Citation Nr: 21009929 Decision Date: 02/23/21 Archive Date: 02/23/21 DOCKET NO. 08-37 924 DATE: February 23, 2021 REMANDED Entitlement to a disability rating in excess of 20 percent for right knee impairment with status-post cruciate ligament tear is remanded. Entitlement to a disability rating in excess of 10 percent for left knee sprain is remanded. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the right hip and thigh is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1986 to November 1995. This matter comes before the Board of Veterans’ Appeals (Board) from March 2007, October 2007, and March 2009 rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Columbia, South Carolina. In August 2013, the Veteran testified before the undersigned at a Central Office hearing. A transcript of that hearing is of record. In December 2016, the case came before the Board. The Board granted entitlement to service connection for hypertension. The Board also granted entitlement to service connection for headaches secondary to hypertension. Moreover, the Board remanded the Veteran’s claims for entitlement to increased ratings for his knees and hip. The Board remanded these issues in order for the Veteran to attend additional VA hip and knee examinations. Lastly, the Board remanded the Veteran’s claims of entitlement to a rating in excess of 50 percent for PTSD and an earlier effective date for the grant of service connection for PTSD in order for the RO to issue a SOC. In January 2018, the case returned to the Board. The Board remanded the Veteran’s right knee disability, left knee disability, and right hip disability for additional examinations. In addition, the Board once again requested the RO to issue a SOC because the December 2016 remand directive was not carried out. In April 2020, the RO issued a SOC in accordance with the Board’s remand directives. The issues of entitlement to a rating in excess of 50 percent for PTSD and an earlier effective date will be the subject of a Board decision at a later date. 1. Entitlement to a disability rating in excess of 20 percent for right knee impairment with status-post cruciate ligament tear is remanded. 2. Entitlement to a disability rating in excess of 10 percent for left knee sprain. is remanded. 3. Entitlement to an initial disability rating in excess of 10 percent for arthritis of the right hip and thigh is remanded. As to the issues of increased ratings for a right knee disability, left knee disability and right hip disability, the Board notes that the Veteran attended a VA examination for these issues in October 2020. During these examinations, the Veteran stated that he experiences flare-ups, but the examiner did not account for the Veteran’s lost range of motion when he experiences a flare-up. Specifically, the examiner stated that “all of the facts cannot be determined, and there is a limitation in the medical community at large to predict the exact loss of ROM during repetitive use since the loss depends on various factors.” Accordingly, the Board acknowledges that in the case of Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court noted that for a joint examination to be adequate, the VA examiner “must express an opinion on whether pain could significantly limit” a Veteran’s functional ability, and that determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups.” Furthermore, the Court stated that the examiner must “obtain information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment [resulting from flare-ups] from the Veterans themselves.” Sharp, 29 Vet. App. at 34. The examiner must also “offer flare opinions based on estimates derived from information procured from relevant sources, including the lay statements of Veterans,” and the examiner’s determination “should, if feasible, be portrayed in terms of the degree of additional range-of-motion loss due to pain on use or during flare-ups. Id. at 10. Thus, the Board finds these examinations to be inadequate and that a remand is necessary in order to provide the Veteran with new examinations. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records from November 17, 2020, to the present. 2. Schedule the Veteran for a VA examination to determine the severity of his left knee, right knee, and right hip disability. The examiner should request the Veteran to identify the extent of his functional loss during flare-ups that have occurred throughout the course of the appeal and then provide range of motion estimates based on that information. In providing all of the requested opinions, the examiner should consider the Veteran’s competent lay claims regarding the observable symptoms he has experienced. The VA examination report must include a complete rationale for all opinions expressed. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Rescan, 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.