Citation Nr: 21005043 Decision Date: 01/28/21 Archive Date: 01/28/21 DOCKET NO. 13-18 220 DATE: January 28, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for left knee retropatellar pain syndrome (left knee disability) is remanded. Entitlement to an initial rating in excess of 10 percent for a right knee retropatellar pain syndrome (right knee disability) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from October 2002 to July 2011. This matter comes before the Board of Veterans’ Appeals (Board) from a January 2012 rating decision by a Department of Veterans Affairs (VA) Regional Office. The Board remanded the appeal in August 2017 and December 2019. 1. Entitlement to a rating in excess of 10 percent for a left knee disability is remanded. 2. Entitlement to a rating in excess of 10 percent for a right knee disability is remanded. The Veteran has reported experiencing flare-ups in his left and right knees. See September 2020 IHP; March 2020 VA physical therapy note; February 2020 VA examination; November 2019 IHP; January 2019 VA examination; August 2017 IHP. In December 2019, the Board remanded the matter for a VA examination and requested the examiner to measure the severity, frequency, and duration of the Veteran’s flare-ups, or in the alternative, to provide an estimate or explain why an estimate was not possible if the examiner could not provide a specific measurement, consistent with Sharp v. Shulkin, 29 Vet. App. 26 (2017). The subsequent February 2020 examiner noted that the examination was not conducted during a flare-up and therefore could not opine on loss of function or motion due to flare-ups. The examiner’s findings are inadequate, as VA’s own Clinician’s Guide instructs examiners to estimate, “per [the] veteran,” what extent, if any, flare-ups affect functional impairment. In other words, examiners should elicit relevant history from the Veteran and estimate functional loss. Thus, the examiner’s opinion is insufficient in light of Sharp, and a remand for an addendum opinion is needed to comply with the Board’s December 2019 remand instructions. Updated treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Then obtain an addendum opinion from a VA examiner other than the February 2020 and January 2019 examiners. No further examination is necessary unless deemed otherwise by the examiner. The entire claims file should be made available to and be reviewed by the examiner. After reviewing the claims file, the examiner should address the following: Considering the Veteran’s reported history during the June 2011, January 2019 and February 2020 VA examinations, please provide an opinion describing functional impairment of the Veteran’s left and right knee disabilities due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms of additional degrees of limitation of motion. If the examiner is unable to provide such an opinion without resorting to mere speculation, the examiner must provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician’s Guide to estimate, “per [the] veteran,” what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation (e.g., lack of insufficient information/evidence, the limits of medical knowledge, etc.). S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. deBruyn, 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.