Citation Nr: A21008372 Decision Date: 04/26/21 Archive Date: 04/26/21 DOCKET NO. 201130-129576 DATE: April 26, 2021 REMANDED Entitlement to an evaluation in excess of 30 percent from December 1, 2020 for residuals of a left total knee replacement is remanded. REASONS FOR REMAND The Veteran had active service from June 1962 to October 1984. The Veteran has been awarded service connection for a left knee disability since 2014. In October 2019, the Veteran underwent total left knee replacement. The Regional Office (RO) assigned a temporary 100 percent disability evaluation for the left knee under Diagnostic Code 5055 from December 1, 2019 to November 30, 2020. From December 1, 2020, the RO assigned a 30 percent disability rating for residuals of total left knee replacement. The Veteran submitted a claim for increased rating related to the left knee replacement in December 2019. The RO issued the decision in March 2020. The Veteran submitted a notice of disagreement and perfected an appeal with a VA Form 10182 in February 2021. The Board notes that the Veteran’s 100 percent temporary rating ended November 30, 2020, but the most recent VA examination of the left knee was in February 2020. 38 C.F.R. § 4.30 states that after a convalescent period, “when the evidence is inadequate to assign a schedular evaluation, a physical examination will be scheduled and considered prior to the termination of a total rating under this section.” The RO had opened a scheduling request in January 2021 for the Veteran for an updated VA examination for the left knee, but subsequently cancelled for reasons unclear to the Board. The Veteran has submitted medical documentation dated November 5, 2020 indicating that he must undergo another total knee replacement due to a failure of the first total left knee replacement. The RO failure to obtain a VA examination for the left knee following a one-year total convalescent rating and in light of a proposed second left knee total replacement constitutes a pre-decisional duty to assist error in the Veteran’s case. The matter is REMANDED for the following action: 1. With the Veteran’s assistance, obtain any private or VA recent medical records relevant to the Veteran’s left knee disability and proposed second total knee replacement. 2. At the appropriate time in consideration of the possible additional left knee total replacement, schedule the Veteran for a VA examination of the left knee. A copy of this decision and remand and all relevant medical and other (lay) records must be made available to the examiner. The examiner must review the pertinent evidence, including the Veteran’s lay assertions, and undertake all indicated studies. The examiner must report all signs and symptoms necessary for rating the Veteran’s left knee disability under the rating criteria. In particular, the examiner should provide the range of motion in degrees of this knee. In so doing, the examiner should test the Veteran’s range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing, where possible. The presence of objective evidence of pain, premature or excess fatigability, incoordination and weakness should also 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. Romina A. Casadei Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Miller, 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.