Citation Nr: 21075429 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 19-02 302 DATE: December 20, 2021 REMANDED Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome is remanded. Entitlement to a rating in excess of 10 percent for chondromalacia patella of the right knee is remanded. REASONS FOR REMAND The Veteran had active duty service from March 2004 to November 2014. This matter comes to the Board of Veterans' Appeals (Board) from a rating decision dated in July 2016 of a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ). The Veteran testified at a Board hearing in October 2020. A copy of the transcript has been associated with the record. The Board notes that the Veteran initially filed a Notice of Disagreement (NOD) regarding the rating of his right wrist disability. However, in his January 2019 VA Form 9, he did not identify the wrist rating as still being on appeal. Therefore, that issue is not properly before the Board. Additionally, in January 2019, the Veteran filed a NOD regarding the ratings for his headache disability and posttraumatic stress disorder, and service connection for a back disability. Those issues have not yet been adjudicated by the AOJ in a Statement of the Case (SOC), nor has the Veteran had the opportunity to file a VA Form 9 after issuance of the SOC. Therefore, those issues are not ripe for review by the Board. The Board sincerely apologizes for any additional delay in rendering a decision for the knee claims on appeal; however, to ensure the Veteran is afforded every opportunity to substantiate his claims, a remand is required. 1. Entitlement to a rating in excess of 10 percent for left knee patellofemoral syndrome is remanded. 2. Entitlement to a rating in excess of 10 percent for chondromalacia patella of the right knee is remanded. The Veteran underwent VA examinations for his knee disabilities in May 2016 and August 2018. The Board concludes that the examinations of record are inadequate for rating purposes. In order to be adequate, VA examiners must provide opinions regarding flare-ups based upon estimates derived from information procured from relevant sources, including lay statements, when a flare-up is not observable at the time of examination. Sharp v. Shulkin, 29 Vet. App. 26 (2017). At both VA examinations, the Veteran reported that he experienced flare-ups of both knees. Neither the May 2016 VA examination report nor the August 2018 VA examination report includes estimates of functional ability with flare-ups or repetitive use over time. Notably, the Veteran reported limited functionality of his knees during a flare. Under Sharp, before a VA examiner opines that he or she cannot offer an opinion as to additional functional loss during flare-ups without resorting to speculation, the examiner must "[E]licit relevant information as to the veteran's flares or ask him to describe the additional functional loss, if any, he suffered during flares[.]" Sharp, 29 Vet. App. at 35. The Board notes that the examiner did not consider the relevant information obtained from the Veteran prior to the examinations concluding that estimates could not be made. Additionally, the examiner should have elicited additional information, such as how far the Veteran can flex and extend his knees during a flare-up, or whether the flare-up was akin to functional ankylosis. In other words, the examiner did not elicit sufficient information regarding flares in order to estimate the average limitation of range of motion or which rating criteria the Veteran's disability most closely approximates. See 38 C.F.R. §§ 4.1,4.3, 4.7. Thus, to comply with Sharp, a remand is necessary in order for the examiner to elicit additional information regarding flares and to estimate the Veteran's functional loss based on all the evidence of record, including, but not limited to, the Veteran's own statements. The matters are REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to assess the current severity of his service-connected bilateral knee disabilities, or by other means if an in-person examination is not feasible. 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. Specifically, the examiner must test the Veteran's active motion, passive motion, ranges of motion of the opposing joint, and pain with weight-bearing and without weight-bearing. The examiner must also attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups during the appeal period beginning in 2016. (a.) In addressing the above, the examiner should review the May 2016 and August 2018 VA examination reports, along with the Veteran's October 2020 Board testimony, and attempt to estimate ranges of motion during flare-ups, as it was in May 2016 and August 2018. If this information cannot be obtained or determined, the examiner should give a detailed explanation why. To the extent possible, the examiner should identify any symptoms and functional impairments due to the service-connected knee disability and discuss the effect of the Veteran's service-connected disability on any occupational functioning and activities of daily living. S. L. Kennedy Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Smith, 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.