Citation Nr: 22018828 Decision Date: 03/30/22 Archive Date: 03/30/22 DOCKET NO. 17-48 623 DATE: March 30, 2022 REMANDED Entitlement to an initial rating in excess of 20 percent for a left shoulder disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1999 to November 2007. This matter came before the Board of Veterans Appeals (Board) on appeal from a March 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran's Law Judge during an August 2019 hearing. The transcript of the hearing is of record. The issue on appeal was previously remanded for development in September 2019 and May 2021 Board decisions. Entitlement to an initial rating in excess of 20 percent for a left shoulder disability is remanded. Pursuant to the May 2021 Board remand directives, the Veteran was afforded a new VA shoulder examination in December 2021. However, the Board finds that remand for additional clarification of the examiner's findings is necessary. The examiner found pain with observed range of motion and with repetitive use over time but determined that the Veteran did not experience any flare ups. However, he provided no supporting rationale for this finding, or his estimated repetitive use range of motion measurements. The medical record appears to include reports from the Veteran that he experienced worsening symptoms with specific activities, exercises, or movements. During the August 2019 Board hearing, the Veteran reported that his range of motion would vary, and that he sometimes experienced sharp pain, popping, and catching with a simple swing of the arm while walking. The examiner noted the Veteran's report that driving, lifting, pushing, pulling, torquing, and abduction aggravated his symptoms, without reference to the repetitive nature of these motions. As the examiner did not include supporting rationale, it remains unclear what case-specific evidence he considered in contrast to these reports. Remand for a clarification addendum is necessary for the Board to obtain all the information necessary to make a fully information assessment of the Veteran's functional limitation. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the provider who rendered the December 2021 VA opinion. If the examiner is not available or unable to provide an addendum opinion, the opinion must be rendered by an appropriate clinician. The opinion should address whether the Veteran experiences functional loss to the left shoulder due to flare-ups and/or repetitive use over time. A complete rationale must be provided for all opinions rendered. In rendering an opinion regarding functional loss during a flare-up or after repeated use over time, the examiner should consider and discuss the Veteran's lay statements and the other evidence of record. If functional loss during flare-ups or with repetitive use over time is determined to be present, the examiner should provide the rationale for any opinion estimating any degrees of limited motion caused by functional loss during flare-ups. If the examiner concludes that an estimate of the range of motion during flare ups or with repetitive motion over time cannot be provided without resorting to mere speculation, the examiner must support that opinion with a full and complete explanation as to why he/she cannot provide the requested opinion without resort to mere speculation. The examiner is advised that a lack of direct observation of function under those circumstances is not a basis for declining to offer an opinion. 2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Bock 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.