Citation Nr: 18144981 Decision Date: 10/25/18 Archive Date: 10/25/18 DOCKET NO. 15-06 644A DATE: October 25, 2018 REMANDED Entitlement to a rating in excess of 40 percent for a right wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty form November 1990 to May 1991. In March 2018, the Veteran testified at a video conference hearing (hearing) before the undersigned Veterans Law Judge. A transcript of the hearing is associated with the claims file. 1. Entitlement to a rating in excess of 40 percent for a right wrist disability is remanded. A remand is warranted for a new VA examination because the examinations of record contain insufficient evidence regarding the Veteran’s current severity of his service-connected right wrist disability. Specifically, the record contains conflicting evidence regarding whether the Veteran’s wrist is ankylosed. Specifically, the Veteran was provided VA examinations in December 2013, May 2017, and June 2018. Although the Veteran reported that he experienced stiffness and pain which limited his range of motion, none of these examiners found ankylosis in his right wrist. In her finding that the Veteran’s abnormal range of motion contributed to functional loss, the June 2018 VA examiner noted “very diminished range of motion and stiffness.” See June 2018 VA Wrist Conditions Disability Benefits Questionnaire (DBQ). In August 2018, the Veteran submitted a private medical opinion regarding his wrist disability. See August 2018 Private Opinion from Dr. A.M. The Veteran reported no strength and decreased range of motion in his wrist. The physical examination revealed “swelling and fullness over the dorsal wrist. Wrist does not flex at all. Extension 20 degrees. Radial deviation 5 degrees. Ulnar deviation 0.” Id. The physician also found the Veteran had evidence of arthritis clinically and on X-ray and noted “dramatic decrease in his range of motion, significant grip strength deficit and generalized median neuropathy.” Id. On the other hand, the Board notes that the Veteran was initially assigned a 40 percent disability rating under DC 5214 in a July 2001 Rating Decision due to “examiner assessment of near ankylosis, and X-ray findings also supportive of current fusion from the prior four-point fusion surgery 12-9-99.” See July 2, 2001, VA rating decision, page 1 (emphasis added). Based on the foregoing discrepancy, the Board finds that a new VA examination and medical opinion is necessary to assess the current severity of the Veteran’s right wrist disability to assess whether ankylosis is present. The matter is REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate medical professional to ascertain the current nature and severity of the Veteran’s service-connected right wrist disability. The examiner is requested to review all pertinent records associated with the claims file including this remand. Specifically provide an x-ray of the Veteran’s wrists, and any other studies, tests, and evaluations deemed necessary by the examiner should be performed. After examining the Veteran and reviewing the claims file, the examiner is asked to respond to the following: (a.) Determine the presence, or absence, of ankylosis of the right wrist. The examiner MUST: (i) REVIEW AND COMMENT ON THE PRIOR FOUR-POINT FUSION SURGERY OF DECEMBER 9, 1999. See July 2, 2001 VA rating decision, page 1. (ii) Review and comment on the December 2013, May 2017, and June 2018 VA examination findings of no ankylosis. If ankylosis is present, indicate whether it is favorable in 20 to 30 degrees dorsiflexion; in any other position, except favorable; or unfavorable in any degrees of palmar flexion, or with ulnar or radial deviation. If ankylosis is not found, the examiner should opine whether the Veteran’s symptoms of his current right wrist disability are no longer fused, and determine if dorsiflexion is less than 15 degrees or palmer flexion limited in line with forearm. (b.) Report all signs and symptoms necessary for rating the Veteran’s service-connected right wrist disability under all applicable Diagnostic Codes. (c.) Perform an appropriate range of motion examinations of the right wrist, expressing all findings in degrees and noting the degree where painful motion begins and ends. Pursuant Correia v. McDonald, 28 Vet. App. 158 (2016), range of motion measurement must be provided in active motion, passive motion, weight-bearing, and nonweight-bearing positions (as appropriate). Additionally, the examiner must document all functional loss of the right wrist disability, including due to pain on use, weakness, repetitive motion, flare-ups, fatigue, and incoordination. Any functional loss must be documented in terms of additional lost degrees of range of motion. Under Sharp v. Shulkin, 29 Vet. App. 26 (2017), the VA examiner shall inquire as to periods of flare-up, and note the frequency and duration of any such flare-ups. Any additional impairment on use or in connection with flare-ups should be described in terms of the degree of additional range of motion loss. The examiner should specifically describe the severity, frequency, and duration of flare-ups; name the precipitating and alleviating factors; and estimate, per the Veteran, to what extent, if any, such flare-ups affect functional impairment. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. (d.) State the effect the service-connected right wrist disability has, if any, on the Veteran’s current level of occupational impairment. A clear rationale for all opinions must be provided. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD G. Lilly, Associate Counsel