Citation Nr: 21072456 Decision Date: 12/03/21 Archive Date: 12/03/21 DOCKET NO. 18-34 469 DATE: December 3, 2021 REMANDED Entitlement to a disability rating in excess of 20 percent for rotator cuff tear and degenerative arthritis of the left shoulder prior to September 23, 2021, and in excess of 30 percent thereafter is remanded. INTRODUCTION The Veteran served on active duty from July 1968 to July 1970. In September 2019, the Board denied an increased rating for the Veteran's left shoulder disability. Thereafter, the Veteran appealed the Board's denial of his increased rating claim to the United States Court of Appeals for Veterans Claims (Court). In October 2020, the Court granted the parties' Joint Motion for Partial Remand (JMPR) and returned the matter to the Board for further consideration. When this case was before the Board in March 2021, the above-noted issue was remanded for further development. The case has since been returned for additional appellate review. REASONS FOR REMAND Though unfortunate, the Board is of the opinion that additional development is required before the above-noted claim is decided. When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). To be considered adequate, a musculoskeletal examination must include an assessment of the veteran's flare-ups, as well as range of motion measurements in weight bearing, non-weight bearing, and in passive motion. See Sharp v. Shulkin, 29 Vet. App. 26 (2017); see also Correia v. McDonald, 28 Vet. App. 158 (2016). The Board observes the Veteran underwent VA shoulder examinations to assess his disability in July and September 2021. However, the examiners failed to provide non weight-bearing and weight-bearing range of motion assessments. Additionally, during his examination in July 2021, the Veteran reported he had little use of his left shoulder during flare-ups. In particular, the Veteran stated he could not use his arm to drive and required his spouse's assistance to dry off following showers. The examiner noted the Veteran held his hand close to his body for most of the examination, as the Veteran reported any movement resulted in significant pain. Following these examinations, the RO awarded an increased disability rating of 30 percent by way of an October 2021 rating decision. The RO assigned an effective date of September 23, 2021 for this increased evaluation, which was the date of the Veteran's most recent VA examination; however, the Veteran's representative has asserted an earlier effective date for the increased evaluation was warranted. In this regard, the Board notes the evidence indicates the Veteran may experience functional ankylosis of his left shoulder disability during flare-ups, and that his flare-ups may have resulted in reduced range of motion prior to the date of his most recent VA examination. Based on the foregoing insufficiencies, the Board finds a new examination and medical opinions are necessary prior to final adjudication of this matter. Accordingly, this case is REMANDED for the following actions: Afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the severity of the Veteran's service-connected left shoulder 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 non weight-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. Also, obtain retrospective opinions from the VA examiner, regarding the severity of the Veteran's service-connected left shoulder disability throughout the pendency of the appeal. In particular, the examiner is asked to state the following: a) whether the Veteran's flare-ups have resulted in functional loss of the left shoulder at any time since January 2018, and if so, the examiner is asked to express that loss in terms of degrees of motion lost due to such factors as pain, weakness, fatigability, incoordination. b) whether the Veteran has experienced functional ankylosis of the left shoulder during flare-ups at any time since January 2018. If the examiner determines such a retrospective opinion is not possible, or would be speculative, the examiner must state whether this is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). T. REYNOLDS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board G. Fraser, Counsel 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.