Citation Nr: 21003727 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 16-58 504A DATE: January 22, 2021 REMANDED Entitlement to a rating in excess of 10 percent for chondromalacia of the left knee (left knee disability) is remanded. Entitlement to a rating in excess of 10 percent for chondromalacia of the right knee (right knee disability) is remanded. REASONS FOR REMAND The Veteran had active duty service from August 1987 to May 1990. He passed away in December 2016 and the Appellant, his surviving spouse, has been substituted as the claimant. These matters come before the Board of Veterans' Appeals (Board) on appeal from a May 2016 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO), which continued the previous 10 percent disability ratings for right and left knee disabilities, respectively. In August 2020, the Appellant testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. Following the August 2020 hearing, the record reflects that the Appellant was sent a letter indicating that she could request a virtual tele-hearing instead of waiting for a travel Board hearing. Upon further review, the Appellant did not have a pending hearing request, as she provided testimony in a hearing with the undersigned Veterans Law Judge on August 17, 2020. The transcript of that hearing is of record. 1. Entitlement to a rating in excess of 10 percent for chondromalacia of the left knee is remanded. 2. Entitlement to a rating in excess of 10 percent for chondromalacia of the right knee is remanded. After a review of the evidence, the Board finds that a remand is necessary for an adequate medical opinion to be obtained in order to assess the severity of the Veteran's bilateral knee disabilities. Although the Veteran was afforded a VA Knee and Lower Leg Conditions Disability Benefits Questionnaire in February 2016 to determine the current severity of his left and right knee disabilities, the Board finds that the VA examination is inadequate. 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); D'Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination must be based on consideration of the claimant's medical history and must describe the disability in sufficient detail so that the Board's evaluation of the disability will be a fully informed one). A retrospective addendum medical opinion must be provided to comply with Sharp v. Shulkin, 29 Vet. App. 26 (2017). 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 February 2016 examination report indicates that the Veteran experienced flare ups. Specifically, he stated that his knee pain prevented him from walking longer distances because his knees would start hurting. However, because the examination was not conducted during a flare-up, the examiner reported that she was unable to say without mere speculation whether pain, weakness, fatigability or incoordination significantly limited functional ability with flare ups; nor was she able to describe any additional function loss in terms of range of motion. It is not apparent why the examiner could not estimate additional loss of range of motion based on the Veteran's statements describing the flare ups, or why the available information in the file was not sufficient to permit such an estimate. Accordingly, the Board finds that a records review and medical opinion should be obtained on remand. Further, the Veteran’s VA treatment records dated from September 2016 until his death in December 2016 should be obtained. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records, dated from September 2016 until his death in December 2016. 2. Forward the claims file, including a copy of this remand, for an addendum opinion. The claims file, including this remand, should be reviewed by the examiner and such review should be noted in the examination report. The examiner must provide a retrospective medical opinion, as best as can be ascertained from a review of the Veteran's self-reports, his VA treatment records, the February 2016 VA examination report, and the Appellant’s testimony in August 2020. The retrospective opinion must estimate any additional degrees of limited motion of the Veteran’s knees caused by functional loss during a flare-up for the time period from January 2016 to December 2016. 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). The examiner should provide a comprehensive rationale for all opinion(s) provided. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Gonzalez 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.