Citation Nr: 18160183 Decision Date: 12/27/18 Archive Date: 12/26/18 DOCKET NO. 17-05 787 DATE: December 27, 2018 REMANDED Entitlement to a compensable rating for right elbow epicondylitis is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from April 1976 to June 1996. This appeal to the Board of Veteran’s Appeals (Board) arose from an October 2016 rating decision by Department of Veteran Affairs (VA) Regional Office (RO). The Veteran has perfected the appeal. See November 2016 Notice of Disagreement (NOD); December 2016 Statement of the Case (SOC); January 2017 Substantive Appeal (VA Form 9). The Board notes that the Veteran’s claim for a compensable rating for left elbow epicondylitis was granted before the certification of this appeal. This issue is not listed on the June 2017 Certification of Appeal (VA Form 8), thus, that issue is not before the Board. The Board will only address the issue of a compensable rating for right elbow epicondylitis. 1. Entitlement to a compensable rating for right elbow epicondylitis is remanded. After a thorough review of the Veteran's claims file, the Board has determined that additional evidentiary development is necessary prior to the adjudication of the Veteran’s claim of entitlement to a compensable rating for right elbow epicondylitis. The Veteran contends that his right elbow pain warrants a compensable rating. Further, the Veteran asserts that he experiences painful motion due to his right elbow disability; thus, his evaluation should reflect his symptoms. On the recent VA examination in April 2017, the Veteran reported having flare-ups that impacted his function of his elbow. Regarding if pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups, the examiner stated that an opinion cannot be rendered without resorting to mere speculation. The examiner further noted that in order to objectively measure any change, the examiner would need to be present during a flare-up or repetitive use over a period of time. The examiner noted that the examination is neither medically consistent or inconsistent with the Veteran’s statements describing functional loss during flare-ups. The Court held in Sharp v. Shulkin, 29 Vet. App 26 (2017), that if there is evidence of flare-ups with functional loss, and the examiner concludes that an opinion regarding the estimated range of motion cannot be provided without resorting to speculation, VA may rely on that conclusion only if (1) it is clear that the examiner has considered all procurable and assembled data; and (2) the opinion must result from a limitation of the medical community at large and not a limitation based on lack of expertise, insufficient testing, or unprocured testing by the examiner. Id. at 33. The April 2017 VA examination report requires further clarification of the findings and the conclusions contained therein. The Board will remand this claim to obtain an opinion that either attempts to estimate additional functional impairment on flare-ups or provides satisfactory rationale for why such an estimate is not possible. The matter is REMANDED for the following action: 1. Provide the Veteran an opportunity to identify any pertinent treatment records for his right elbow disability. The RO/AMC should secure any necessary authorizations. 2. Additionally, all updated VA treatment records should be obtained. If any requested outstanding records cannot be obtained, the Veteran should be notified of such. 3. Once all available, relevant medical records have been received, and associated with the claims file, schedule the Veteran for an appropriate VA examination or examinations to determine the current nature and severity of his service-connected right elbow disability. The examiner must conduct all indicated tests and studies, to include range of motion studies, as indicated below. a) The elbows must be tested in both active and passive motion, and in weight-bearing and non-weight-bearing. The examiner should identify at what point during the range of motion that pain sets in. 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 must clearly explain why that is so. b) The examiner must describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. c) The examiner must also state whether the examination is taking place during a period of flare-up (e.g., on a "bad day"). If not, the examiner must 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 must provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). d) The examiner is requested to identify the presence, or absence of ankylosis of the right elbow. If the presence of ankylosis is identified, this determination should be expressed in terms of whether the ankylosis is favorable or unfavorable; and, if feasible, in terms of the degrees of flexion or extension in which the left elbow joint is ankylosed. e) The examiner should identify any nerves and muscle groups affected and state whether the level of impairment is characterized as slight, moderate, moderately severe, or severe. If any nerve involvement is wholly sensory, the examiner should so indicate. In answering all questions, please articulate the reasons underpinning every conclusion. That is, (1) identify what facts and information, whether found in the record or outside the record, support the conclusion, and (2) explain how that evidence justifies the conclusion. 4. Then, review the record, conduct any additional development deemed necessary, and readjudicate the claim. If any benefit sought remains denied, furnish to the Veteran and his representative an appropriate supplemental statement of the case (SSOC). The Veteran and his representative should be afforded the appropriate time period to respond. Thereafter, if indicated, the case should be returned to the Board for the purpose of appellate disposition. DEBORAH W. SINGLETON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Syesa Middleton, Associate Counsel