You say you've gotten good reviews for this piece, but it continually is rejected when submitted for publication, and you wonder why?

First of all, second-guessing editors and trying to analyzing their responses is a loser's game. Most are underpaid or volunteers, all are overworked and understaffed as they struggle to keep a publication afloat that scarcely gets noticed on a good day. I suspect that somewhere out there is an editor that might respond favorably to this story, might even publish it. Acceptance, in that case, wouldn't mean a whole lot more than rejection, unfortunately. You're asking the wrong question. What you need to ask is, "Is this a satisfying story?" To answer that you need to resolve some issues for yourself regarding stories in general, and what makes them work. Or not.

I'd be willing to bet that all the editors who rejected this story read it all the way through before making a determination, possibly more than once. You have a strong prose style and you manage to get things done without tripping over your grammar and syntax, and you establish a forward momentum with your words that keeps the reader following along to see what's going to happen. Unfortunately, when they reach the end, they will be disappointed. You've done a good job of setting up your characters in an unstable situation, one that demands a plot to resolve it, but you don't really settle anything. It's all promise and no delivery. So, without indulging myself in the thankless ego-exercise of rewriting your work for you, I'll try to highlight some places where you appear to me missing the point, in terms of creating a narrative arc.

Most crippling is the prison in which you've placed your main character. He is unable to interact with anything going on around him, and so you're stuck with two parallel tracks, one internal, one external, that have no chance to come together, cross-pollinate and create the kind of tension that generates a seamless, organic third-act. You seem to have recognized this, albeit too late, by finally forcing Ryan back into the world. This is what I call pulling a rabbit out of your hat. It's a trick, one that is unexpected and which surprises us. But you're not an illusionist, you're an author, and when you drop a solution like this onto the page, it doesn't entertain, it merely annoys.

Keep in mind, the essence of a story is change. It is the transition from Point A to Point B that constitutes the story part. Ryan doesn't change, even after his explosive awakening. No change, no story. I agree that it's essential that Ryan eventually arrives at a place where he can participate in the events around him. But you need to establish this from the start. Perhaps he's slowly emerging from his coma. Perhaps he doesn't even realize it at first. Certainly his family doesn't. That simple device would permit you to create a steady progression for Ryan, apart from the circumstances around him.

It would also permit you to exploit the most important aspect of a fully-realized plot, which is the interaction and conflict between the internal storyline and the external storyline. Right now, the family simply moves on and off the stage, telling Ryan (and the readers) about the stories happening out there. But they don't really exist, not in the present moment of this story.

I think the problem is you are trying to juggle too many plot lines, and don't really know what this story is about. You've left some valuable options unexploited, which is like leaving runners on base. For example, Ronald observes that everything has changed since Ryan's accident. In his current incarnation, Ryan is simply the quiet sphinx who sees all and knows all. But if he's been out of it, and is only now emerging from his stupor, he would be learning about the changes in his family, and responding to them as he, and the readers, encounter each new revelation.

The last thing that's missing is a connection between the rest of the family and Ryan's condition. Right now, it's simply the way things worked out. However, if there were to be some kind of serious complication in their family circumstances, some decision or result that is in limbo due to Ryan's incapacity, then you would have characters faced with conflicting emotions and attitudes. Ronald's interest in ending Ryan's life might be much more pragmatic than the manic-depressive impulse it is now.

I don't suggest that these are the ideas you should follow when you rewrite this. But I do suggest that you rewrite it, and that you engage in a similar process.