Citation Nr: 22012736 Decision Date: 03/07/22 Archive Date: 03/07/22 DOCKET NO. 17-27 443 DATE: March 7, 2022 REMANDED Entitlement to a disability rating in excess of 30 percent for total left knee arthroplasty is remanded. Entitlement to a total disability rating based on unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran had active service in the United States Air Force from October 1981 to October 2001. These matters come before the Board of Veterans' Appeals (Board) from a July 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In October 2019, the Veteran testified before the undersigned Veterans Law Judge. A copy of the transcript is associated with the claims file. This matter was previously remanded by the Board for further development in November 2019 and July 2021. The matters return for appellate consideration. In July 2021, the Board requested that the RO send the Veteran a VA Form 21-8940 in support of his TDIU claim. The Board finds there has been substantial compliance in this regard. Stegall v. West, 11 Vet. App. 268 (1998). 1. Entitlement to a disability rating in excess of 30 percent for total left knee arthroplasty is remanded. The Veteran contends that his left knee disability is more disabling than contemplated in the assigned evaluation. In the July 2021 remand, the Board determined that an addendum opinion was necessary to determine the Veteran's passive range of motion measurements as the February 2020 examination demonstrated objective evidence of pain on passive range of motion and non-weight bearing testing. Pursuant to the remand, an October 2021 VA addendum opinion was obtained. The examiner noted status post total left knee arthroplasty with residual pain, stiffness, and impaired gait; however, the examiner indicated that the Veteran "could not reliably determine and demonstrate [range of motion] loss during a flare up or after repetitive use." In addition, the examiner noted medical records did not sufficiently identify previous range of motion during flare ups or after repetitive motion, and that general medical knowledge of the Veteran's joint condition is insufficient to reasonably estimate range of motion for each plane of motion as there is great variability between claimants who have the same condition. Lastly, the examiner concluded that pain, weakness, fatigability, or incoordination does not significantly limit functional ability during flare ups or when the joint is used repeatedly over time. The Board finds that the October 2021 VA opinion is inadequate because the examiner's conclusion is inconsistent with the medical evidence of record. The examiner concluded the Veteran could not reliably determine and demonstrate range of motion loss during a flare up or after repetitive use, and that medical records did not sufficiently identify previous range of motion during flare ups or after repetitive motion. However, this is inaccurate as previous VA examination reports in June 2016 and February 2020 document functional loss in the left knee during repeated use over time and flare ups, and quantified measurements as flexion limited to 90 degrees and extension to 0 degrees. Additionally, the Board is unclear regarding the examiner's inability to express estimated range of motion measurements for each plane of motion in the Veteran's left knee and its relation to others with the same condition. The Board finds that medical evidence of record along with the Veteran's lay statements regarding decreased functional use, i.e., flexion previously limited to 130 degrees and currently to 90 degrees, was not properly considered and evaluated in the October 2021 VA opinion. See August 2020 Correspondence. As such, an addendum opinion, addressing all medical evidence and lay statements, is needed to assess the Veteran's passive range of motion measurements in the left knee. If another examination is warranted to comply with the Board's remand, another examination should be scheduled. 2. Entitlement to a TDIU is remanded. Finally, because a decision on the remanded issue discussed above could significantly impact a decision on the issue of entitlement to a TDIU, the issues are inextricably intertwined. As such, a decision on the claim for a TDIU would be premature, and a remand is also required pending resolution of the intertwined claim. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from the October 2021 VA examiner or another appropriate clinician. The examiner providing the opinion must be provided access to the electronic claims file and indicate review of the file in the examination report. The claims folder and a copy of this remand in its entirety must be provided to the examiner in conjunction with the addendum opinion. The examiner is requested to review all pertinent records associated with the claims file, and the examiner must indicate on the examination report that such review was undertaken. If examination of the Veteran is necessary, such should be arranged. To comply with the Correia v. McDonald, the examiner must test and record the range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing of both knees. 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. The examiner should note that the June 2016 and February 2020 VA examination reports show left knee range of motion measurements during repeated use over time and flare ups. The examiner should also consider the Veteran's statements in August 2020 regarding decreased flexion as well as pain and instability following his total knee revision. 2. Readjudicate the Veteran's claims on appeal. If the benefits sought on appeal remain denied, provide the Veteran and his representative a supplemental statement of the case and allow an appropriate period for response. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Y. Asfaw, 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.