Citation Nr: 18144453 Decision Date: 10/24/18 Archive Date: 10/24/18 DOCKET NO. 16-18 527 DATE: October 24, 2018 REMANDED Entitlement to an evaluation in excess of 10 percent for limitation of extension with residuals, left femur fracture, status post open reduction and internal fixation (s/p ORIF), is remanded. Entitlement to an evaluation in excess of 20 percent for limitation of flexion with residuals, left femur fracture, s/p ORIF, is remanded. Entitlement to an evaluation in excess of 10 percent for impairment of the thigh with residuals, left femur fracture, s/p ORIF, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to the service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1979 to January 1983. The Veteran filed a July 2014 claim seeking an increased disability rating for his service-connected left femur fracture, limitation of extension rated at 10 percent. His service-connected left femur fracture, limitation of flexion rated at 20 percent and his service-connected impairment of the left thigh disability rated at 10 percent. In July 2014, the Veteran also filed a TDIU claim. This matter is on appeal from a September 2014 rating decision. In January 2015, the Veteran filed a notice of disagreement (NOD) asserting that his left femur conditions are getting worse and that he now has a spur which is growing in his left thigh and causing it to rub against a nerve and muscle. The Veteran also indicated that he is unable to work due to his disabilities. In a February 2015 Board decision, the Veteran’s claims were remanded for issuance of a Statement of the Case (SOC), because the Veteran requested that a Decision Review Officer issue a SOC after his January 2015 NOD, which was not issued. The Veteran was afforded a hip and thigh VA examination in December 2015 and the SOC denying the Veteran’s claims were issued in March 2016. The Veteran’s claims were returned to the Board for appellate review. The Board notes that the Veteran’s representative submitted a March 2018 signed letter on behalf of the Veteran indicating that he continues to appeal his increased rating claims for his left femur disabilities and his claim for TDIU. While the record contains a December 2015 VA examination regarding the Veteran’s three separate left thigh service-connected disabilities, the examination is not adequate for rating purposes because the Veteran refused to undergo range of motion testing. The examiner stated that the Veteran was not examined and that due to pain, the Veteran was unable to try any movements. However, the Veteran has since stated in his 2015 NOD that his left femur disabilities were worse. Thus, increasing in severity since his last 2014 VA examination. As, such, the Veteran should be provided an opportunity to report for a new VA examination to ascertain the current severity and manifestations of his left femur and left thigh disabilities. Accordingly, a remand is warranted. TDIU Finally, because a decision on the remanded issues could significantly impact a decision on the issue of TDIU, the issues are inextricably intertwined. A remand of the claims for TDIU is required. The matters are REMANDED for the following action: 1. Obtain VA treatment records from March 2016 to the present. 2. Schedule the Veteran for an examination to determine the current severity of the following service-connected disabilities: left femur fracture-limitation of extension, left femur fracture-limitation of flexion and impairment of left thigh, to include the Veteran’s contention that he now has a spur which is growing in his left thigh and causing it to rub against a nerve and muscle. The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. The examiner should test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. The examiner should attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. (Continued on the next page)   To the extent possible, the examiner should identify any symptoms and functional impairments due to his service-connected left femur fracture-limitation of extension, left femur fracture-limitation of flexion and impairment of left thigh disability alone and discuss the effect of the Veteran’s service-connected left femur fracture-limitation of extension, left femur fracture-limitation of flexion and impairment of left thigh disabilities on any occupational functioning and activities of daily living. MATTHEW W. BLACKWELDER Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. Franklin, Associate Counsel