Citation Nr: 20072891 Decision Date: 11/12/20 Archive Date: 11/12/20 DOCKET NO. 16-51 513 DATE: November 12, 2020 REMANDED Entitlement to an initial rating in excess of 10 percent for right and left rib resection is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from August 1993 to August 2014. In July 2019, the Veteran testified at a Board hearing. The transcript is of record. In November 2019, the Board remanded the case for further development, which has not been completed. Stegall v. West, 11 Vet. App. 268, 271 (1998). 1. Entitlement to an initial rating in excess of 10 percent for right and left rib resection The Board regrets the additional delay; however, a remand is necessary to ensure compliance with the Board’s prior remand instructions and to ensure that due process is met. Id. At the hearing the Veteran testified that she had two separate surgeries in 2007 and 2008 that resulted in ribs being removed on the right and left side. The Veteran explained that during the first rib resection and scalenectomy the surgeon went in through an incision under her arm and took out the rib on both the left and right sides. In November 2019 the Board remanded the case for a VA examination. While the VA examination was obtained, the examiner failed to address the remand directive requesting clarification as to whether the Veteran’s resection in 2007 and 2008 resulted in the removal of ribs on the right and left sides. Furthermore, the record indicates that the Veteran receives pain management at Johns Hopkins for her thoracic outlet syndrome. A remand is required to allow VA to obtain authorization and request these records. The matters are REMANDED for the following action: 1. Contact the Veteran and afford her the opportunity to identify by name, address and dates of treatment or examination any medical records relevant to thoracic outlet syndrome, to include Johns Hopkins pain management and neurology. Subsequently, and after securing the proper authorizations where necessary, make arrangements to obtain all the records of treatment or examination from all the sources listed by the Veteran which are not already on file. All information obtained must be made part of the file. All attempts to secure this evidence must be documented in the claims file. If, after making reasonable efforts, the records cannot be obtained, notify the Veteran and her representative and (a) identify the specific records that cannot be obtained; (b) briefly explain the efforts made to obtain those records; and (c) describe any further action to be taken with respect to the claim. The Veteran must then be given an opportunity to respond. 2. After the above development is completed, obtain an addendum medical opinion from a medical professional with appropriate expertise. The examiner should review the Veteran’s claims file. If the examiner determines that an opinion cannot be provided without an examination, the Veteran should be scheduled for one. Based on a review of the record, and a new examination if necessary, the examiner must address the following: (a.) Whether the Veteran’s rib resection surgeries in 2007 and 2008 included the removal of any ribs, and if so, how many ribs were removed. The examiner is advised that the Veteran is competent to report her symptoms and treatment history. The examiner must specifically consider the Veteran's testimony stating that she had a rib removed on the left and right side during the 2007 and 2008 surgeries as well as the surgical and treatment notes from Johns Hopkins regarding thoracic outlet syndrome. The opinion and rationale should reflect such consideration. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. If the medical professional cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation for why an opinion cannot be rendered. In so doing, the medical professional shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question(s). 3. Finally, readjudicate the appeal. If the claim for an increased rating for thoracic outlet syndrome remains denied, issue a supplemental statement of the case and return the case to the Board. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. A. Prinsen 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.