Citation Nr: 21024589 Decision Date: 04/23/21 Archive Date: 04/23/21 DOCKET NO. 14-42 445 DATE: April 23, 2021 REMANDED An initial rating higher than 20 percent for chronic right scapulothoracic and scapulocervical strain with scapulothoracic dysfunction is remanded. REASONS FOR REMAND The Veteran served honorably on active duty in the United States Army from December 1965 to December 1967. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In May 2018, the Board issued a decision denying an increased rating for chronic right scapulothoracic and scapulocervical strain with scapulothoracic dysfunction. In an April 2019 Order, the United States Court of Appeals for Veterans Claims (Court) endorsed a joint motion for remand (JMR), vacated the Board’s May 2018 decision, and remanded the case for further action consistent with the terms of the joint motion. As noted above, this matter was returned to the Board pursuant to an April 2019 JMR. “A joint motion for remand, when drafted properly, identifies … clear instructions to the Board as to what it is required to address, and what actions it is required to take, on remand. This increases both administrative and judicial efficiency.” Carter v. Shinseki, 26 Vet. App. 534, 541 (2014), vacated on other grounds sub nom. Carter v. McDonald, 794 F.3d 1342 (Fed. Cir. 2015). In September 2019, the Board remanded this matter for further development. Unfortunately, another remand is necessary. After remand the Veteran was afforded a VA examination to determine the extent of his chronic right scapulothoracic and scapulocervical strain with scapulothoracic dysfunction. Specifically, he was afforded a muscle injury examination, shoulder injury examination, and cervical spine examination. The Veteran underwent two shoulder examinations, one in December 2019 and another in November 2020. The December 2019 examination indicated that the Veteran reported flare-ups and the examiner was able to describe functional loss during a flare-up in terms of range of motion. The November 2020 examiner indicated no reports of flare-ups, but when asked for clarification based on the discrepancy between the December 2019 examination and the November 2020 examination, the examiner reported that it was an error that there were no reports of flare-ups. The examiner though did not attempt to elicit relevant information regarding the description of the Veteran’s flare-ups and any additional functional loss suffered during flare-ups. Furthermore, the November 2020 examiner did not provide funcitonal loss after repetitive use in terms of range of motion. When asked for clarification the examiner provided the same functional loss in terms range of motion as in the December 2019 examination. However, the Veteran demonstrated reduced range of motion in his November 2020 examination compared to the December 2019 examination. The Board finds it factually inconsistent that the Veteran would demonstrate greater range of motion after repetitive use in his November 2020 examination compared to his regular range of motion. As such, the Board finds the most recent VA shoulder examination to be inadequate and a remand is necessary to obtain a new examination. The matter is REMANDED for the following action: Schedule the Veteran for an examination by an appropriate clinician, preferably by one who has not examined him before, to determine the current severity of his service-connected chronic right scapulothoracic and scapulocervical strain with scapulothoracic dysfunction. The examiner should provide a full description of the disability and report all signs and symptoms. (Continued on the next page)   The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. If it is not possible to provide a specific measurement 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). If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement 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). JOHN Z. JONES Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Michael Chandeck, 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.