## Facts

- Bobby R. Sharp, a U.S. Army veteran, sought higher initial disability ratings for service-connected musculoskeletal conditions affecting both shoulders and his bilateral hands and elbow/forearms.
- He reported that his disabilities worsened during periodic flare-ups, causing additional pain and reduced endurance and function.
- After a Board remand, VA provided a September 2015 compensation examination.
- The examiner acknowledged flare-ups and additional functional loss, but declined to estimate additional range-of-motion loss or functional impairment during flare-ups, stating that doing so would require “mere speculation” without direct observation during a flare.
- The examiner did not meaningfully elicit details about flare-ups such as severity, frequency, duration, precipitating/alleviating factors, or specific functional impact.
- The Board of Veterans’ Appeals found the examination adequate and denied ratings higher than 10% for the shoulder and elbow/forearm disabilities (while awarding 10% for certain hand/forearm disabilities).
- Sharp appealed, arguing the Board relied on an inadequate examination and that VA law required an estimate of functional loss during flare-ups based on available evidence, including lay statements.

## Issues

1. Whether a VA examiner may decline to estimate additional functional loss during flare-ups solely because the examination did not occur during a flare-up and any estimate would be “speculation.”
2. What duties VA examiners and the Board have to obtain and consider all “procurable” information, including lay evidence, before concluding an opinion cannot be provided without resort to speculation.

## Decision

- The court set aside the relevant portions of the Board’s decision and remanded for further development and readjudication.
- The court held VA is not categorically required to examine a claimant during an actual flare-up.
- The court held that when flare-ups are alleged, the examiner must attempt to estimate additional functional loss during flare-ups based on all procurable information, including the veteran’s descriptions, medical history, and records.
- A statement that an opinion would be speculative is adequate only if the examiner shows due diligence in obtaining the necessary information and explains that the inability reflects limits of medical knowledge generally, not a failure to gather evidence or a refusal to use clinical judgment.
- The Board erred by accepting the examiner’s speculative statement without ensuring these requirements were met.

## Legal Principles

- An examiner’s “cannot opine without speculation” conclusion is permissible only after consideration of all procurable and assembled data and a clear explanation grounded in the limits of medical knowledge at large.
- For musculoskeletal flare-ups, examiners must elicit and record, as feasible, flare-up severity, frequency, duration, precipitating and alleviating factors, and functional impact, and then use medical judgment to estimate additional functional loss.
- Lay evidence may provide an adequate factual basis to estimate functional loss during flare-ups; direct observation during a flare-up is not a prerequisite.
- The Board must ensure examination adequacy and may not rely on a speculative opinion that lacks the required factual development and medical explanation.

## Conclusion

The court required VA examiners and the Board to address flare-up functional loss through estimates based on all available evidence, including competent lay reports, and to treat speculation as acceptable only when further estimation is impossible due to limits of medical knowledge rather than incomplete fact-gathering or examiner reluctance.


Sharp v. Shulkin, 29 Vet. App. 26 (2017)