Citation Nr: 21065440 Decision Date: 10/26/21 Archive Date: 10/26/21 DOCKET NO. 17-27 163 DATE: October 26, 2021 REMANDED Entitlement to increase rating in excess of 10 percent for right knee strain with degenerative joint disease (also claimed as knee) is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from March 1981 to January 1989. This matter is before the Board of Veteran's Appeals (Board) on appeal from a January 2017 rating decision by a Department of Veteran Affairs (VA) Regional Office (RO). During the December 2019 VA examination, the Veteran reported functional loss or functional impairment of his right knee and pain associated with transferring positions, kneeling, squatting, sitting two hours, standing, or walking one hour, or climbing one flight of stairs. The examiner indicated that the Veteran had pain on exam, and it caused functional loss. The examiner indicated that the Veteran's right knee was not examined immediately after repetitive use over time. The examiner opined that the examination was neither medically consistent nor inconsistent with the Veteran's statements describing functional loss with repetitive use over time. The Board finds the report of the December 2019 VA examination problematic. In Sharp v. Shulkin, 29 Vet. App. 26, 35 (2017), the United States Court of Appeals for Veterans Claims (Court) spoke to the nature of the evidence at the disposal of most examiners such that estimates of functional loss during flare-ups and repetitive use over time can be made without resorting to speculation. To make such estimates, the examiner must "obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment of flares from the veterans themselves." Id. In other words, it is anticipated that examiners will offer flare and repetitive use opinions based on estimates derived from information procured from relevant sources, including the lay statements of veterans. Id. The December 2019 examiner did not examine the right knee after repetitive use over time and did not consider the Veteran's statements regarding right knee functional impairment after repeated use in order to provide an estimate of ranges of motion after repeated use over time. Additionally, during initial range of motion testing, the examiner indicated that there was pain with flexion that caused functional loss, but he did not indicate where in the range of flexion the pain began. The Board regrets the additional delay; however, it is necessary to ensure that there is a complete record upon which to decide the claim so that the Veteran is afforded every possible consideration. As such, on remand, the Veteran must be afforded a new VA examination to determine the nature and severity of his right knee disability, taking into consideration his statements, the evidence of record, and accepted medical principles. Accordingly, the matter is REMANDED for the following action(s): 1. Obtain updated VA treatment records from October 2020 to the present. 2. Thereafter, schedule the Veteran for a VA examination to assess the current severity of his right knee disability. 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. Range of motion measurements must be included and if pain is noted, the point in the range of motion at which pain starts should be clearly noted. In so doing, 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 and after repeated use over time. 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 or after repeated use over time 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). Please note that the Board cannot accept a rationale that the Veteran is not having a flare-up at the time of the examination or that repetitive use over time was not directly observed to explain why range of motion values cannot be provided. M. SORISIO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Brooks, J. 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.