Citation Nr: 18145891
Decision Date: 10/30/18	Archive Date: 10/30/18

DOCKET NO. 09-21 124
DATE:	October 30, 2018
REMANDED
Entitlement to an initial disability rating in excess of 10 percent for left knee patellar tendonitis (left knee disability) is remanded.
Entitlement to an initial disability rating in excess of 10 percent for left sacroiliitis (back disability) is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from February 2002 to January 2006.
This appeal was most recently before the Board in October 2017, at which time both issues were remanded for VA examinations.  The Veteran was afforded VA examinations for her spine and left knee in November 2017.  At that time, the examiner was unable to determine how much the Veteran’s pain in her spine and left knee impacted her functionality in terms of range of motion, as the Veteran was not being examined immediately after repetitive use after time.  The examiner was also unable to determine how much the Veteran’s pain limited her functional ability with flare-ups, reasoning that the Veteran was not being examined during a flare up and there was no history of flare-ups.
The Board finds that this examination is inadequate for rating purposes.  In previous VA examinations, the Veteran is noted to have a history of flare ups of pain in her spine and left knee that appeared to cause some degree of functional impairment.  See February 2011 VA Examinations.  In addition, it does not appear that the November 2017 VA examiner attempted to determine the extent of limitation the Veteran’s pain caused in her back and left knee.  See Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017) (the Court held that, pursuant to VA regulations and the VA Clinician’s Guide, when conducting evaluations for musculoskeletal disabilities, VA examiners are obligated to inquire whether there are periods of flare-ups and, if the answer is yes, to state their “severity, frequency, and duration; name the precipitating and alleviating factors; and estimate, ‘per [the] veteran,’ to what extent, if any, they affect functional impairment”).  In light of Sharp, a new examination is necessary.
The matters are REMANDED for the following action:
1. Contact the Veteran, and with her assistance, identify any outstanding records of pertinent medical treatment from VA or private health care providers since October 2017 to the present.
2. After completing the development above, afford the Veteran an appropriate VA examination to determine the nature and severity of her service-connected left knee and low back disabilities.
In order to comply with Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), the examiner is asked to describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use.  If the examination does not take place during a flare, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees.  If there is no pain and/or no limitation of function, such facts must be noted in the report.  The examiner should comment as to whether there is any medical reason to accept or reject the Veteran’s description of reduced range of motion during flares or repetitive use.
Also, in order to comply with the Court’s decision in Correia v. McDonald, 28 Vet. App. 158 (2016), the VA examination must include range of motion testing in the following areas:
•	Active motion;
•	Passive motion;
•	Weight-bearing; and
•	Nonweight-bearing.
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 VA examiner should provide a complete rationale for any opinions provided.



3. Readjudicate the claims on appeal.  If the claims are not granted to the Veteran’s satisfaction, provide her and her representative a Supplemental Statement of the Case and allow them the appropriate time to respond before returning the appeal to the Board.
 
T. MAINELLI
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	C. Orie, Associate Counsel