Citation Nr: 18142701 Decision Date: 10/16/18 Archive Date: 10/16/18 DOCKET NO. 15-04 049 DATE: October 16, 2018 ORDER A rating in excess of 50 percent for left upper extremity neuropathy is denied. A rating in excess of 40 percent for right upper extremity neuropathy is denied. A rating of 40 percent, but no more, for left lower extremity neuropathy prior to October 4, 2016, is granted. A rating in excess of 40 percent for left lower extremity neuropathy from October 4, 2016 to April 24, 2017, is denied. A rating of 60 percent, but no more, for left lower extremity neuropathy as of April 25, 2017, is granted. A rating of 40 percent, but no more, for right lower extremity neuropathy prior to October 4, 2016, is granted. A rating in excess of 40 percent for right lower extremity neuropathy from October 4, 2016 to April 24, 2017, is denied. A rating of 60 percent, but no more, for right lower extremity neuropathy as of April 25, 2017, is granted. A certificate of eligibility for financial assistance in the purchase of specially adapted housing is granted. Entitlement to special monthly compensation (SMC) by reason of being housebound is granted. REMANDED Entitlement to automobile or other conveyance and adaptive equipment or for adaptive equipment only, is remanded. FINDINGS OF FACT 1. Throughout the course of the appeal, the neuropathy in the Veteran’s bilateral upper extremities has been characterized by severe constant pain, tingling and numbness; complete paralysis has not been shown. 2. Prior to April 25, 2017, the neuropathy in the Veteran’s bilateral lower extremities has been characterized by constant pain, tingling and numbness with symptoms equivalent to “moderately severe” incomplete paralysis. 3. As of April 25, 2017, the neuropathy in the Veteran’s bilateral lower extremities has been characterized by constant pain, tingling and numbness with symptoms equivalent to “severe” incomplete paralysis. 4. The Veteran’s service-connected disabilities in his lower extremities result in loss of use of both lower extremities such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair. 5. The Veteran has been assigned TDIU based upon his service-connected diabetes and residuals thereto, to include bilateral upper and lower extremity neuropathy, and also has been assigned a 70 percent rating for his service-connected psychiatric disorder. CONCLUSIONS OF LAW 1. The criteria for a rating in excess of 50 percent for left upper extremity neuropathy have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, Diagnostic Code (DC) 8515. 2. The criteria for a rating in excess of 40 percent for right upper extremity neuropathy have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8515. 3. The criteria for a rating of 40 percent, but no more, for left lower extremity neuropathy prior to October 4, 2016, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 4. The criteria for a rating in excess of 40 percent for left lower extremity neuropathy from October 4, 2016 to April 24, 2017, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 5. The criteria for a rating of 60 percent, but no more, for left lower extremity neuropathy as of April 25, 2017, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 6. The criteria for a rating of 40 percent, but no more, for right lower extremity neuropathy prior to October 4, 2016, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 7. The criteria for a rating in excess of 40 percent for right lower extremity neuropathy from October 4, 2016 to April 24, 2017, have not been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 8. The criteria for a rating of 60 percent, but no more, for right lower extremity neuropathy as of April 25, 2017, have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.6, 4.120, 4.123, 4.124, 4.124a, DC 8520. 9. The basic eligibility requirements for a certificate for specially adapted housing have been met. 38 U.S.C. §§ 2101(b), 5107; 38 C.F.R. §§ 3.102, 3.809. 10. The criteria for SMC by reason of being housebound have been met. 38 U.S.C. §§ 1114, 5107; 38 C.F.R. §§ 3.350, 3.352. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from January 1966 to January 1969. In May 2018, the Veteran testified at a Travel Board hearing before the undersigned Veteran’s Law Judge. A transcript of the hearing is of record. The Board observes that in an October 2012 rating decision, the Regional Office (RO) reduced the assigned ratings for the Veteran’s right upper extremity, and bilateral lower extremity disorders. However, as the RO subsequently increased the assigned rating for the Veteran’s right upper extremity disorder to 40 percent for the entire period on appeal, to include the entire period for which it was initially reduced, the propriety of that rating reduction is moot and no longer on appeal. Similarly, given the that Board is increasing the Veteran’s bilateral lower extremity neuropathy ratings to 40 percent (in each extremity) for the entire period on appeal, the propriety of those rating reductions is also moot and no longer on appeal. The Board notes that in October 2017, the RO awarded the Veteran service connection for bilateral lower extremity neuropathy affecting the femoral nerve, and assigned separate 40 percent ratings for each extremity, effective October 4, 2016. However, while the Veteran’s symptoms on appeal may overlap with the symptoms addressed in this rating decision, the Board determines that these ratings are not on appeal given that the Veteran did not file a notice of disagreement with respect to the ratings and/or effective date of the award. See Tyrues v. Shinseki, 23 Vet. App. 166, 176 (2009) (in situations where an issue is bifurcated, an appellant must then specifically appeal each bifurcated issue). Increased Ratings The Veteran asserts that he is entitled to increased ratings for his neuropathy of the bilateral upper and lower extremities. Disability evaluations are determined by the application of a schedule of ratings which is based on average impairment of earning capacity. Generally, the degrees of disability specified are considered adequate to compensate for considerable loss of working time from exacerbations or illnesses proportionate to the severity of the several grades of disability. See 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. 38 U.S.C. § 1155; 38 C.F.R. Part 4. Where there is a question as to which of two separate evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that particular rating. 38 C.F.R. § 4.7. When a reasonable doubt arises regarding the degree of disability, such doubt will be resolved in favor of the Veteran. 38 C.F.R. § 4.3. In cases where entitlement to compensation has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. See Francisco v. Brown, 7 Vet. App. 55, 58 (1994). Nevertheless, where the evidence contains factual findings that show a change in the severity of symptoms during the course of the rating period on appeal, assignment of staged ratings would be permissible. See Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Entitlement to a rating in excess of 50 percent for left upper extremity neuropathy 2. Entitlement to a rating in excess of 40 percent for right upper extremity neuropathy Throughout the course of the appeal, separate 50 percent and 40 percent ratings have been assigned for the Veteran’s left (major) and right (minor) upper extremity neuropathy, respectively, due to severe, incomplete paralysis of the upper median nerve group. 38 C.F.R. §§ 4.123, 4.124a, DC 8515. The Board agrees that this is the most appropriate diagnostic code even though the Veteran’s symptoms were noted to affect different nerve groups (medial and radicular) during the course of the appeal. In any event, the Board notes that the rating criteria is the same for the medial and radicular nerve groups. See 38 C.F.R. §§ 4.123, 4.124a, DCs 8515, 8510-8512. In rating diseases of the peripheral nerves, the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type of picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. In order to warrant a rating in excess of 50 percent for neuropathy of the upper median major nerve group, and in excess of 40 percent for neuropathy of the upper median minor nerve group the evidence must demonstrate “complete” paralysis (70 percent for major, and 60 percent for minor, under DC 8515). 38 C.F.R. § 4.124a. Here, based on the evidence of record, a rating in excess of 50 percent for left upper extremity neuropathy, and in excess of 40 percent for left upper extremity neuropathy is not warranted for the entire period on appeal as the evidence does not demonstrate “complete” paralysis of the upper median major and minor nerve groups, respectively. Specifically, at an October 2012 VA examination, the Veteran reported serve pain, tingling, and numbness in his upper extremities. Upon examination, the examiner determined that the Veteran had “severe” incomplete paralysis of his bilateral upper median nerve group. Further, while the Veteran had mostly absent upper extremity reflexes and some absent upper extremity sensation, his muscle strength was mostly normal with only decreased grip, and no muscle atrophy. Similarly, the Veteran’s October 2013 VA examination did not reveal complete paralysis of the median nerve group in the upper extremities. Moreover, while the Veteran reported severe pain, tingling, and numbness, his motor, sensory, and muscle strength testing demonstrating normal to decreased functioning. The Veteran’s most recent October 2016 VA examination did not reveal complete paralysis of the median nerve group in the upper extremities, or functioning equivalent thereto. In fact, the Board observes that the Veteran’s symptoms were improving as he reported only moderate pain, tingling, and numbness. On examination, testing revealed bilateral “moderate” incomplete paralysis of the radicular nerve group in the upper extremities. Additionally, while the Veteran had some absent sensations in his upper extremities, he nevertheless still had normal to decreased muscle strength and reflexes throughout. As a result, the functioning in the Veteran’s upper extremity was not equivalent to complete paralysis. Additionally, the Veteran’s treatment records do not reflect “complete” paralysis of his bilateral upper median/radicular major and/or minor nerve groups, respectively. Therefore, the Board finds that a rating in excess of 50 percent for left upper extremity neuropathy, and a rating in excess of 40 percent for right upper extremity neuropathy is not for application. 3. Entitlement to a rating in excess of 20 percent for left lower extremity neuropathy prior to October 4, 2016, and in excess of 40 percent from October 4, 2016 to April 24, 2017 4. Entitlement to a rating in excess of 20 percent for right lower extremity neuropathy prior to October 4, 2016, and in excess of 40 percent from October 4, 2016 to April 24, 2017 Prior to October 2016, the Veteran was assigned two separate 20 percent ratings under DC 8521 (addressing impairment to the external popliteal nerve group), which was later changed to DC 8520, to reflect impairment of the sciatic nerve group. 38 C.F.R. § 4.124a. As a preliminary matter, the Board agrees that DC 8520 is the most appropriate diagnostic code, and changes his assigned rating to this diagnostic code for the entire period on appeal given that the Veteran’s October 2012 and October 2013 VA examinations reflect bilateral extremity impairment to the sciatic nerve group. Next, the Board initially assigns the Veteran separate 40 percent ratings prior to October 4, 2016, for bilateral lower extremity neuropathy in each extremity, respectively, under DC 8520 for “moderately severe” incomplete paralysis of sciatic nerve group. Of note, the Board finds that the VA examinations from October 2012, October 2013, and October 2016 indicate that the Veteran’s bilateral lower extremity neuropathy most closely reflects the criteria for a 40 percent rating under DC 8520. Under DC 8520, a 60 percent rating is warranted when there is incomplete paralysis that is “severe” in nature with marked muscular atrophy. 38 C.F.R. § 4.124a. Based upon the evidence of record, the Board determines that ratings in excess of 40 percent for neuropathy in either of the Veteran’s lower extremities, respectively, are not warranted prior to April 25, 2017, as he did not have “severe” incomplete paralysis of the sciatic nerve group, or symptoms equivalent thereto. Specifically, at a VA examination in October 2012, while the Veteran stated that he had severe intermittent pain, numbness, and tingling in his lower extremities, the examiner determined the Veteran with “moderate” incomplete paralysis of the sciatic nerve group in his lower extremities. Further, while the Veteran did not have any bilateral reflexes, he nevertheless still had (albeit decreased) motor and sensory functioning. Moreover, there was no evidence of muscle atrophy. In an October 2013 VA examination, the Veteran continued to exhibit bilateral lower extremity neuropathy consistent with a 40 percent rating in each extremity. Here, while the Veteran continued to report severe symptoms, the examiner opined that the Veteran had only moderately severe incomplete paralysis of his sciatic nerve in his lower extremities. Further, the Board also observes that the Veteran displayed improved muscle strength despite not having deep tendon reflexes in his lower extremities. Moreover, no muscle atrophy was noted. In his most recent October 2016 VA examination, the Veteran’s symptoms on balance remained the most consistent with the criteria for a 40 percent rating. In this case, while the Veteran reported severe pain, tingling, and numbness with absent sensory and refluxes in his lower extremities, he nevertheless exhibited some muscle strength and diminished reflexes. The examiner also determined that the Veteran had moderately severe incomplete paralysis of his sciatic nerve. Additionally, while the Veteran did display weakened flexion below the knee, there was no evidence of muscle atrophy. In fact, he was still able to walk and use his lower extremities despite significant impairment. Moreover, while the Veteran’s treatment records, including from January 2015, reflect that while he had lower extremity weakness and some sensory deficits, there is no evidence of muscle atrophy or sufficient evidence of symptoms that are equivalent to “severe” incomplete paralysis of the sciatic nerve group during this period. Therefore, separate ratings in excess of 40 percent for bilateral lower extremity neuropathy are not warranted prior to April 25, 2017.   5. Entitlement to a rating in excess of 40 percent for left lower extremity neuropathy as of April 25, 2017 6. Entitlement to a rating in excess of 40 percent for right lower extremity neuropathy as of April 25, 2017 Since April 25, 2017, the Board finds that while the Veteran’s treatment records do not explicitly report muscle atrophy, the Board finds that his symptoms related to bilateral lower extremity neuropathy most closely reflect the criteria for a 60 percent rating under DC 8520 due to “severe” incomplete paralysis. Specifically, the April and November 2017 treatment records indicate that the Veteran has essentially lost all sensation in his lower extremities. Further, the medical treatment records report that the Veteran was hospitalized several times due to falls that he sustained due to his lower extremity neuropathy. Additionally, the VA treatment records since April 2017 reflect that the Veteran required the use of a motorized wheelchair due to the severity of his disorder. As such, separate 60 percent ratings for each lower extremity under DC 8520 is warranted. The Board has considered whether or not the Veteran is entitled to the higher 80 percent rating for incomplete paralysis under DC 8520. Nevertheless, there is no evidence of complete paralysis of the Veteran’s lower extremities. In fact, the Veteran’s February 2018 VA treatment records indicate that he had between 15-70 degrees of flexion in his knees and some muscle strength in his legs. As such, even though the Veteran had some weakness with flexion, the Board finds that the evidence is not sufficient to support the criteria for an 80 percent rating as the Veteran did not have foot drop or loss of movement below the knee. Therefore, separate ratings of 60 percent, but not more for bilateral lower extremity neuropathy as of April 25, 2017, are warranted. In order to prevent any potential prejudice to the Veteran, the Board has also considered whether the Veteran could receive separate ratings for impairment to multiple nerves in the Veteran’s upper and lower extremities (not to include the previously discussed nerve ratings that are not on appeal). In this case, the Board determines that the October 2012, October 2013, and October 2016 VA examiners reported that while the Veteran had impairment to multiple nerves, his symptoms were all characterized as pain, weakness, numbness, and tingling in his bilateral upper and lower extremities. Therefore, given that the Veteran’s symptomology for his nerve impairments overlap in each extremity, separate ratings would result in pyramiding, and therefore are not for application. 38 C.F.R. § 4.14; see Esteban v. Brown, 6 Vet. App. 259, 261-62 (1994). In considering the appropriate disability rating, the Board has also considered the statements from the Veteran that his bilateral upper and lower neuropathy is worse than the ratings he currently receives. In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. See Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). Competency of evidence differs from weight and credibility. While the Veteran is competent to report symptoms because this requires only personal knowledge as it comes to him through his senses, he is not competent to identify a specific level of disability of his bilateral upper and lower extremity neuropathy according to the appropriate diagnostic codes. Rucker v. Brown, 10 Vet. App. 67, 74 (1997); Layno v. Brown, 6 Vet. App. 465, 469 (1994); see also Cartright v. Derwinski, 2 Vet. App. 24, 25 (1991) (“although interest may affect the credibility of testimony, it does not affect competency to testify”). On the other hand, such competent evidence concerning the nature and extent of the Veteran’s neuropathy have been provided by the medical personnel who have examined him during the current appeal and who have rendered pertinent opinions in conjunction with the evaluations. The medical findings (as provided in the examination reports) directly address the criteria under which these disabilities are evaluated. The Board also finds that consideration for an extraschedular evaluation, a component of a claim for an increased rating, is not warranted. Bagwell v. Brown, 9 Vet. App. 337, 339 (1996). Although the Board may not assign an extraschedular rating in the first instance, it must specifically adjudicate whether to refer a case for extraschedular evaluation when the issue either is raised by the claimant or is reasonably raised by the evidence of record. Barringer v. Peake, 22 Vet. App. 242 (2008). In considering whether an extraschedular rating may be warranted, VA must first determine whether the available applicable schedular rating criteria are inadequate because they do not contemplate the Veteran’s level of disability and symptomatology. If the rating criteria are inadequate, VA must then determine whether the Veteran exhibits an exceptional disability picture indicated by other related factors such as marked interference with employment or frequent periods of hospitalization. If such related factors are exhibited, then referral must be made to the Under Secretary for Benefits or the Director of the Compensation and Pension Service for extraschedular consideration. See Thun v. Peake, 22 Vet. App. 111 (2008). In this case, the evidence does not indicate that Veteran’s disability picture could not be adequately contemplated by the applicable schedular rating criteria discussed above. Specifically, the Board has reviewed all of his relevant symptoms related to the issues on appeal, including limitations with activities of daily living, and concludes that there are no symptoms that were not able to be addressed by the applicable diagnostic codes. See Mittleider v. West, 11 Vet. App. 181 (1998). As such, the Veteran’s symptoms are not which are so unusual that they are outside the schedular criteria. Therefore, given that the applicable schedular rating criteria are more than adequate in this case, the Board need not consider whether the Veteran’s disability picture includes exceptional factors, and referral for consideration of the assignment of a disability evaluation on an extraschedular basis is not warranted. See Thun, 22 Vet. App. at 111; see also Bagwell v. Brown, 9 Vet. App. 337, 338-9 (1996); Floyd v. Brown, 9 Vet. App. 88, 96 (1996); Shipwash v. Brown, 8 Vet. App. 218, 227 (1995). SMC based on Housebound Status In this case, the Board finds that the issue of entitlement to SMC based upon housebound status has been raised by the record given that the Veteran has been awarded TDIU and has numerous separate disabilities that have a combined rating of 60 percent or more. See generally Roberson v. Principi, 251 F.3d 1378 (Fed. Cir. 2001); Rice v. Shinseki, 22 Vet. App. 447 (2009). Under the applicable statutes and regulations, a veteran may be entitled to special monthly compensation for housebound benefits if, in addition to having a single permanent disability rated 100 percent disabling under the VA Schedule for Rating Disabilities (not including ratings based upon unemployability under 38 C.F.R. § 4.17 of this chapter), the Veteran either: • Has an additional disability or disabilities independently ratable at 60 percent or more, separate and distinct from the permanent disability rated as 100 percent disabling and involving different anatomical segments or bodily systems; or • Is “permanently housebound” by reason of disability or disabilities. This requirement is met when the Veteran is substantially confined to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime. 38 U.S.C. § 1114(s); 38 C.F.R. § 3.350(i). While the total disability requirement must be met by a single disability, the 60 percent requirement may be met by applying the combined rating of the Veteran’s remaining disabilities. See Bradley v. Peake, 22 Vet. App. 280 (2008) (noting that combined ratings to satisfy the second requirement but not the first). Moreover, in order to be considered “permanently housebound,” the requirement that the Veteran be “substantially confined” to the home or its immediate premises is broadly construed and met when the Veteran is simply unable to leave the home to earn a living, as opposed to requiring that the Veteran be unable to leave the house at all. 38 U.S.C. § 1114(s). The Board determines that the requirements for SMC based on housebound status have been meet on a schedular basis. Here, the Veteran was in receipt of TDIU based on his service connected diabetes and residuals thereto, to include bilateral upper and lower extremity neuropathy. Next, for the period after September 15, 2015, the Board observes that the Veteran was assigned a 70 percent rating for his psychiatric disability. Therefore, SMC based on housebound status is warranted on a schedular basis. Adapted Housing and Special Adaptation Grant The Veteran is claiming entitlement to benefits for adapted housing or, in the alternative, a special adaption grant. Eligibility for assistance in acquiring specially adapted housing under 38 U.S.C. § 2101(a) may be granted if a claimant is entitled to compensation for permanent and total disability due to: • The loss or loss of use of both lower extremities, such as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; • Blindness in both eyes, having only light perception, plus the anatomical loss or loss of use of one lower extremity; • The loss or loss of use of one lower extremity together with residuals of organic disease or injury which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; • The loss or loss of use of one lower extremity together with the loss or loss of use of one upper extremity which so affect the functions of balance or propulsion as to preclude locomotion without the aid of braces, crutches, canes, or a wheelchair; • The loss or loss of use of both upper extremities such as to preclude use of the arms at or above the elbow; • Full thickness or subdermal burns that have resulted in contractures with limitation of motion of two or more extremities or of at least one extremity and the trunk; or, • Service-connected ALS rated 100 percent disabling under 38 C.F.R. § 4.124a, Diagnostic Code 8017. 38 C.F.R. § 3.809(a) & (d). The phrase “preclude locomotion” is defined as the necessity for regular and constant use of a wheelchair, braces, crutches, or canes as a normal mode of locomotion although occasional locomotion by other methods may be possible. 38 C.F.R. § 3.809(c). Based on the evidence of record, the Board determines that specially adapted housing is warranted based upon loss of use of the Veteran’s lower extremities. In this case, and as discussed, the medical treatment records reflect that the Veteran’s service-connected lower extremity neuropathy is sufficiently severe that it precludes locomotion for purposes of 38 C.F.R. § 3.308(c). Specifically, the October 2016 and November 2017 VA treatment records indicate that the Veteran generally used a motorized wheelchair and/or walker to ambulate. Further, in January and February 2018, the Veteran was assessed for adaptive equipment and it was determined that due to his neuropathy, he was very limited in performing most activities of daily living and needed adaptive equipment such as a motorized wheelchair, grab bars, a heavy-duty shower chair, a raised toilet, etc., for mobility and safety. Therefore, in the Board’s view, the Veteran’s limitations in his lower extremities are severe enough that they effectively preclude locomotion. As such, entitlement to specially adapted housing is warranted. Additionally, as the Board finds that this benefit is warranted, he is legally precluded from also obtaining a special home adaptation grant under 38 C.F.R. § 3.809a. Therefore, this aspect of his claim is moot and is not considered. REASONS FOR REMAND 1. Entitlement to automobile or other conveyance and adaptive equipment or for adaptive equipment only, is remanded. The Board observes that in an August 2016 rating decision, the RO denied this claim. The Veteran subsequently filed a notice of disagreement to this rating decision a few weeks later (in August 2016), as well as submitted a new claim in October 2016. However, the RO treated this as a new claim and only issued a new rating decision. Therefore, a remand is required for further adjudication of this issue and the issuance of a statement of the case (SOC). Manlincon v. West, 12 Vet. App. 238 (1999); Godfrey v. Brown, 7 Vet. App. 398, 408-410 (1995); Archbold v. Brown, 9 Vet. App. 124 (1996). The matter is REMANDED for the following action: 1. The AOJ should undertake any additional action it deems necessary, including any additional VA examinations, in order to properly adjudicate the issue on appeal.   2. If the claim is not fully granted, a SOC should be issued. The Veteran must be informed of his appeal rights and that he must file a timely substantive appeal to perfect the appeal. If an appeal is perfected, return the case to the Board. B.T. KNOPE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Meyer, Associate Counsel