Citation Nr: 18147906 Decision Date: 11/06/18 Archive Date: 11/06/18 DOCKET NO. 12-29 596 DATE: November 6, 2018 REMANDED Entitlement to a disability rating in excess of 20 percent for residuals of frostbite of the right upper extremity is remanded. Entitlement to a disability rating in excess of 20 percent for residuals of frostbite of the left upper extremity is remanded. Entitlement to a disability rating in excess of 20 percent for residuals of frostbite of the right lower extremity is remanded. Entitlement to a disability rating in excess of 20 percent for residuals of frostbite of the left lower extremity is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1978 to September 1989. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an October 2010 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Roanoke, Virginia. In a July 2016 decision, the Board denied entitlement to ratings in excess of 20 percent for residuals of frostbite of the bilateral upper and lower extremities. The Veteran appealed the Board’s decision to the United States Court of Appeals for the Veterans Claims (Court). In May 2017, pursuant to a Joint Motion for Remand (JMR) filed by the Veteran and the Secretary of Veterans Affairs, the Court issued an Order vacating the Board’s June 2016 decision, and remanding the case back to the Board for further action consistent with the terms of the JMR. Subsequently, this case was again before the Board in October 2017. At that time, the Board remanded the case for additional development. Unfortunately, for the reasons discussed below, another remand is required. See Stegall v. West, 11. Vet. App. 268 (1998). Entitlement to disability ratings in excess of 20 percent for residuals of frostbite of the bilateral upper and lower extremities. In the October 2017 remand, the Board ordered the RO to schedule the Veteran for an appropriate VA examination to ascertain the current severity and manifestations of his service-connected residuals of frostbite of the bilateral upper and lower extremities. Specifically, the VA examiner was ordered to “discuss all radiological reports indicating possible x-ray abnormalities of the hands and feet” and indicate whether such findings show osteoporosis, subarticular punched out lesions, or osteoarthritis. “Specifically x-ray reports dated April 20, 2011; September 20, 2012; September 8, 2015; June 8, 2016; January 12, 2016; and any subsequent x-ray reports must be discussed.” In February 2018, the Veteran underwent VA examinations for peripheral nerves, foot, hand and finger, and cold injury residuals, all performed by the same examiner. The VA examiner noted that no records were reviewed. However, in the examination report itself, various medical reports were listed. The Board cannot tell if the examiner reviewed all the Veteran’s treatment reports, or just listed a selection of them. In this potentially partial list of treatment reports, hand and foot x-rays from September 20, 2012 were listed. A VA treatment report from June 8, 2016 noted x-rays of the right foot, but the actual x-ray report was not listed. Additionally, VA treatment reports from April 20, 2011 and January 12, 2016 were listed in the examination report, but contain no mention of x-rays. The VA examiner noted that evidence dated September 8, 2015 could not be found at all. The Board notes that even when x-rays were listed, the VA examiner did not discuss the results, as specified. Furthermore, in the October 2017 remand, the VA examiner was ordered to perform all “evaluations, studies, and tests deemed necessary” to determine the current severity of the Veteran’s service-connected residuals of frostbite. The Board notes that x-rays are necessary to evaluate the presence of abnormalities such as arthritis, which could lead to a higher evaluation of the Veteran’s disabilities. However, in the February 2018 VA examinations, the VA examiner did not perform imaging studies of the Veteran’s bilateral upper and lower extremities. Finally, the VA examiner was ordered to provide a rationale for any conclusions and opinions reached. The VA examiner opined that the Veteran had was no tissue loss, nail abnormalities, or color changes, but noted that he had tingling and numbness. The examiner noted that based upon that examination, the findings were consistent with residual frostbite, but no other abnormalities were noted. The Board notes that the VA examiner provided no rationale for this conclusion. As a result, a new VA examination is necessary to determine the current severity and manifestations of the Veteran’s residuals of frostbite of the bilateral upper and lower extremities. 38 C.F.R. § 3.159(c)(4). The matters are REMANDED for the following actions: 1. In accordance with the provisions of 38 C.F.R. § 3.159(c)(1), make efforts to obtain all VA and private treatment records concerning these claims. 2. After the above has been completed, schedule the Veteran for VA examinations to ascertain the current severity and manifestations of his residuals of frostbite of the bilateral upper and lower extremities. The claims file must be reviewed by the examiner. The most up-to-date Disability Benefits Questionnaire must be employed, to include imaging studies of the Veteran’s bilateral upper and lower extremities. The VA examiner must discuss all radiological reports indicating possible x-ray abnormalities of the hands and feet and indicate whether such findings show osteoporosis, subarticular punched out lesions, or osteoarthritis. Specifically, x-ray reports dated April 20, 2011; September 20, 2012; September 8, 2015; June 8, 2016; and January 12, 2016, and any subsequent x-ray reports must be discussed. All opinions and conclusions must be supported by a rationale. A. C. MACKENZIE Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Abrams, Associate Counsel