Citation Nr: 1320103 Decision Date: 06/21/13 Archive Date: 07/02/13 DOCKET NO. 05-36 588 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Salt Lake City, Utah THE ISSUE Entitlement to an initial rating in excess of 10 percent for left upper extremity paresthesia, involving dermatome at C7, associated with whiplash injury, cervical spine. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD M. Riley, Counsel INTRODUCTION The Veteran served on active duty from March 1975 to April 1976. This case comes before the Board of Veterans' Appeals (Board) on appeal from a February 2005 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Salt Lake City, Utah, which, in pertinent part, granted entitlement to service connection for paresthesias of the left upper extremity with an initial 10 percent evaluation assigned effective January 5, 2004. In August 2009, the Board remanded the case for additional development. The appeal returned to the Board in May 2011 and the claim for an increased initial rating for paresthesias of the left upper extremity was denied. The Veteran appealed this denial to the Court of Appeals for Veterans Claims (Court). In February 2012, the Court granted a Joint Motion for Remand (JMR) filed by the parties, which requested that the portion of the May 2011 decision that denied an increased initial rating for paresthesias of the left upper extremity be vacated and remanded. The appeal has now returned to the Board. When the case was previously before the Board in May 2011, the issue for entitlement to an increased initial rating for residuals of a whiplash injury to the cervical spine was adjudicated. The Board's decision with respect to this issue was not disturbed by February 2012 JMR and is no longer before the Board. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The parties agreed in the February 2012 JMR that the Board's May 2011 decision did not provide adequate reasons or bases for its selection of Diagnostic Code 8616, pertaining to neuritis of the ulnar nerve, as the appropriate diagnostic code to rate the service-connected paresthesias of the left upper extremity. The JMR also noted that the Board failed to discuss whether staged or separate ratings were appropriate to compensate the Veteran for symptoms associated with the service-connected neurological disability. After review of the evidence, the Board finds that a remand is necessary to obtain a VA opinion addressing specific medical questions raised by this case. Service connection was granted for left upper extremity paresthesia, involving dermatome at C7, associated with whiplash injury, cervical spine, but it is not clear exactly which nerves are affected. The evidence of record indicates that the Veteran's service-connected neurological disability may involve two nerves of the left upper extremity. A December 2004 nerve conduction study performed at the Salt Lake City VA Medical Center (VAMC) demonstrated mild left cervical radiculopathy with mild left ulnar compression neuropathy at the elbow and slight left median compression neuropathy at the wrist (consistent with carpal tunnel syndrome). A similar VA consultation performed in February 2006 also indicated that the Veteran's complaints of hand numbness were mostly over the ulnar distribution of the left extremity. However, upon VA examination in May 2010, the Veteran was diagnosed with subtle left nerve root compromise with a slightly decreased triceps reflex and slight denervation of the pronator teres muscle. This muscle is affected by the median nerve. Thus, the record contains evidence of both ulnar and median nerve involvement possibly stemming from the Veteran's service-connected disability. Although the Veteran was most recently provided a VA peripheral nerves examination in August 2012, this examination was performed in response to a claim for nonservice-connected pension, and appears to have focused mainly on the right upper extremity. The examiner provided a diagnosis of "neuritis of the ulnar nerve" but did not specify whether this diagnosis pertained to the left upper extremity, the right upper extremity, or both. Furthermore, the examiner did not identify any specific nerve affected by the Veteran's service-connected disability; in fact, the examination report indicates that all the Veteran's left cervical and upper extremity nerves were normal. A VA medical opinion is therefore required to determine the precise nature and nerves affected by the Veteran's service-connected paresthesias of the left upper extremity. Accordingly, the case is REMANDED for the following action: 1. Schedule the Veteran for an appropriate VA examination to determine the current severity of the left upper extremity paresthesia. The examiner should be provided the claims folder for review prior to the examination. All indicated testing should be conducted. Based on the examination and review of the record, the examiner should address the following questions: a) What specific nerve or nerves are involved in the service-connected left upper extremity paresthesia, involving dermatome at C7, associated with whiplash injury? b) For each affected nerve, indicate the degree of lost or impaired function; whether mild, moderate or severe incomplete paralysis or complete paralysis. c) Is the Veteran's diagnosed left carpal tunnel syndrome (identified during the December 2004 VA nerve conduction study test) associated with the service-connected paresthesias of the left upper extremity? d) Is "neuritis of the left ulnar nerve" the appropriate medical diagnosis for the Veteran's service-connected paresthesias of the left upper extremity? A full rationale (i.e. basis) for all expressed opinions must be provided. 2. Readjudicate the claim on appeal with consideration of all the evidence of record, including the August 2012 VA peripheral nerves examination and any medical opinion added to the record. If the benefit sought on appeal is not fully granted, issue a SSOC before returning the case to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matter the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2012). _________________________________________________ M. E. LARKIN Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2012).