Citation Nr: 21026721 Decision Date: 05/03/21 Archive Date: 05/03/21 DOCKET NO. 17-54 266 DATE: May 3, 2021 REMANDED Entitlement to a rating in excess of 30 percent for left patellofemoral pain syndrome, to include the matter of propriety of a reduction in the rating for such disability is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from August 1997 to May 2000. This matter is before the Board of Veterans' Appeals (Board) on appeal from a January 2017 rating decision, which reduced the rating for the Veteran's left patellofemoral pain syndrome from 30 percent to 10 percent effective April 1, 2017. In October 2020, a virtual hearing was held before the undersigned; a transcript is in the record. Entitlement to a rating in excess of 30 percent for left patellofemoral pain syndrome, to include the matter of propriety of a reduction in the rating. The most recent VA examination to assess the severity of the Veteran's left knee disability was in June 2016. Since then, the Veteran has testified he has suffered from flare-ups of the left knee that have not been assessed during VA examination. See October 2020 Board Hearing Transcript, p. 5. The Veteran's representative has requested a new VA examination of the Veteran undergo as previous VA examinations were not conducted during flare-ups of his left knee. Id. at p. 3. In particular, on June 2016 VA examination, the Veteran reported flare-ups of the left knee aggravated by climbing stairs, squatting, and kneeling. The examination was not conducted during a flare-up. Although the June 2016 VA examiner noted a history of flare-ups, he did not adequately describe (opine regarding) the additional loss of function that occurs during flare-ups as required under Sharp v. Shulkin, 29 Vet. App. 26, 32 (2017). The Board is aware of the difficulty in providing an opinion [here, regarding severity of flare-ups] that in part requires some speculation, particularly when the Veteran is not experiencing a flare-up at the time of an examination. Recognizing that arranging an examination during a flare-up would be nigh impossible, and that the best evidence regarding the severity of the knee disability during flare-ups would be from the report of treatment for which the Veteran presented during a flare-up (and the Veteran here has not identified such occasion), the Board nonetheless finds that to comply with governing legal guidelines a medical opinion (even if it requires some degree of speculation) that addresses the degree of severity of the left knee disability during flare-ups is necessary. The Veteran further reported suffering from instability and a meniscal condition of the left knee. He testified that he had a scope procedure on the left knee, which failed to relieve pain. See October 2020 Board Hearing Transcript, p. 9. He asserted he had swelling and subluxation of the left knee, and reported that the knee gives out. Id. In addition to the Veteran's contentions, the Board notes that the June 2016 VA examiner noted active range of motion measurements, but not passive, weight-bearing, or non-weight-bearing range of motion measurements. 38 C.F.R. § 4.59 requires that VA examinations include joint testing for pain on both active and passive motion, in weightbearing and non-weightbearing and, if possible, with range of the opposite undamaged joint. Interpreting caselaw has held that an examination that did not include such measurements is inadequate. See Correia v. McDonald, 28 Vet. App. 158 (2017). Considering the duration of the intervening period since he was last examined, the Veteran's contentions, and the facts presented above, a remand for a contemporaneous and adequate examination of the Veteran's left knee is necessary. The matters are REMANDED for the following: 1. Obtain any outstanding records of VA treatment the Veteran has received for his left knee. 2. When the development sought above is completed, arrange for an orthopedic examination of the Veteran to assess the nature and severity of his left knee disability. The Veteran's record (to include this remand and all records received pursuant to the development sought above) must be reviewed in conjunction with the examination. All pertinent findings should be described in detail. The findings must include range of motion studies for findings of functional limitations due to pain on both active and passive motion and in weight-bearing and non-weight-bearing. [If the left knee cannot be tested on "weight-bearing," the examiner must explain why that is so.] Considering the Veteran's reported history, describe any functional impairment of the Veteran's left knee due to (during) 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. Elicit from the Veteran a detailed description of his flare-ups, and indicate whether his account is consistent with clinical findings on examination and the overall record, and opine whether the accounts can be relied on to assess the severity of the disability during flare-ups (and if not, explain why not). If such opinion cannot be provided without resort to mere speculation, indicate whether the need to speculate is caused by a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (additional facts are required [if so indicating what further information is needed], or the examiner lacks requisite knowledge or training). Specifically indicate: whether the knee is ankylosed, and if so, identify the position of ankylosis; whether there is limitation of extension, and if so at what degree of extension; and whether there is malunion or nonunion of the tibia and fibula. Also opine whether the Veteran has severe painful motion or weakness in the left lower extremity. Comment on the nature and extent of the impact the knee disability has on occupational functioning. All opinions should include a detailed explanation of rationale, with citation to supporting clinical findings and medical principles (as deemed appropriate). GEORGE R. SENYK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Griffith 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.