Citation Nr: 18140635 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 16-25 978 DATE: REMANDED Entitlement to a rating in excess of 10 percent for left knee chondromalacia with degenerative joint disease is remanded. Entitlement to a rating in excess of 10 percent for right knee chondromalacia with degenerative joint disease is remanded. Entitlement to a compensable rating for right bundle branch block is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1978 to July 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a September 2014 rating decision. 1. Entitlement to an increased rating for left knee chondromalacia with degenerative joint disease is remanded. 2. Entitlement to an increased rating for right knee chondromalacia with degenerative joint disease is remanded. While the record contains a relatively recent VA examination regarding the Veteran’s bilateral knee disability, the December 2016 VA examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The examiner did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups. Additionally, while the examiner stated that an opinion could not be provided without resort to speculation, the examiner did not indicate that the speculation was due to lack of knowledge within the medical community. 3. Entitlement to an increased rating for right bundle branch block is remanded. A December 2016 VA examination reflects that the Veteran denied angina, dyspnea, fatigue, dizziness, or syncope. The examination report further indicates that the Veteran’s heart disability does not require continuous medication. An exercise stress test was not performed, as it was not clinically indicated. An interview-based METs test indicates that the Veteran denied experiencing symptoms attributable to a cardiac condition with any level of physical activity. These findings are consistent with those of a prior May 2014 VA examination. The December 2016 VA examiner noted that the Veteran had been notified of a left axis deviation, which is unrelated to his service-connected heart disability. The December 2016 VA examination, however, does not show adequate consideration of the relevant evidence. Specifically, it ignores the Veteran’s report of occasional minor chest pains, anxiety, and dizziness. See May 2016 substantive appeal. To the extent that the VA examination was based on an inaccurate or incomplete factual basis, the Board finds that a new VA examination is warranted. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination of the current severity of his service-connected bilateral knee disability. 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. To the extent possible, the examiner should identify any symptoms and functional impairments due to the bilateral knee disability alone and discuss the effect of the Veteran’s bilateral knee disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected heart 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 attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the heart disability alone and discuss the effect of the Veteran’s heart disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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 the Veteran’s report of occasional minor chest pains, anxiety, and dizziness. See May 2016 substantive appeal. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD P. López, Associate Counsel