Citation Nr: 18148754 Decision Date: 11/09/18 Archive Date: 11/08/18 DOCKET NO. 10-20 106 DATE: November 9, 2018 REMANDED Entitlement to an initial rating in excess of 10 percent for posttraumatic laceration of flexor of right thumb with cystic changes and degenerative joint disease of the first metacarpal and interphalangeal joint (right thumb disability), is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from September 1966 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this appeal for additional development in March 2017 and December 2017. Entitlement to a TDIU has been raised by the record and is part and parcel of the Veteran’s increased rating claim currently before the Board. Rice v. Shinseki, 22 Vet. App. 447 (2009); March 2018 VA examination report. The Board acknowledges the Veteran’s February 2018 correspondence expressing his disagreement with the December 2017 Board remand. The Veteran is advised that a remand is not a final decision on his claim. 1. Entitlement to an initial rating in excess of 10 percent for a right thumb disability is remanded. The Veteran presented for a VA examination in March 2018. The examiner stated that he could not opine whether the Veteran experienced additional functional loss during flare-ups or after repetitive use, because an accurate measurement of range of motion can only be taken at those times. However, the examiner noted that the Veteran’s abnormal range of motion did not contribute to functional loss, and described the functional impact of the Veteran’s disability as interfering with repetitive mechanical work, lifting, pushing, and pulling. The Board notes that this description is consistent with the other evidence of record. Thus, the Board finds that range of motion is not the most appropriate mechanism to describe the Veteran’s functional loss due to flare-ups and repetitive use. Cf. Sharp v. Shulkin, 29 Vet. App. 26 (2017). On remand, an opinion should be obtained discussing the Veteran’s functional loss in terms of interference with the normal working movements of the hand and its digits. See 38 C.F.R. § 4.40. Moreover, review of the examination report indicates a report of abnormal range of motion for both the Veteran’s service-connected right thumb and his nonservice-connected left thumb. However, the examiner also stated that the Veteran’s left thumb was undamaged, i.e., not abnormal. See March 2018 VA Examination Report (Remarks). The report also indicates that the Veteran exhibited less movement than normal due to “ankylosis, adhesions, etc.” and indicates that the Veteran’s thumb was not ankylosed, but does not explain the source of the restricted movement. Additionally, the examiner omitted findings concerning the range of flexion for the Veteran’s right ring finger. In an abundance of caution, and to ensure that the Veteran is afforded every consideration, on remand the Board will schedule a new examination, rather than seek an addendum opinion addressing these deficiencies.   2. Entitlement to a TDIU is remanded. The evidence of record suggests that the Veteran is unable to secure or follow a substantially gainful occupation by reason of his service-connected disabilities, given his education and occupational background. Thus, entitlement to a TDIU has been raised by the record. As the Veteran’s disability rating does not allow for an award of a schedular TDIU under 38 C.F.R. § 4.16(a), the Board will remand this matter for referral to the Director of the Compensation Service to consider the Veteran’s entitlement to a TDIU on an extraschedular basis. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for a VA examination to determine the current nature, extent, and severity of the Veteran’s service-connected right thumb disability. The claims file should be made available to and be reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The examiner should respond to the following: (a) Describe all impairments attributed to the Veteran’s service-connected right thumb disability picture, including any associated muscle and neurological impairments affecting the hands. See, e.g., September 2013 EMG study from A.G. For any impairments so identified, complete a corresponding Disability Benefits Questionnaire. (b) Conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested for pain (1) on active motion, (2) on passive motion, (3) in weight-bearing, (4) in nonweight-bearing, and (5) with range of motion of the opposite undamaged joint. 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. (c) Considering the Veteran’s reported history, as well as the nature of his disability, please also provide an opinion describing functional impairment of the Veteran’s service-connected right thumb disability due to flare-ups, accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms additional loss of motion and impairment of the normal working movements of the right hand and its digits (i.e. gripping, lifting, pushing, pulling, pinching, turning). If unable to provide such an opinion without resorting to speculation, please provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician’s Guide to estimate, “per [the] veteran,” what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. In reaching his or her conclusions, the VA examiner should specifically review and consider the Veteran’s reports of pain flare-ups, as well his report of functional impairments that interfered with his employment such as reduced grip, reduced dexterity and speed, weakness, and inability to perform repetitive tasks such as typing and tool use. 4. Then refer to the Director of Compensation Service the matter of whether a TDIU is warranted on an extraschedular basis pursuant to 38 C.F.R. § 4.16(b). Should the Director indicate that further evidentiary development is required, such development should be undertaken. The Director’s attention is drawn to the March 2018 VA examiner’s statement that the Veteran should avoid repetitive mechanical work and moderate to heavy lifting due to his service-connected right thumb disability, and the Veteran’s work history in facility maintenance and reports of exceeding lifting limits at his job. See September 2011 VA Form 21-8940; January 2012 records from Dr. A.G.; March 2018 VA examination report. S. BUSH Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.M. Badaczewski, Associate Counsel