Citation Nr: 21007701 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 14-08 134 DATE: February 10, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right thumb is remanded. Entitlement to an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right index finger is remanded. Entitlement to an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right long finger is remanded. Entitlement to a compensable initial rating for degenerative arthritis with limitation of motion of the ring and little finger of the left hand is remanded. REASONS FOR REMAND The Veteran had active military service from March 1979 to June 2001. These matters come before the Board of Veterans’ Appeals (Board) from the September 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Indianapolis, Indiana. The Board notes that jurisdiction currently rests with the Oakland, California RO. In April of 2016, the Veteran testified at a video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the record. Addressing the relevant procedural history, this case was previously before the Board in November of 2017 at which time it was remanded for additional development, to specifically include affording the Veteran a new VA examination. The case has now been returned to the Board for further appellate review.  Entitlement to an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right thumb is remanded, an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right index finger, an initial rating in excess of 10 percent for degenerative arthritis with limitation of motion of the right long finger, and a compensable initial rating for degenerative arthritis with limitation of motion of the ring and little finger of the left hand is remanded. Although the Board regrets the additional delay, an additional remand is required for further development and adjudicative action. While the record contains a contemporaneous VA examination, the examination does not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). In Sharp, the Court held that a VA examiner must attempt to elicit information from the record and the Veteran regarding the severity, frequency, duration, or functional loss manifestations during flare-ups before determining that an estimate of motion loss in terms of degrees could not be given. It also held that any inability to furnish such an estimate must be predicated on a lack of medical knowledge among the medical community at large, rather than insufficient knowledge by the individual examiner. Id. In contrast, the February 2018 VA examiner stated in declining to provide an estimate as to whether there is additional limitation of motion upon flare-ups after repetitive use that, “[i]t is not possible to determine, without resorting to mere speculation, to estimate loss of range of motion, because there is no conceptual or empirical basis for making such a determination without directly observing function under these conditions”. As this examiner did not adequately explain why such a determination could not be made and did not indicate whether this inability to furnish such an estimate was predicated on a lack of medical knowledge among the medical community at large rather than the examiner’s own insufficient knowledge, the Board cannot make a fully-informed decision this issue until a new VA examination is obtained on remand. The matters are REMANDED for the following actions: 1. Obtain all outstanding VA medical records pertinent to the issues on appeal and associate them with the record. 2. Following the completion of step one, schedule the Veteran for an examination of the current severity of his right hand. 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. To the extent possible, the examiner should identify any symptoms and functional impairments due to each of the fingers on the Veteran’s right hand alone and discuss the effect of the Veteran’s respective disabilities on any occupational functioning and activities of daily living. The examiner is specifically asked to opine whether there is additional limitation of motion upon flare-ups, pain, weakness, or fatigue. The examiner must estimate the Veteran’s functional loss due to flares and repeated use over time for the entire time period on appeal, based on all the evidence of record, or explain why this is not feasible. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment 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). 3. Thereafter, readjudicate the claims. If the benefits sought on appeal remain denied, issue a supplemental statement of the case to the Veteran and his representative. Then return the appeal to the Board for further appellate review. MICHAEL MARTIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K. 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.