Citation Nr: 21006452 Decision Date: 02/04/21 Archive Date: 02/04/21 DOCKET NO. 15-25 161 DATE: February 4, 2021 REMANDED Entitlement to a disability rating in excess of 10 percent for degenerative disc disease, L5-S1, status post lumbar discectomy is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1990 to September 1994 and from July 2004 to October 2005. This matter is on appeal from a January 2012 decision of a Department of Veterans Affairs (VA) Regional Office (RO). In October 2018, a videoconference hearing was held before the undersigned. A transcript of the hearing is in the record. The case was previously before the Board in April 2019 when it was remanded for further development.   Entitlement to a disability rating in excess of 10 percent for degenerative disc disease, L5-S1, status post lumbar discectomy is remanded. The Veteran contends that he is entitled to an increased rating for his lumbar spine disability. However, upon review of the record, the Board finds that an addendum opinion is necessary to address the functional limitation caused by the Veteran’s flare-ups. As explained in the prior remand, the Veteran has been provided with VA examinations and the examiners have not provided opinions which adequately address functional limitation during flare-ups. See Sharp v. Shulkin, 29 Vet. App. 26, 35-36 (2017). The Veteran was provided with a VA examination in December 2019 in which the examiner, Dr. C.P., stated that the Veteran experienced severe flare-ups that cause additional functional loss and limited functional ability after repeated use over time, but that such functional impairment could not be described in terms of range of motion. He then indicated that such occurred daily, lasted several hours, were severe, were precipitated by sitting, walking, bending, and laying supine, and impacted the Veteran’s ability to walk, sit, drive, and go up and down stairs. In October 2020, the RO requested an addendum opinion to obtain the estimated range of motion during flare-ups and after repeated use over time or to state why it is not possible to do so, per Sharp. In October 2020, Dr. C.P. provided further information indicating that pain and fatigue caused mild functional loss after repeated use over time and during flare ups and indicated that he could not describe in terms of range of motion. He then provided a description of the Veteran’s flare ups and functional loss after repeated use over time indicating that they occurred once a week, lasted the entire day, were mild and resulted in difficulty with prolonged sitting/standing/walking/climbing stairs due to pain/discomfort. It is unclear why the description of the impact of flare ups and repeated use over time changed from what was described during the December 2019 examination. In a subsequent October 2020 email to Dr. M.W., a clinician who had not examined the Veteran, the RO indicated that Dr. C.P. still did not provide a statement as to why he could not provide an estimate on the frequency, duration, and severity of decreased range of motion in degrees during flare-ups. VA then received an addendum from Dr. M.W., which stated that flare-ups do not cause functional limitation because the existing clinical evidence does not support any additional limitations. However, it does not appear that this addendum opinion was provided by Dr. C.P., who examined the Veteran, and it seems inconsistent with the findings made by Dr. C.P. in December 2019 that the flare ups were severe and result in pain and fatigue that cause functional loss. Given the conflicting findings made by Dr. C.P. in the December 2019 examination report and October 2020 addendum opinion without a clear explanation for why such conflicting findings were made, the Board finds that remand is needed to obtain an opinion that substantially complies with the Board’s prior remand request. See also Stegall v. West, 11 Vet. App. 268, 271 (1998). The matter is REMANDED for the following action: Schedule an examination (or telehealth interview, if an in-person examination is not feasible) of the Veteran for review and an addendum medical opinion. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups and after repeated use over time. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment, including after repeated use over time, without speculation, the examiner must state whether all procurable medical evidence had been considered, to specifically include the Veteran’s description as to the severity, frequency, duration of the flare-ups and his description as to the extent of functional loss during a flare-up and after repetitive use over time; whether the inability is due to the limits of medical community or the   limits of the examiner’s medical knowledge; and whether there is additional evidence, which if obtained, would permit the opinion to be provided. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. H. White, Associate 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.