Citation Nr: 18149580 Decision Date: 11/09/18 Archive Date: 11/09/18 DOCKET NO. 12-13 868 DATE: November 9, 2018 REMANDED Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to an initial disability rating in excess of 40 percent for low back pain and bulging disc, with foraminal stenosis, lumbar spine is remanded. INTRODUCTION The Veteran served on active duty from March 1984 to November 1984, April 1988 to November 1988, and February 1999 to March 2001. In March 2011, the Veteran attended an informal conference with a Decision Review Officer at the Portland RO. In August 2016, the Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge. A transcript of each of the proceedings is of record. When this case was most recently before the Board in August 2018, the above-noted issues were remanded for additional development. The case has now been returned to the Board for further appellate review. REASONS FOR REMAND The Board finds additional development is yet again required before the Veteran’s remaining claims are decided. As noted in the Board’s August 2018 remand, a remand by the Board confers upon the claimant, as a matter of law, the right to compliance with the remand instructions, and imposes upon VA a concomitant duty to ensure compliance with the terms of the remand. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Although the Board issued clear remand instructions to the RO by way of the above-noted August 2018 remand, to date, the RO has yet to comply with any of those instructions. Therefore, a remand is once again necessary in order to obtain substantial compliance with the Board’s August 2018 remand directives, which are again reiterated below. On remand, relevant ongoing medical records should be obtained. 38 U.S.C. § 5103A (c) (2012); see also Bell v. Derwinski, 2 Vet. App. 611 (1992) (VA medical records are in constructive possession of the agency, and must be obtained if the material could be determinative of the claim). Accordingly, the case is REMANDED for the following action: 1. Undertake appropriate development to obtain any outstanding records pertinent to the Veteran’s remaining claims. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, afford the Veteran a VA examination by a physician with sufficient expertise to fully assess the severity of the Veteran’s service-connected lumbar spine disability. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. Ensure the examiner provides all information required for rating purposes, to specifically include both active and passive range of motion testing, as well as weight-bearing and nonweight-bearing range of motion assessments. In addition, the examiner must consider and discuss all procurable and assembled data such as the frequency, duration, characteristics, precipitating and alleviating factors, and the severity of the flare-ups, and then provide an assessment of the functional loss during flares, if possible in degrees of motion lost. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary, he or she should be directed to clearly explain why that is so. 3. Also, afford the Veteran VA examinations by a physician or physicians with sufficient expertise, who have not previously examined this Veteran, to address the etiology of the Veteran’s claimed right knee and left wrist disabilities. All pertinent evidence of record must be made available to and reviewed by the examiner(s). Any indicated studies should be performed. Following a review of the relevant records and lay statements, the appropriate examiner should state an opinion as to whether it is at least as likely as not (a 50 percent probability or greater) the Veteran’s current right knee disability originated during her periods of active service or was permanently worsened during her periods of active service. The appropriate examiner should also state whether there is a 50 percent or better probability that the left wrist disability: a) originated during the Veteran’s periods of active service or is otherwise etiologically related to her active service; b) was permanently worsened during her periods of active service; c) was caused by her right knee disability; or d) was permanently worsened by her right knee disability. The examiner(s) must provide a complete rationale for all proffered opinions. The examiner(s) must discuss and consider the Veteran’s competent lay statements. If an examiner is unable to provide any required opinion, he or she should explain why. If an examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation as to why this is so. If the inability to provide a more definitive opinion is the result of a need for additional information, the examiner should identify the additional information that is needed. (Continued on the next page)   4. Finally, undertake any other development determined to be warranted, and then readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, furnish to the Veteran and her representative a supplemental statement of the case and afford them the requisite opportunity to respond. Thereafter, if indicated, the case should be returned to the Board for further appellate action. T. REYNOLDS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Fraser, Counsel