Citation Nr: 21025243 Decision Date: 04/27/21 Archive Date: 04/27/21 DOCKET NO. 14-07 255A DATE: April 27, 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 right knee patellofemoral pain syndrome is remanded. Entitlement to a rating in excess of 10 percent for residuals of a right femur fracture is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty in the United States Army from September 2000 to December 2003, including service in Iraq. The Veteran presented sworn testimony at a hearing before the undersigned in January 2018. The Board remanded these issues for additional development in July 2018. The Board notes, that the Veteran is currently employed full-time; therefore, the issue of entitlement to a TDIU is not before the Board. REASONS FOR REMAND Entitlement to an increased rating for right knee, and left knee disabilities, and residuals of a right femur fracture, all currently rated at 10 percent, are remanded. The Veteran asserts that his service-connected right knee, left knee and residuals of right femur fracture, and disabilities are more severe than his 10 percent evaluations would indicate. Specifically, at the January 2018 Board hearing, the Veteran testified that his service-connected right knee, left knee and service-connected residuals of his right femur fracture had worsened since his most recent VA examination, conducted in January 2014. In October 2018, the Board remanded this issue for additional development, to include VA examinations. The Board notes, the Veteran reported that painful flare ups with his right femur and both knees; however, the October 2019 VA examiner did not provide an estimate for additional loss of motion during flare-ups, pursuant to Sharp v. Shulkin, 29 Vet. App. 26 (2017). The Board emphasizes that in Sharp the Court held that the examiner must "elicit relevant information as to the veteran's flares or ask him to describe the additional functional loss, if any, he suffered during flares and then estimate the veteran's functional loss due to flares based on all the evidence of record, including the veteran's lay information, or explain why she could not do so." As such, the examiner's failure to estimate the Veteran's limitation of motion during flare-ups and on repeated use renders the examination report not adequate for rating purposes. Additionally, regarding his bilateral knee disabilities, the Board notes that although the Veteran was not diagnosed with right knee or left knee instability at the October 2019 VA examination, the Veteran has reported that sometimes his knees “ will start giving out” and reports his knees lock up in the cold. See January 2018 Hr’g Tr at 5; see also October 2019 Knee and Leg DBQ. Regarding the residuals of his right femur, the Veteran reported, that he experiences daily pain in the right hip, that he describes as “nerve” pain that is worse with prolonged walking, standing, or attempting to run. He reported that he treated his symptoms with over the counter medications like aspirin or resting. See October 2019 Hip and Thigh DBQ. The Board finds that a contemporaneous examination(s) is necessary to determine the current impact and severity of the residuals of a right femur fracture, right knee and left knee disabilities, including the Veteran’s functional loss due to the residuals of a right femur fracture, his right knee and left knee disabilities. The Board notes that the Veteran is competent to describe the residuals of a right femur fracture and knee symptomology, see English v. Wilkie, 30 Vet. App. 347 (2018). The matters are REMANDED for the following action: 1. Notify the Veteran that he may submit lay statements from himself and supporting statements from other individuals who have first-hand knowledge of and/or were contemporaneously informed of the extent and severity of his right knee and left knee and residuals of right femur fracture disabilities, to include knee locking, instability or falling as a result of his service-connected disabilities. The Veteran should be provided an appropriate amount of time to submit this lay evidence. 2. Schedule the Veteran for a VA examination(s) to determine the nature, extent and severity of his right knee disability, left knee disability, and residuals of right femur fracture. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. Full range of motion testing must be performed where possible. The joint(s) involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing. 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. The examiner is asked to describe any instability or subluxation of the right, or left knee, to state whether there is any weakness in the affected extremity, and to provide an evaluation of the limitations and restrictions imposed by the Veteran’s service-connected right knee disability, left knee disability, or residuals of right femur fracture on his work routine activities like sitting, standing, walking, lifting, carrying, pushing, and pulling for up to six-to-eight hours per day. The VA examiner must acknowledge and discuss the Veteran’s competent reports of his knees locking in the cold and episodes of his knees giving out. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). STEVEN D. REISS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Jacquelynn M. Jordan, 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.