Citation Nr: 20080997 Decision Date: 12/28/20 Archive Date: 12/28/20 DOCKET NO. 15-26 269 DATE: December 28, 2020 REMANDED Entitlement to a disability rating in excess of 20 percent for painful snapping iliopsoas tendon is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1997 to December 1998. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a June 2014 rating decision. In March 2019, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. The Veteran’s claim for an increased rating was remanded by the Board in August 2019 for further development. Unfortunately, the Veteran’s claim must be remanded yet again. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the Veteran’s claim, so he is afforded every possible consideration. Entitlement to a disability rating in excess of 20 percent for painful snapping iliopsoas tendon is remanded. Pursuant to the Board’s August 2019 remand, the Veteran was afforded a Hip and Thigh Conditions Disability Benefits Questionnaire in November 2019. The Board finds that the November 2019 examination is inadequate as it did not comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017). See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). VA examiners are required to obtain information from the Veteran as to the severity, frequency, and duration of flare-ups, as well as precipitating and alleviating factors, and the extent of functional impairment. Sharp, 29 Vet. App. at 32. VA examiners are also required to estimate the additional loss of range of motion during a flare-up based on all procurable information from the record, as well as the Veteran’s own statements. Id. at 34-35. If an estimate cannot be provided without resort to speculation, it must be clear whether this is due to a lack of knowledge among the medical community at large, or insufficient knowledge of the specific examiner. Id. at 36. The November 2019 examination report states that the Veteran reported flare-ups of his left hip that occur intermittently, are moderate to severe in intensity, and last for one day. The Veteran advised of left hip flare-ups that are precipitated by squatting and are alleviated by Aleve 500 milligrams taken twice daily. The examination report further reflects that the Veteran has constant, irritating pain and some burning sensation and also pain with squatting and bending. The November 2019 examination report provides that the examination is not being conducted during a flare-up and that pain, weakness, fatigability, and incoordination do not significantly limit functional ability with flare-ups. The examination report does not contain a description of the Veteran’s range of motion during a flare-up. It is not clear whether the examiner determined there was no additional loss of range of motion during a flare-up or could not estimate additional loss of range of motion based on the Veteran’s statements describing the flare-ups or the available information in his claims folder. Should the new VA examination be conducted while the Veteran is not experiencing a flare-up of his left hip, the estimation of additional loss of range of motion during a flare-up must be made after obtaining information concerning the severity, frequency, and duration of flare-ups, as well as precipitating and alleviating factors. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from November 2014 to the present. 2. After the above development is completed, schedule the Veteran for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) by an appropriate clinician to determine the current severity of his service-connected painful snapping iliopsoas tendon. (a.) 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. (b.) The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement 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). (c.) To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s painful snapping iliopsoas tendon alone and discuss the effect of it on any occupational functioning and activities of daily living. (d.) 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. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran's statements. If it is not possible to provide a specific measurement 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). P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, 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.