Citation Nr: 21012843 Decision Date: 03/05/21 Archive Date: 03/05/21 DOCKET NO. 14-13 923 DATE: March 5, 2021 ORDER Entitlement to an initial rating in excess of 50 percent for posttraumatic stress disorder (PTSD) with persistent depression, prior to September 12, 2018, is denied. Entitlement to a rating in excess of 70 percent for PTSD with persistent depression, from September 12, 2018, is denied. REMANDED Entitlement to an initial rating in excess of 20 percent for right shoulder impingement is remanded. Entitlement to an initial rating in excess of 10 percent for chronic low back strain with myofascial pain is remanded. Entitlement to an initial rating in excess of 10 percent for cervical spine degenerative arthritis, prior to October 28, 2019, is remanded. Entitlement to a rating in excess of 20 percent for cervical spine degenerative arthritis, from October 28, 2019, is remanded. FINDINGS OF FACT 1. For the period prior to September 12, 2018, the Veteran’s PTSD with major depressive disorder and anxious distress manifested itself by symptoms no greater than occupational and social impairment with reduced reliability and productivity. 2. For the period from September 12, 2018 and continuing thereafter, the Veteran’s PTSD with persistent depression manifested itself by symptoms no greater than occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. CONCLUSIONS OF LAW 1. For the period prior to September 12, 2018, the criteria for a rating in excess of 50 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110; 38 C.F.R. §§ 3.102, 4.130, DC 9411. 2. For the period from September 12, 2018 and continuing thereafter, the criteria for a rating in excess of 70 percent for PTSD have not been met. 38 U.S.C. §§ 1155, 5107(b), 5110; 38 C.F.R. §§ 3.102, 4.130, DC 9411. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to October 1990. This issue comes before the Board of Veterans’ Appeals (Board) on appeal from September 2012, October 2014, October 2018, June 2020, and September 2020 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). In a January 2018 decision, the Board remanded the increased rating claims for PTSD and right shoulder and denied ratings in excess of 10 percent for the Veteran’s cervical spine and thoracolumbar spine. The Veteran appealed the denial to the Court of Appeals for Veterans Claims, which in August 2018, on the basis of a Joint Motion for Partial Remand, vacated the denials and remanded the matter to the Board for corrective action. This case was again before the Board in March 2019. The Veteran’s claims were remanded for additional development. The case is now again before the Board for further appellate action. In September 2017, the Veteran testified at a hearing before a now-retired Veterans Law Judge of the Board. A transcript of the hearing is of record. In January 2021 correspondence, the Veteran was given the opportunity to request another hearing and was notified that if he did not provide a response in 30 days, it would be assumed that he did not want another hearing. The Veteran did not respond to the letter; therefore, the Board will proceed with adjudication of the Veteran’s claims. Increased Rating Disability ratings are determined by applying a schedule of ratings that is based on average impairment of earning capacity. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R., Part 4. Each disability must be viewed in relation to its history and the limitation of activity imposed by the disabling condition should be emphasized. 38 C.F.R. § 4.1. Examination reports are to be interpreted in light of the whole recorded history, and each disability must be considered from the point of view of the appellant working or seeking work. 38 C.F.R. § 4.2. Where there is a question as to which of two disability evaluations shall be applied, the higher evaluation is to be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating is to be assigned. 38 C.F.R. § 4.7. The Board notes that while the regulations require review of the recorded history of a disability by the adjudicator to ensure an accurate evaluation, the regulations do not give past medical reports precedence over the current medical findings. Where an increase in the disability rating is at issue, the present level of the Veteran’s disability is the primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). It is also noted that staged ratings are appropriate for an increased rating claim whenever the factual findings show distinct time periods where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119 (1999), Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to an initial rating in excess of 50 percent for PTSD with persistent depression, prior to September 12, 2018, is denied. 2. Entitlement to a rating in excess of 70 percent for PTSD with persistent depression, from September 12, 2018 and continuing thereafter, is denied. An April 2014 rating decision granted service connection for PTSD with persistent depression and assigned an initial rating of 50 percent, effective April 15, 2013. An October 2014 rating decision denied an increased rating in excess of 50 percent. A September 2020 rating decision increased the rating to 70 percent, effective September 12, 2018. The Veteran contends that he is entitled to higher ratings. In claims for increased disability compensation, the effective date will be the earliest date as of which it is factually ascertainable that an increase in disability has occurred, if a claim is received by VA within one year of that date. Otherwise, the effective date will be the date of receipt of claim or date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(2); 38 C.F.R. § 3.400(o)(2). The Veteran’s PTSD with persistent depression has been rated under Diagnostic Code 9411, which is rated under the General Rating Formula for Mental Disorders. 38 C.F.R. § 4.130, Diagnostic Code 9411. Under the General Rating Formula for Mental Disorders, a 50 percent rating is warranted for occupational and social impairment with reduced reliability and productivity due to such symptoms as: flattened affect; circumstantial, circumlocutory, or stereotyped speech; panic attacks more than once a week; difficulty in understanding complex commands; impairment of short- and long-term memory (e.g., retention of only highly learned material, forgetting to complete tasks); impaired judgment; impaired abstract thinking; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships. 38 C.F.R. § 4.130. A 70 percent rating is warranted for even greater occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood, due to such symptoms as: suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. Id. A 100 percent rating is warranted if there is total occupational and social impairment, due to such symptoms as: gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. Id. When rating a mental disorder, VA must consider the frequency, severity, and duration of the Veteran’s psychiatric symptoms, the length of remissions, and the Veteran’s capacity for adjustment during periods of remission. The rating agency must assign a rating based on all the evidence of record that bears on occupational and social impairment, rather than solely on the examiner’s assessment of the level of disability at the moment of the examination. When rating the level of disability from a mental disorder, the rating agency must consider the extent of social impairment but cannot assign a rating solely on the basis of social impairment. 38 C.F.R. § 4.126. The Veteran’s actual symptomatology, and resulting social and occupational impairment, will be the primary focus when assigning a disability rating for a mental disorder, and the Veteran may qualify for a particular rating by demonstrating the particular symptoms associated with that percentage, or other symptoms of similar severity, frequency, and duration. Vazquez-Claudio v. Shinseki, 713 F.3d 112, 116-17 (Fed. Cir. 2013). In deciding claims, it is the Board’s responsibility to evaluate the entire record on appeal. See 38 U.S.C. § 7104(a). Although the Board has an obligation to provide reasons and bases supporting this decision, there is no need to discuss each and every piece of evidence submitted by the Veteran or on his behalf. See Gonzales v. West, 218 F.3d 1378, 1380-81 (Fed. Cir. 2000). Rather, the Board’s analysis below will focus specifically on what evidence is needed to substantiate the claims and what the evidence in the claims file shows, or fails to show, with respect to the claims. See Timberlake v. Gober, 14 Vet. App. 122, 128-30 (2000). Turning to the evidence, the Veteran was afforded a VA PTSD examination in December 2013. Based on the clinical evaluation and a review of the Veteran’s claims file, the examiner diagnosed the Veteran with PTSD and persistent depression secondary to PTSD under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. The examiner indicated that she was unable to differentiate what portion of the occupational and social impairment is caused by each disorder. It was reported that the Veteran began seeking a bachelor’s degree at a community college in 2012 and received decent grades. He stated that one quarter he had trouble with writing, so he took a break for a quarter. When he returned to school, he had three courses that were heavy on reading and writing and states he did not do well. He was still enrolled as a full-time student. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood, anxiety, chronic sleep impairment, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. A March 2014 VA neuropsychology consult reported that the Veteran denied suicidal or homicidal ideation. The Veteran had performed well in his college math and other classes and was mostly struggling with the writing component. He had also noticed difficulty with concentration and short-term memory. The Veteran was afforded another VA PTSD examination in October 2014. Based on the clinical evaluation and a review of the Veteran’s claims file, the examiner diagnosed the Veteran with PTSD and persistent depression secondary to PTSD under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. The examiner indicated that she was unable to differentiate what portion of the occupational and social impairment is caused by each disorder. The Veteran reported that he had not worked since his last deployment, though a January 2012 medical note reported he was working as a cook. He said he has interviewed for jobs such as security positions but was told he was overqualified. The Veteran attended community college for four quarters and did well. However, he stated that he failed two classes last quarter, then elected to discontinue college work for now. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood, anxiety, and chronic sleep impairment. In January 2015, the Veteran completed a Social Security Administration (SSA) adult function report. The Veteran reported living with his domestic partner and her daughter. He reported having trouble sleeping due to pain and disturbing dreams. The Veteran reported difficulties with conversations and talking on the phone and stated his memory is not good. He reported that he socializes with his daughter and grandson by visiting a park and going for coffee. He described the frequency of these visits as once a week if he felt well enough, but realistically once a month. An April 2015 VA mental health group counseling note reported that the Veteran expressed no suicidal or homicidal ideation. An April 2015 SSA record reported that the Veteran was able to hold a conversation and was taking classes; however, he did need to take a break due to symptoms of depression and anxiety and a desire to spend more time with his family. He was able to independently handle activities of daily living, chores, and pay bills. He was able to drive and do his own shopping and was able to extensively fill out forms. He was shown to have a good support structure with son and stepdaughter and was shown in recent exams to be increasing his activity level. He stated that he was mostly limited from interests and hobbies due to money rather than any cognitive or mental limits. He appeared well adjusted and was determined to be “Non Severe.” A June 2015 SSA record reported that the Veteran experienced anxiety and pain when he is outside of his home so he spends most of his day in his bedroom. He stated that he only leaves the house for VA appointments and obligations he cannot find a way out of. He stated his memory has continued to deteriorate and he had increased difficulty forming complete sentences and expressing thoughts. A March 2016 VA mental health consult reported that the Veteran was divorced and living with his girlfriend of six years and her 16-year old daughter. He was enrolled in community college. His affect was restricted and mood anxious. He denied suicidal or homicidal ideation. His concentration and memory were reported as good. A November 2016 VA mental health note reported that the Veteran denied suicidal or homicidal ideation. A June 2017 VA mental health note reported the Veteran was living with his significant other, but the house they were renting was being sold. The Veteran’s significant other expressed that she was no longer interested in co-habitation. A July 2017 VA mental health note reported that the Veteran decided to live on his own, so he had put his belongings in storage and was looking for an apartment. An August 2017 VA mental health note reported the Veteran was now homeless and was showering at his son’s home and sometimes sleeping on his couch. He did not qualify for subsidized housing because of his savings. Another August 2017 VA record reported that he continued to be homeless and was sleeping on mass transit and spending nights in coffee shops. It was reported that his PTSD symptoms were worsening. An October 2017 VA medical record documented the Veteran’s report that he was “still literally homeless” and his income continued to be $1,550 a month. He sold many of his belongings and now had $20,000 in savings. A February 2018 mental health discharge note reported that the Veteran had reconciled with his girlfriend and was living with her after living with a friend in New Mexico. He felt that the relationship with his girlfriend was mending. His affect was restricted, and mood was depressed. He denied suicidal and homicidal ideation. He occasionally loses track of his subject, hesitates and then will proceed. He had no psychotic symptoms and was well-organized. He was diagnosed with PTSD and depression. An April 2018 VA Form 21-686c reported that the Veteran was married on April 27, 2018. A May 2018 SSA record concluded that the Veteran had a medically determinable impairment of PTSD and depression that was considered severe. Objective evidence supported distractibility though he was able to follow “SRT” on neuropsychological testing. It was reported that the Veteran reported trouble with word finding and cognition; however, neuropsychological testing showed him to be within average to superior range. A May 2018 VA record reported the Veteran had pretty severe dysthymia and was upset that he was not rated at 100 percent, which would have allowed him to get a place on his own, without his girlfriend, whom he had married. He stated that she forced him to marry her for housing benefits. He was conflicted and seemed depressed about that. The Veteran was afforded another VA PTSD examination in September 2018. Based on the clinical evaluation and a review of the Veteran’s claims file, the examiner diagnosed the Veteran with PTSD and persistent depressive disorder under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. The examiner indicated that she was able to differentiate what portion of the occupational and social impairment is caused by each disorder. To the Veteran’s persistent depressive disorder, she attributed fatigue, poor concentration, feelings of hopelessness, low self-esteem, and lack of motivation. To the Veteran’s PTSD, she attributed anxiety, fatigue due to sleep disturbance/nightmares, distractibility due to intrusive memories, lack of interest in activities he used to enjoy, emotional detachment, and poor concentration. The Veteran lived with his girlfriend and described the relationship as “pretty distant.” The Veteran has a friend in New Mexico that he talks to every couple of months; otherwise, he is not in touch with any other friends. The Veteran has three grown children who live in the area and he sees them about once a month. The Veteran spends his time doing crossword puzzles and taking care of chores around the house. He used to enjoy reading but finds it difficult to concentrate enough to comprehend reading. The Veteran denied suicidal and/or homicidal ideation. Cognition appeared to be within normal limits although not formally assessed. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; chronic sleep impairment; mild memory loss, such as forgetting names, directions or recent events; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a worklike setting. The Veteran was afforded another VA PTSD examination in August 2020. Based on the clinical evaluation via video telehealth and a review of the Veteran’s claims file, the examiner diagnosed the Veteran with PTSD and persistent depression secondary to PTSD under DSM-5 criteria. The examiner opined that the Veteran had symptoms resulting in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. The examiner indicated that he was able to differentiate what portion of the occupational and social impairment is caused by each disorder. To the Veteran’s persistent depressive disorder, he attributed low levels of depression in response to chronic pain and limitations on his physical activity because of chronic pain, fatigue most of the time, poor concentration, feelings of hopelessness, and low self-esteem. To the Veteran’s PTSD, he attributed intrusive symptoms related to trauma, avoidance of trauma related stimuli, marked alterations in reactivity associated with trauma related stimuli, and negative alterations to cognitions and mood related to trauma stimuli. The Veteran had poor eye contact with the camera. His affect was euthymic, and mood was dysphoric. He reported feeling hopeless and worthless “quite a bit.” He denied suicidal ideation, intent, or plan. His sleep varies and is always broken, averaging five hours a day. He has nightmares related to combat 7 to 10 times a month. He seldom leaves his apartment and spends most of his days in bed. He does not feel safe outside his apartment. He is socially very withdrawn and sees few friends infrequently. He does some housework, but seldom cooks. His judgement was grossly intact. He described his concentration and memory as “not good” though he appeared to track the conversation well. He stated that deadlines and commitments cause significant anxiety. He had no history of mania or psychosis. The examiner reported that the Veteran exhibited the following symptoms for VA rating purposes: depressed mood; anxiety; chronic sleep impairment; mild memory loss; disturbances of motivation and mood; difficulty in establishing and maintaining effective work and social relationships; and difficulty in adapting to stressful circumstances, including work or a worklike setting. As chronicled above, for the period from April 15, 2013 to September 12, 2018, the Veteran clearly experienced psychiatric symptomatology as a result of his PTSD with symptoms such as anxiety, sleep impairment, and difficulty in establishing and maintaining effective work and social relationships. However, the objective evidence of record does not establish that his PTSD was manifested by occupational and social impairment with deficiencies in most areas, such as work, school, family relationships, judgment, thinking or mood. In support of such finding, the Board assigns great probative value to the December 2013 and October 2014 VA medical examination reports. The VA examiners, licensed psychologists, thoroughly reviewed the Veteran’s mental history and diagnosed the Veteran with PTSD and depression under DSM-5 criteria. The examiners opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity. In consideration of occupational functioning, the Veteran was not working but had been intermittently attending community college. The Veteran was able to independently handle activities of daily living, chores, and pay bills. He was able to drive and do his own shopping. A June 2015 SSA record reported that he was mostly limited from interests and hobbies due to money rather than any cognitive or mental limits and appeared well adjusted. However, the Veteran also reported that he Veteran experienced anxiety and pain when he is outside of his home so he spends most of his day in his bedroom, leaving the house only for VA appointments and obligations he cannot find a way out of. In July 2017, the Veteran broke up with his girlfriend, which led to a period of homelessness and moving out of the area to live with a friend. However, in February 2018, he had reconciled with his girlfriend and was living with her felt that their relationship was mending. In May 2018, it was reported that the Veteran had married his girlfriend; however, he was conflicted and seemed depressed about that, as he expressed that she forced him to marry her for housing benefits. The Veteran consistently denied suicidal ideation throughout the appellate period. The Board has taken into consideration the frequency, severity, and duration of the Veteran’s symptoms of PTSD during the appellate period, as well as his statements regarding his assessment of the severity of his symptoms. However, the symptoms presented here, and their resulting effects, do not rise to the level of the next higher ratings in excess of 70 percent, which requires such symptoms as suicidal ideation; obsessional rituals that interfere with routine activities; speech intermittently illogical, obscure, or irrelevant; near-continuous panic or depression affecting ability to function independently, appropriately and effectively; impaired impulse control (such as unprovoked irritability with periods of violence); spatial disorientation; neglect of personal appearance and hygiene; difficulty in adapting to stressful circumstances (including work or a work-like setting); and inability to establish and maintain effective relationships. For these reasons, the Board finds that, prior to September 12, 2018, the Veteran’s PTSD has not been manifested by symptomatology more nearly approximating the criteria for a 70 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9411. The benefit-of-the-doubt doctrine is not for application, and an increased rating under this code is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim for a rating in excess of 50 percent for the Veteran’s PTSD, from April 15, 2013 to September 12, 2018, must be denied. Turning to the period from September 12, 2018, as chronicled above, the Veteran clearly experienced psychiatric symptomatology during this period as a result of his PTSD with symptoms such as depressed mood, anxiety, sleep impairment, mild memory loss, disturbances of motivation and mood, and difficulty in establishing and maintaining effective work and social relationships. However, the preponderance of evidence weighs against finding that his level of occupational and social impairment was total during this period. In support of such finding, the Board assigns great probative value to the September 2018 and August 2020 VA medical examinations. The VA examiners, licensed psychologists, thoroughly reviewed the Veteran’s mental history and diagnosed the Veteran with PTSD and persistent depressive disorder under DSM-5 criteria. The September 2018 examiner opined that the Veteran had symptoms resulting in occupational and social impairment with reduced reliability and productivity, while the August 2020 examiner opined that the Veteran had symptoms resulting in occupational and social impairment with deficiencies in most areas, such as work, school, family relations, judgment, thinking and/or mood. Additionally, the Board has taken into consideration the frequency, severity, and duration of the Veteran’s symptoms of mental disorders during the appellate period, as well as his statements regarding his assessment of the severity of his symptoms. However, the symptoms presented here, and their resulting effects, do not rise to the level of the next higher rating from September 12, 2018. The Veteran was living with his wife, though he described the relationship as distant. He socialized with his children once a month and spoke with a friend infrequently. He spent his time doing crossword puzzles and helping with chores, though he rarely left his home. The Veteran described his concentration and memory as “not good,” though the August 2020 examiner reported that he appeared to track the conversation well. Clearly, such findings are not consistent with a higher 100 percent rating, which requires such symptoms as gross impairment in thought processes or communication; persistent delusions or hallucinations; grossly inappropriate behavior; persistent danger of hurting self or others; intermittent inability to perform activities of daily living (including maintenance of minimal personal hygiene); disorientation to time or place; memory loss for names of close relatives, own occupation or own name. 38 C.F.R. § 4.130. For these reasons, the Board finds that the Veteran’s PTSD and persistent depressive disorder, from September 12, 2018, has not been manifested by symptomatology more nearly approximating the criteria for a 100 percent disability rating under 38 C.F.R. § 4.130, Diagnostic Code 9434. The benefit-of-the-doubt doctrine is not for application, and an increased rating under this code is not warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102; Gilbert v. Derwinski, 1 Vet. App. 49, 53-56 (1990). Accordingly, the claim must be denied. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 20 percent for right shoulder impingement is remanded. 2. Entitlement to an initial rating in excess of 10 percent for chronic low back strain with myofascial pain is remanded. 3. Entitlement to an initial rating in excess of 10 percent for cervical spine degenerative arthritis, prior to October 28, 2019, is remanded. 4. Entitlement to a rating in excess of 20 percent for cervical spine degenerative arthritis, from October 28, 2019, is remanded. While further delay is regrettable, the Board finds that further development is required prior to adjudicating the Veteran’s claims. The Board finds that there has not been substantial compliance with the mandates of the March 2019 Board remand. The remand noted that the Veteran’s claim folder included correspondence regarding the Veteran’s records from the Social Security Administration (SSA), though the Veteran’s SSA records had not been obtained or associated with the claims file. Therefore, the Board’s remand specified that the RO should first secure for the record copies of all SSA decisions and medical records considered in the determination of the Veteran’s claims for SSA disability benefits. After that development was completed, the Veteran was to be afforded VA examinations to determine the nature and severity of his service-connected right shoulder, neck and back disabilities. In October 2019, the RO requested the Veteran’s records from the SSA. After a follow-up request was made on July 1, 2020, the Veteran’s SSA records were received on July 7, 2020. These records totaled 123 pages and included records that addressed the Veteran’s SSA disability claims for neck pain, back pain, and shoulder pain. However, before the SSA records were obtained, the Veteran was evaluated at VA examinations for his right shoulder, cervical spine, and thoracolumbar spine in October 2019. As these examinations were completed prior to the Veteran’s SSA records being associated with the claims file, the RO did not comply with the March 2019 remand. The United States Court of Appeals for Veterans Claims Court has stated that compliance by the Board or the AOJ is neither optional nor discretionary. Where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure compliance. See Stegall v. West, 11 Vet. App. 268 (1998). Therefore, on remand new VA examinations are necessary to consider the Veteran’s SSA records in determining the severity of the Veteran’s service-connected right shoulder, cervical spine degenerative arthritis, and chronic low back strain with myofascial pain. Regarding the Veteran’s claim for entitlement to a rating in excess of 10 percent for cervical spine degenerative arthritis, prior to October 28, 2019, the Board notes that the Veteran had been provided inadequate VA examinations in March 2012 and October 2014 during the appellate period. The Board finds that these examinations were inadequate as the examiners failed to estimate the degree of additional range-of-motion loss during flare ups. See Sharp v. Shulkin, 29 Vet. App. 26 (2017). There is no indication that the examiners made any attempt to ascertain adequate information from relevant sources to estimate the degree of additional range-of-motion loss after repeated use. Thus, on remand, if possible, the VA examiner should provide a retrospective opinion regarding functional limitations of the Veteran’s cervical spine during flare ups for the period from October 2011 to October 2019 based on the Veteran’s lay statements of experienced symptomatology. By this remand, the Board makes no determination, express or implied, concerning the credibility of any lay statements on file. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. After the above development has been completed, schedule the Veteran for a VA examination to determine the nature and severity of his right shoulder impingement. The examination should include all tests and evaluations deemed necessary by the examiner. The examiner should report all manifestations related to the disability. The claims file must be made available to the examiner for review. (a.) The examiner is requested to test the range of motion of the right shoulder in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, or concludes such testing is not necessary, he or she should clearly explain why that is so. (b.) If the examination does not take place during a flare-up or after repetitive use, the examiner should obtain from the Veteran information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups or repetitive use. The examiner must express an opinion as to whether or not the Veteran’s functional ability is significantly limited during flare-ups or after repetitive use, and that determination should, if feasible, be portrayed in terms of the degree of additional loss of range-of-motion during flare-ups. 4. Schedule the Veteran for a VA examination to determine the nature and severity of his cervical spine degenerative arthritis. The examination should include all tests and evaluations deemed necessary by the examiner. The examiner should report all manifestations related to the disability. The claims file must be made available to the examiner for review. (a.) The examiner is requested to test the range of motion of the cervical spine in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, or concludes such testing is not necessary, he or she should clearly explain why that is so. (b.) If the examination does not take place during a flare-up or after repetitive use, the examiner should obtain from the Veteran information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups or repetitive use. The examiner must express an opinion as to whether or not the Veteran’s functional ability is significantly limited during flare-ups or after repetitive use, and that determination should, if feasible, be portrayed in terms of the degree of additional loss of range-of-motion during flare-ups. (c.) If possible, provide a retrospective opinion regarding functional limitations of the Veteran’s cervical spine during flare ups for the period from October 2011 to October 2019 based on the Veteran’s lay statements of experienced symptomatology. If it is not possible to provide a retrospective opinion without speculation, the examiner must state whether the need to speculate 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. 5. Schedule the Veteran for a VA examination to determine the nature and severity of his chronic low back strain with myofascial pain. The examination should include all tests and evaluations deemed necessary by the examiner. The examiner should report all manifestations related to the disability. The claims file must be made available to the examiner for review. (a.) The examiner is requested to test the range of motion of the thoracolumbar spine in active motion, passive motion, weight-bearing, and nonweight-bearing (if applicable). If the examiner is unable to conduct the required testing, or concludes such testing is not necessary, he or she should clearly explain why that is so. (b.) If the examination does not take place during a flare-up or after repetitive use, the examiner should obtain from the Veteran information about the severity, frequency, duration, precipitating and alleviating factors, and extent of functional impairment resulting from flare-ups or repetitive use. The examiner must express an opinion as to whether or not the Veteran’s functional ability is significantly limited during flare-ups or after repetitive use, and that determination should, if feasible, be portrayed in terms of the degree of additional loss of range-of-motion during flare-ups. 6. Upon completion of the above actions, readjudicate the claims. If any determination remains unfavorable to the Veteran, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. The Veteran has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999).   These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans’ Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. § §§ 5109B, 7112. KELLI A. KORDICH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Moore, 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.