Citation Nr: 18148073 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 16-31 051 DATE: November 6, 2018 REMANDED Entitlement to an increased rating exceeding 30 percent for service connected left knee arthritis status-post left total knee arthroplasty (“left knee disability”) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to August 1980. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. Entitlement to an initial increased rating exceeding 30 percent for service connected left knee arthritis status-post left total knee arthroplasty is remanded. The Board notes that the Veteran has received several temporary evaluations of 100 percent for his left knee disability, however, these temporary rating periods are not on appeal. Regarding the rating period on appeal, the Board must reconsider this case in light of Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). Correia provides a precedential finding that the final sentence of 38 C.F.R. § 4.59 requires VA examinations of the musculoskeletal system to include testing as for both active and passive motion, in weight-bearing and nonweight-bearing, and if possible, with range of motion measurements of the opposite undamaged joint. The Board has reviewed the findings in the Veteran’s VA examinations of record, dated November 2012, November 2013, and October 2015, for his service-connected left knee disability and finds that these findings do not meet the specifications of Correia. Specifically, the examiners did not discuss nor address whether the range-of-motion testing was conducted on active or passive motion, and weight-bearing or nonweight-bearing. Given this, the Board is not satisfied that any examinations of record are adequate for determining whether the current rating for the Veteran’s left knee disability should be increased. Additionally, Sharp requires, when a Veteran complains of flare-ups, the examiner must “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.” 29 Vet. App. at 10-11. If feasible, functional loss due to flare-ups should be expressed in terms of the degree of additional range-of-motion loss. If the examiner cannot express functional loss in this manner without resorting to speculation, he/she must explain the basis for his or her conclusion that a non-speculative opinion cannot be offered. Furthermore, in situations where an examination is not conducted during a flare-up, a VA examiner should estimate functional loss based on the Veteran’s descriptions of his/her additional loss of function during flare-ups, gleaned from his/her medical records, or discerned from other sources available to the examiner. Id. at 35-36. In the November 2013 VA examination, the Veteran reported flare-ups of his left knee disability occurring once or twice a week; however, the examination does not indicate whether it was conducted during a flare-up. If so, the examination does not provide findings that include their severity, frequency, and duration, nor do they provide to what extent they affect his functional impairment. Conversely, if not, the examination fails to show the examiner ascertained the required information as to the severity, frequency, duration, characteristics, or functional loss regarding his flare-ups by alternative means. The Veteran did not report flare-ups in the VA examinations conducted in November 2012 and October 2015, thus the Board finds Sharp is inapplicable for these examinations. Therefore, the Board finds that an additional examination is necessary to gather such information to adequately understand the Veteran’s additional and/or increased symptoms and limitations, pursuant to Correia and Sharp, and under 38 C.F.R. § 3.159(c)(4). The matter is REMANDED for the following action: 1. Request the Veteran to identify all medical providers (VA and private) from whom he has received treatment for his left knee disability, and obtain any outstanding records and associate them with the Veteran’s claims file. 2. After associating all newly acquired records with the claims file, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his left knee disability. The claims file, including a copy of this remand, must be made available to the examiner in conjunction with the examination, and the examiner should note review of the record in the examination report. All pertinent medical complaints, symptoms, and clinical findings must be reported in detail. 3. The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and non-weight-bearing, and if possible, with range of motion measurements of the opposite undamaged joint. The examiner should report (in degrees) the point at which pain is objectively recorded. The examiner must also attempt to elicit information, based on all the evidence of record, regarding the severity, frequency, and duration of any flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s left knee disability, and report or estimate functional loss in terms of the degree of additional loss of range of motion. If the examiner cannot express functional loss in this manner without resorting to speculation, he/she must explain the basis for his/her conclusion that a non-speculative opinion cannot be offered. The examiner must provide a complete rationale for any opinion given. M. H. HAWLEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Hodges, Associate Counsel