Citation Nr: 23009727 Decision Date: 02/15/23 Archive Date: 02/15/23 DOCKET NO. 17-44 691 DATE: February 15, 2023 REMANDED An initial rating more than 10 percent for a left knee disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1966 to July 1970, to include service in the Republic of Vietnam. His appeal is before the Board of Veterans' Appeals (Board) from a July 2016 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In March 2019 and September 2021, the Board remanded this matter for further development. The Veteran contends that an initial rating greater than 10 percent for his left knee condition is warranted. In support, the Veteran reported pain, stiffness, weakness, popping and flare ups. See Notice of disagreement (September 2016); VA medical examinations (July 2021 and February 2022). In September 2021, the Board remanded this matter for a medical examination. Specifically, the Board instructed the examiner to provide a retrospective opinion describing the Veteran left knee flare ups. See Vigil v. Peake, 22 Vet. App. 63 (2008) (holding that the duty to assist may include development of medical evidence through a retrospective medical evaluation where there is a lack of medical evidence for the relevant time period). In February 2022, the Veteran was provided a medical evaluation where the examiner stated that the Veteran suffers from daily flare ups with decrease mobility. Then, in April 2022, the examiner provided an addendum stating that the Veteran does not have any additional loss of range of motion with flare ups. See VA medical examinations (February and April 2022). This examination and addendum are inadequate, in part, since there is credible evidence that the Veteran experiences decreased mobility, and limitation of motion during his flare-ups that were not properly discussed in the February and April 2022 examinations. See VA medical examination (February and April 2022). Additionally, the examiner did not comply with the September 2021 Board remand instructions to provide the severity, frequency, and duration of flare ups with precipitating and alleviating factors. Moreover, the examiner did not provide a retrospective opinion or a complete rationale to discuss the severity of the Veteran's left knee condition throughout the appeal. This evidence is necessary to resolve the issue on appeal. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned); see also Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007) (holding that a medical opinion must be supported by an analysis that the Board can consider and weigh against contrary opinions). On remand, the examiner must provide a complete rationale for the Board to properly address the current and past severity of the conditions on appeal, including during episodes of flare ups. See Stegall v. West, 11 Vet. App. 268 (1999). Thus, the Veteran must be afforded a complete examination to determine the severity and impact of his left knee condition, specifically during flare ups. The matter is REMANDED for the following action: 1. Review and comply with the March 2019 and September 2021 Board remands instructions. 2. Obtain complete VA and non-VA treatment records of the Veteran's left knee condition. Notify the Veteran that he may submit additional lay statements from himself and from other individuals who have first-hand knowledge, and/or were contemporaneously informed of the severity of his left knee problems. The Veteran shall be provided an appropriate amount of time to submit this lay evidence. 3. Schedule a VA examination with an examiner other than the February and April 2022 examiner (or telehealth interview, review of the record, etc. if an in-person examination is not feasible). The examiner must determine the severity and impact of the Veteran's service-connected left knee condition. The examiner shall provide a full description of his left knee condition, severity and report all signs and symptoms necessary for evaluating the Veteran's disability. In doing so, the examiner must specifically acknowledge and discuss the Veteran's medical and competent lay reports regarding the severity of his left knee condition during flare ups. The examiner shall identify all left knee condition conditions impairment found to be present. 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 will clearly explain why that is so. The examiner shall describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner shall also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner will provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. In responding to the above inquiries, the examiner must review all the competent medical and lay evidence related to the Veteran's left knee condition. If unable to render a medical opinion, provide a statement as to whether there is any additional evidence that could enable an opinion to be provided, or whether the inability to provide the opinion is based on the limits of medical knowledge. The examiner must take into consideration the credible lay evidence of record and provide a complete rationale and explanation for all opinions reached. If the examiner is unable to provide any requested opinion without resort to speculation, he or she must explain why this is so. SHAUN S. SPERANZA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Alvarado- 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.