Citation Nr: 21028560 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-02 043 DATE: May 11, 2021 REMANDED Entitlement to a rating in excess of 20 percent for left knee derangement is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) on an extraschedular basis is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1979 to October 1980. These matters come before the Board of Veterans' Appeals (Board) on appeal from a rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO) that, in relevant part, denied entitlement to a rating in excess of 20 percent for left knee derangement in April 2009, and denied entitlement to extraschedular TDIU in September 2013. The Veteran testified at a hearing before the undersigned in July 2016. These matters were previously remanded by the Board in November 2017 and again in August 2020. The case has been returned to the Board at this time for further appellate review. 1. Entitlement to a rating in excess of 20 percent for left knee derangement is remanded. The Board's August 2020 remand directed the AOJ to obtain a new VA examination evaluating the Veteran's left knee condition, claimed as left knee derangement. The subsequent October 2020 medical examination reported range of motion findings different from the Veteran's multiple prior exams. The flexion and extension measurements are approximately 60-100 degrees greater than any other measurement in the Veteran's record since 2009. The Veteran's record does not reflect any significant interventions that may have caused a dramatic improvement, nor does examiner did provide any explanation for this discrepancy. The examiner also reported that there was no additional loss of function or range of motion after repetitive testing, which is also inconsistent with several former examinations. Therefore, the Board finds an new VA examination is necessary to accurately address the severity of the Veteran's left knee disability. 2. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. After readjudication of the TDIU issue following the August 2020 remand, the AOJ granted entitlement to schedular TDIU in November 2020, effective June 13, 2016. The AOJ referred the remaining extraschedular period prior to June 13, 2016 to the Director of Compensation Services (Director), who denied extraschedular TDIU entitlement. Because an increased rating of the Veteran's left knee condition could entitle him to additional schedular TDIU which would overlap with period for which only extraschedular TDIU was previously available, the Board finds that the issue of TDIU is inextricably intertwined with the issue of the left knee derangement rating, and therefore must also be remanded. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding that where a decision on one issue would have a "significant impact" upon another, and that impact in turn could render any appellate review on the other claim meaningless and a waste of judicial resources, the two claims are inextricably intertwined). The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left knee disability. 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. 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). The examiner must 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 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). The examiner must consider and address the significant discrepancies between the Veteran's functional testing in October 2020 and prior examinations/measurements, including limitations in range of motion between 0-40 degrees from March 2009 to October 2018, and reported increases of weakness, pain, incoordination, and limitation in motion accompanying those reports. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. 2. Following any additional indicated development, the AOJ should review the claims file and readjudicate entitlement to a TDIU. If the benefits sought on appeal remain denied, the Veteran and his representative should be furnished a supplemental statement of the case and given the opportunity to respond thereto before the case is returned to the Board. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Narnor, Harriyah 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.