Citation Nr: 22018708 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 15-42 183 DATE: March 30, 2022 REMANDED Entitlement to a rating in excess of 10 percent prior to May 1, 2015, and in excess of 20 percent from May 1, 2015, to October 3, 2017, for instability of the left knee is remanded. Entitlement to a rating in excess of 30 percent from December 1, 2018, for left knee total arthroplasty is remanded. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1973 to January 1976. These matters were most recently remanded in July 2021 to afford the Veteran a new examination for his left knee. 1. Entitlement to a rating in excess of 10 percent prior to May 1, 2015, and in excess of 20 percent from May 1, 2015, to October 3, 2017, for instability of the left knee is remanded. 2. Entitlement to a rating in excess of 30 percent from December 1, 2018, for left knee total arthroplasty is remanded. 3. Entitlement to a total rating based on individual unemployability due to service-connected disability (TDIU) is remanded. In November 2021, the Veteran reported for a VA examination regarding his left knee disability. The examiner noted that there was a history of left knee pain, swelling and instability that worsened over time until the total left knee arthroplasty in October 2017. The examiner noted a diagnosis of knee instability in 2017 and in the opinion on the Veteran's left knee affecting his ability to work noted "mild instability" of the knee as unlikely to be the primary cause of knee pain. It is unclear if the mild instability refers to the Veteran's current status or the period prior to October 3, 2017. Furthermore, the opinion contradicts itself as the examiner goes on to note that there is no history of instability in the left knee. The Board notes the March 2015 VA Examination reported the Veteran had swelling of the left knee, frequent episodes of joint locking, and a meniscal tear. Additionally, the examiner noted there was no evidence to suggest pain, fatigue, or other symptoms that may limit the Veteran's functional ability and did not provide an estimated range of motion. During the examination, the Veteran stated that he experienced pain during flare-ups. As the November 2021 VA Examination is medically inconsistent and did not address the severity of any knee instability prior to October 3, 2017 and did not provide an estimate for functional loss during flare-ups, a remand is warranted. As the issue of TDIU is intertwined with the Veteran's left knee, it must be remanded. The matters are REMANDED for the following action: 1. Schedule the Veteran for the appropriate VA examination to assess the severity of his service-connected left knee. The claims folder and all pertinent medical records should be made available to the examiner for review. All necessary diagnostic testing should be performed. The examiner must make determinations regarding range of motion, including any additional functional impairment. The examiner MUST attempt to elicit information regarding functional loss due to flare-ups and repeated use over time. If the Veteran suffers from such loss, the examiner should express the loss in terms of degrees of additional loss in range of motion (i.e., in addition to that observed clinically), if feasible, taking into account all of the evidence, including the Veteran's competent statements with respect to the frequency, duration, characteristics, and severity of his limitations. 2. The examiner MUST comment on the severity of the Veteran's knee instability prior to October 3, 2017. As the Veteran was rated for knee instability at the time, the examiner must assume there was instability in the knee prior to the knee arthroplasty. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran's claims should be readjudicated based on the entirety of the evidence. If any benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case. An appropriate period of time should be allowed for response. B. G. LeMoine Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.