Citation Nr: 18160697
Decision Date: 12/27/18	Archive Date: 12/27/18

DOCKET NO. 10-46 486
DATE:	December 27, 2018
Entitlement to a disability rating in excess of 10 percent for right knee chondromalacia patella is remanded.
Entitlement to a disability rating in excess of 10 percent for left knee chondromalacia patella with arthritis is remanded.
The Veteran served on active duty in the United States Army from August 1985 to August 2005.
The Veteran’s right knee disability is currently evaluated for chondromalacia patella under DC 5099-5014 with a 10 percent rating, and his left knee is evaluated for chondromalacia patella with arthritis under DC 5099-5014, also with a 10 percent rating.  The Veteran contends he should be entitled to a higher disability rating for his bilateral knee disability due to an increase in the severity of chronic pain.  See December 2008 VA Form 21-4138.      
The Veteran was afforded VA knee examinations in April 2009, January 2017, and May 2018 to assess the severity of his bilateral knee disability.  In October 2018 correspondence from the Veteran, he contends his report of flare-ups was not properly taken into consideration.  The Court of Appeals for Veterans Claims (Court) has 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.  Sharp v. Shulkin, 29 Vet. App. 26 (2017).  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.  The Board finds the evidence of record, including the VA knee examinations, does not adequately address the Veteran’s reports concerning flare-ups, and remand is necessary.    
The matter is REMANDED for the following action:
1. Schedule the Veteran for a VA examination of the current severity of his bilateral knee disability.  The examiner should perform range of motion and instability testing.  The examiner should take a history from the Veteran as to the progression of the disability.
Based upon a review of the medical records, lay statements submitted in support of the claim, and statements elicited from the Veteran during examination, the examiner should state how the Veteran characterizes the additional functional loss of each knee during a flare-up.
The Veteran should be asked to identify: (1) the frequency of flare-ups; (2) the duration of flare-ups; (3) any precipitating factors; and (4) any alleviating factors.
2. Based upon the evidence of record, and the information elicited on examination, for each knee state whether it is at least as likely as not (50 percent probability or greater) that during a flare-up limitation of flexion is limited to 30 degrees (the measurement required for the next higher rating), and/or extension is limited to 10 degrees.  If limitation of flexion is limited to less than 30 degrees, or limitation of extension is limited to more than 10 degrees, please estimate the additional degree of motion loss.  If an estimation cannot be provided, the examiner must explain why this is the case.  
Responses to the medical opinions above should be supported with a clinical explanation or rationale.
3. Upon completion of the above, readjudicate the issues on appeal.  If any benefit remains denied, the Veteran and his representative should be provided with a Supplemental Statement of the Case.

V. Chiappetta
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Mask, Associate Counsel

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