Citation Nr: 20009673 Decision Date: 02/06/20 Archive Date: 02/05/20 DOCKET NO. 17-23 926 DATE: February 6, 2020 REMANDED Entitlement to a rating in excess of 10 percent for left knee patellar tendonitis is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1987 to December 2009. This matter comes before the Board of Veterans’ Appeals (Board) from a June 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran is seeking a disability rating in excess of 10 percent for left knee patellar tendonitis. Specifically, the Veteran contends that his left knee disability causes him constant pain, sharp and stabbing, with associated stiffness, popping, swelling, and grinding. Based on a review of the claims folder, the Board finds that additional development is needed prior to adjudication of the claims. The Veteran underwent a VA examination of his left knee for compensation and pension purposes in May 2018. During the examination, the Veteran reported that he experienced flare-ups of pain in the knees in the mornings and evenings, during which time his pain would reportedly increase from a seven to eight on the pain scale. The VA examiner indicated that the examinations were not performed during periods of flare-ups and that he was unable to say without mere speculation whether pain, weakness, fatigue, or incoordination significantly limited the functional ability of the Veteran’s left knee during flare-ups. The examiner explained that he was unable to evaluate the Veteran’s functional ability during a flare. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court clarified the responsibilities of a VA examiner and the Board when an examiner is asked to provide an opinion as to additional functional loss during flare-ups of musculoskeletal disability pursuant to DeLuca v. Brown, 8 Vet. App. 202 (1995). Case law and VA guidelines anticipate that examiners will offer flare-up opinions based on estimates derived from information procured from relevant sources, including lay (non-expert) statements. An examiner must do all that reasonably should be done to become informed before concluding that a requested opinion cannot be provided without resorting to speculation. Sharp found a VA examination to be inadequate because the examiner, although acknowledging that the veteran was not then suffering from a flare-up of any of his conditions, failed to ascertain adequate information, such as frequency, duration, characteristics, severity, and functional loss, regarding the flare-ups by alternative means. The Veteran’s reports of increased knee pain upon flare-ups is suggestive that his range of motion is further restricted during flare-ups. Therefore, the Board finds that remand is warranted for a VA examination that follows the guidelines of Sharp. The matters are REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s claims. 2. Schedule the Veteran for an appropriate VA examination to assess the manifestations of the left knee disability. The Veteran’s electronic claims file must be made available for review prior to the examinations and the examination reports should reflect that such review was accomplished. All testing deemed necessary to rate the left knee disability under the criteria of the VA rating schedule must be conducted and the results reported in detail. The examiner is asked to indicate the point during range-of-motion testing that motion is limited by pain. The examiner should test the range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing for the left knee. If an examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should explain why. The examiner should describe the extent of any functional loss due to weakened movement, excess fatigability, incoordination, or pain on use, and should state whether any pain claimed by the Veteran is supported by adequate pathology and/or is evidenced by visible behavior such as facial expression or wincing. The examiner should express an opinion as to whether pain or other manifestations during flare-ups or with repeated use could significantly limit functional ability of the affected part. The examiner should portray the degree of any additional range-of-motion loss due to pain on repeated use or during flare-ups. If no estimate can be provided, the examiners should provide a sufficiently detailed explanation as to why. If the Veteran is not suffering from a flare-up of his left knee at the time of the examination, the examiner must attempt to ascertain information, such as frequency, duration, characteristics, severity, and functional loss, regarding any flare-ups by alternative means and to estimate the functional impact of any flare-ups in terms of range of motion on the basis of that information. 3. After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the claim should be readjudicated based on the entirety of the evidence. If the benefit sought on appeal remains denied, furnish the Veteran and his representative a supplemental statement of the case (SSOC) and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Hughes, Law Clerk 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.