Citation Nr: 21028637 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-29 132A DATE: May 11, 2021 REMANDED Entitlement to a rating for residuals of a thoracic spine injury, status post fusion T3-T9, with degenerative arthritis, in excess of 20 percent from November 7, 2010 to March 21, 2019 and in excess of 40 percent disabling thereafter, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1994 to October 2000. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision issued by the Department of Veterans Affairs (VA) regional office. The Veteran testified at a Board hearing in April 2018, and a transcript of the hearing is of record. As the Veterans Law Judge (VLJ) who presided over the hearing has since retired, the Veteran was offered another hearing before a different VLJ but did not request another hearing. The matter was most recently remanded in September 2019 and has returned to the Board for further adjudication. Unfortunately, there has not been substantial compliance with the prior remand directives and another remand is required. Stegall v. West, 11 Vet. App. 268, 271 (1998). The claim must be remanded again because the December 2019 VA examination and September 2020 VA addendum opinion are inadequate. The examiner was asked by the Board to provide a retrospective opinion regarding the severity of all manifestations of the Veteran's thoracic spine disability since November 2010 and did not do so. Instead of a reasoned medical analysis, the examiner provided a recitation of the medical evidence during this period. Remand is needed for a more thoughtful response to the Board's remand directive from an orthopedic surgeon. The matters are REMANDED for the following action: Obtain a retrospective medical opinion from an orthopedic surgeon and not the physician assistant who conducted the December 2019 VA examination. Copies of all pertinent records must be made available to the examiner for review. Based on a review of the record, the examiner is asked to describe the severity of all manifestations of the Veteran's thoracic spine disability since November 2010, with consideration of the Veteran's range of motion (ROM), during periods of flare-ups. If there have been changes in the nature or severity of this disorder since November 2010, the examiner is asked to specifically note where in time those changes occurred. The need for an examination (or telehealth interview, review of the record, etc., if an in-person examination is not feasible) is left to the discretion of the examiner. In providing this opinion, the examiner should consider any lay evidence of symptoms experienced over the years. As the Veteran reported flare-ups at the March 2019 VA examination, the examiner should consider the factors that precipitate a flare-up and the frequency, duration, and severity of any flare-ups. The examiner should use that information to comment on the functional limitations caused by pain and any other associated symptoms. Such comments should include whether there was additional limitation of motion following repetitive testing due to pain, weakness, fatigability, etc. Any determination concerning this functional loss should be expressed in degrees of additional range of motion loss. A detailed rationale is requested for all opinions provided. The examiner must review the evidence added to the record since the December 2019 VA examination to specifically include the lay statement submitted by the Veteran's wife on October 2020, citing increased pain over 18 years of marriage. All opinions must be supported by a clear rationale, and a discussion of the facts and medical principles involved would be of considerable assistance. J. Komperda Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Jarman, 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.