Citation Nr: 21009551 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 14-37 335 DATE: February 22, 2021 REMANDED Entitlement to a rating in excess of 10 percent for right knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for left knee patellofemoral pain syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from May 2002 to November 2003. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board notes that new and material evidence was received after the April 2012 rating decision and before the February 2013 rating decision addressing the same issues that was appealed to the Board, and therefore the appeal stems from the April 2012 rating decision. In June 2018, the Board remanded the appeal. In April 2019, the Board denied ratings in excess of 10 percent for the Veteran’s bilateral knee patellofemoral pain syndrome. The Veteran appealed the April 2019 Board decision to the United States Court of Appeals for Veterans Claims (Court). In May 2020, the Court granted a Joint Motion for Partial Remand (JMPR) that vacated the Board’s decision regarding the knees and remanded the claims for further action. The Board remanded the claims in October 2020 to obtain an opinion in compliance with the Court’s directives and Sharp v. Shulkin, 29 Vet. App. 26, 33 (2017), as the VA examiner did not adequately explain why she could not express the degree of loss of additional range of knee motion during flare-ups, with the Court emphasizing there is no requirement that the flare-ups be active during an examination in order for the examiner to provide an estimate of functional loss, and further noting that the Veteran described his flare-ups during the January 2019 VA examination. Although the Board sincerely regrets further delay, a remand is again required, because the resultant November 2020 VA examination and December 2020 VA opinions are inadequate. Specifically, the VA examiner did not provide the degree of loss of additional range of motion during flare-ups as directed in the October 2020 Board remand in order to comply with Sharp. Stegall v. West, 11 Vet. App. 268 (1998). Instead, the examiner merely related examples of the Veteran’s functional impairment without assessing any additional knee motion loss and noted that the Veteran should be seen by an orthopedic specialist on this matter. Additionally, the November 2020 VA examination report provides no indication of joint testing in passive motion or in weight bearing and non-weight bearing, violating Correia v. McDonald, 28 Vet. App. 158 (2016). Barr v. Nicholson, 21 Vet. App. 303 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one). As such, an updated VA examination is necessary. Any outstanding 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 schedule the Veteran for a VA examination with a VA physician, preferably an orthopedic specialist, to determine the current nature and severity of his bilateral knee patellofemoral pain syndrome. The claims file, to include a copy of this remand must be made available to and be reviewed by the examiner. All findings should be reported in detail. The examiner is asked to address the following: (a.) Full range of motion testing must be performed where possible. The joints involved should be tested in (1) active motion, (2) passive motion, (3) in weight-bearing, (4) in non-weight-bearing. Please specify range of motion measurements in all areas outlined above. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (b.) Please also provide an opinion describing functional impairment of the Veteran’s bilateral knee patellofemoral pain syndrome 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. Failure to do so will result in an inadequate opinion. If the examiner is unable to provide such an opinion without resort to 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. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. J. Rogers, 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.