Citation Nr: 21025552 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 15-23 694 DATE: April 28, 2021 REMANDED The appeal for an initial disability rating greater than 20 percent for right shoulder bursitis with arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1965 to November 1968. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2013 Agency of Original Jurisdiction (AOJ) decision which granted service connection for right shoulder bursitis with arthritis. A noncompensable disability rating was assigned at that time, later increased to 20 percent for the entire period. The Board has remanded this issue three times, in September 2015, March 2019, and again in January 2021. Another remand is necessary, because the Board’s instructions from the most recent remand have not been fully accomplished. Where the record before the Board is inadequate to render a fully informed decision, a remand to the RO is required in order to fulfill its statutory duty to assist the Veteran to develop the facts pertinent to the claim. Furthermore, the RO is required to fully complete the development ordered by the Board. Stegall v. West, 11 Vet. App. 268 (1998); Ascherl v. Brown, 4 Vet. App. 371, 377 (1993). In January 2021, the Board determined that the evidence of record did not adequately address whether a higher disability rating could be awarded based upon additional functional impairment of the Veteran’s right shoulder during flare-ups. See DeLuca v. Brown, 8 Vet. App. 202, 206-07 (1995); Sharp v. Shulkin, 29 Vet. App. 26, 35(2017). The Board suggested that a telemedicine appointment would likely be sufficient to obtain this information. In March 2021, the Veteran was provided with a VA examination over the phone. The record shows that the Veteran does not own a computer, or any device which would allow for a telemedicine appointment with video conferencing. Furthermore, he is an older gentleman who lives 400 miles from the nearest VA facility which was available to conduct the examination. Especially in light of the COVID situation in March, it was determined that a phone interview was in the Veteran’s best interest. Review of the examination report reflects that the examination provider made what appear to be extraordinary efforts to obtain an accurate examination over the phone, taking great care to explain what was needed from the Veteran. Similarly, the Veteran appears to have been entirely cooperative and truthful. However, the examination report does not cover the extent of the Veteran’s functional impairment during flare-ups. Much attention was paid to describing the deterioration in the Veteran’s range of right shoulder motion following repetitive motion and with weight-bearing; but there is no mention of flare-ups. Therefore, another attempt to obtain this information is necessary. It is important to clarify that the Board does not find a clinical in-person examination is necessary to obtain this information, under the circumstances set forth above, which have not significantly changed since March 2021. Indeed, information regarding flare-ups is often obtained by history, as clinical examinations do not always occur when a flare-up is on-going. Under the circumstances, this information should be obtainable over the phone. A medical professional should solicit the information, however, as expertise with taking medical histories and discussing symptoms and functioning is necessary. Therefore, upon remand, another attempt to obtain information regarding the Veteran’s functional impairment during right shoulder flare-ups is necessary. As the appeal is being remanded, the Veteran’s VA treatment records should be updated for his claims file. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from January 2021 to the Present. 2. Obtain an addendum opinion from an appropriate clinician regarding the severity of the Veteran’s right shoulder flare-ups. A conversation with the Veteran is the most important part of this addendum; the examination scheduler is encouraged to provide for this conversation in the most appropriate way possible in light of the discussion above. The claims file must be made available to the examiner for review. To the extent possible, the examiner must provide a full description of the severity, frequency, and duration of any/all flare-ups, their effect on the Veteran’s daily functioning, to include their impact upon his range of motion. Precipitating and alleviating factors should be identified. The examiner should state, to the extent possible, whether during flare-ups or with repeated use over time flexion or abduction of the arm would be limited to midway between the side and shoulder level(about 45 degrees) or to 25 degrees from the side, or would the Veteran continue to be able to lift the arm to shoulder level (i.e.to90 degrees). A more exact estimate need not be provided. If the examiner is unable to provide such an estimate, the examiner must explain why the available information, including the Veteran’s statements, medical history, and the examination findings, is not sufficient for that purpose. A complete medical rationale for all explanations should be provided. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Heather J. Harter, 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.