Citation Nr: 21075728 Decision Date: 12/21/21 Archive Date: 12/21/21 DOCKET NO. 15-18 310 DATE: December 21, 2021 REMANDED Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome with degenerative arthritis (right knee disability) prior to June 2, 2021, and a rating in excess of 30 percent thereafter is remanded. Entitlement to a rating in excess of 30 percent for left knee patellofemoral pain syndrome (left knee disability) is remanded. REASONS FOR REMAND The Veteran had active duty service from July 1988 to July 2002. These matters come before the Board of Veterans' Appeals (Board) on appeal from a November 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO), which, in pertinent part, continued the 10 percent ratings for the right and left knee patellofemoral pain syndrome, respectively. The Board notes that in a previous July 2015 rating decision the RO increased the ratings for the bilateral knee disability to 10 percent, effective April 20, 2015, respectively. Additional evidence was received within one year of this rating decision. Thus, it did not become final. In a September 2018 rating decision, the RO increased the left knee disability to 30 percent, effective April 20, 2015. These matters were last before the Board in April 2021, at which time they were remanded for additional evidentiary development. In a July 2021 rating decision, the RO increased the rating for the right knee disability to 30 percent, effective June 2, 2021, and granted service connection for left knee limited flexion and assigned a 10 percent rating, effective June 2, 2021. 1. Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome with degenerative arthritis (right knee disability) prior to June 2, 2021, and a rating in excess of 30 percent thereafter is remanded; 2. Entitlement to a rating in excess of 30 percent for left knee patellofemoral pain syndrome (left knee disability) is remanded. Pursuant to the Board's remand instructions, a VA examination was performed in June 2021. However, after a review of the evidence, the Board finds that this medical opinion is insufficient to determine the present claims. In this regard, the Veteran reported flare-ups of pain throughout the rating period on appeal, including during the October 2018 VA examination. However, the June 2021 examiner did not provide an opinion regarding the range of motion loss during a flare up and noted that the Veteran did not complain of flare-ups at that time. However, opinion is still required regarding the previously reported flare-ups. Accordingly, the Board finds that an addendum medical opinion is warranted on remand in order for the examiner to provide an estimated range of motion loss during a flare in compliance with the Board's previous remand instructions and Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017). The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file the Veteran's updated VA treatment records from December 2021 to the present. 2. After completion of #1, forward the claims file, including a copy of this remand, to the June 2021 examiner for an addendum medical opinion for the Veteran's service-connected right and left knee disabilities. If the June 2021 examiner is unavailable, forward to an appropriate clinician. A VA examination is only necessary if deemed so by the examiner. The examiner should conduct a review of the record and respond to the following questions: A. With regard to the June 2021 VA examination, flare-ups have been reported throughout the rating period on appeal, including during the October 2018 VA examination. The examiner should provide an estimate of the degree of lost motion during flare-ups for the right knee. B. With regard to the June 2021 VA examination, flare-ups have been reported throughout the rating period on appeal, including during the October 2018 VA examination. The examiner should provide an estimate of the degree of lost motion during flare-ups for the left knee. C. With regard to the June 2021 VA examination, how far back do the results apply, i.e., one year, two years, etc.? The examiner is to attempt to elicit information from the record to reply to A, B, and C. Should the examiner maintain that they cannot do so without resorting to speculation, they must explain why this is so. Note: Any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large and not the insufficient knowledge of the examiner. The examiner may indicate the degree of confidence that they place on their estimate, on a scale of 1 to 5, with 1 being least confident and 5 being most confident. The examiner should provide a comprehensive rationale for each opinion provided. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion. Eric S. Leboff Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Merrick 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.