA examiner did not provide any further explanation addressing the Veteran’s lay statements, private treatment records, or VA treatment records demonstrating treatment and emergency room visits related to the Veteran’s gout. As such, remand for an addendum VA medical opinion is warranted. See Stegall, 11 Vet. App. at 271. The matters are REMANDED for the following action: Forward the record and a copy of this Remand to the examiner who provided the August 2020 VA examination, or, if that examiner is unavailable, to another suitable qualified examiner, for completion of an addendum opinion. If the examiner determines that a new examination is necessary to provide the requested opinion, such examination should be scheduled. The examiner should address the following: (a.) Provide an opinion as to whether the Veteran’s functional impairment due to flare ups and the range of motion measurements for active motion, passive motion, weight-bearing, and/or non-weight-bearing for both knees can be estimated for the prior VA examination conducted in August 2012. If the examiner is unable to provide a retrospective opinion as to these findings, he or she should clearly explain so in the report. (b.) The examiner must address whether the Veteran’s gout affecting his bilateral knees is productive of one or two exacerbations a year in a well-established diagnosis for any time during the appeal period; (c.) The examiner must address whether the Veteran’s gout affecting his bilateral knees manifested in symptom combinations productive of definitive impairment of health or objectively supported by examination findings or incapacitating exacerbations occurring 3 or more times a year for any time during the appeal period; (d.) The examiner must address whether the Veteran’s gout affecting his bilateral knees manifested in weight loss and anemia productive of severe impairment of health or severely incapacitating exacerbations occurring 4 or more times a year or a lesser number over prolonged periods for any time during the appeal period; (e.) The examiner must address whether the Veteran’s gout affecting his bilateral knees manifested with constitutional manifestations associated with active joint involvement that is totally incapacitating for any time during the appeal period. A complete rationale should be given for all opinions and conclusions expressed. The examiner should specifically consider and address the Veteran’s lay statements regarding experiencing flare ups, VA treatment records, and private treatment records demonstrating visits to an emergency room. See February 2012, August 2012, September 2012 Statements in Support of Claim; December 2012 Notice of Disagreement (NOD); August 2013 and April 2014 private treatment records; May 2014 Correspondence; March 2019 VA treatment records. If the examiner cannot provide an opinion without resorting to speculation, he/she should explain why an opinion cannot be provided. Tiffany Dawson Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. P. Moore, 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.