Citation Nr: 18149762 Decision Date: 11/13/18 Archive Date: 11/13/18 DOCKET NO. 16-39 897 DATE: November 13, 2018 REMANDED Entitlement to an increased rating for residuals of a cerebral vascular accident (CVA) is remanded. Entitlement to a disability rating in excess of 20 percent for left upper extremity weakness associated with being status post CVA is remanded. Entitlement to a disability rating in excess of 10 percent for a seizure disorder associated with being stats post CVA is remanded. REASONS FOR REMAND The Veteran had active service from March 1990 to November 2007. These matters come before the Board of Veterans’ Appeals (Board) on appeal from an August 2015 rating decision, which granted service connection for a CVA, rated 100 percent disabling (under 38 C.F.R. § 4.124a, Diagnostic Code 8009) from November 24, 2014, to June 1, 2015, and 10 percent thereafter. During the course of the appeal, the 10 percent rating assigned from June 1, 2015, was increased to 20 percent (also from June 1, 2015) for left upper extremity weakness associated with the CVA, under 38 C.F.R. § 4.124a, Diagnostic Code 8512. The Veteran was also awarded a separate 10 percent rating for a seizure disorder associated with the CVA, under 38 C.F.R. § 4.124a, Diagnostic Code 8912. The Veteran asserts that higher ratings are still warranted for his CVA and residuals. 1. Entitlement to an increased rating for residuals of a cerebral vascular accident is remanded. It is not clear that all of the residuals from the Veteran’s November 2014 CVA have been evaluated. The July 2015 VA central nervous condition examination indicates that the Veteran has, in addition to the left upper extremity symptoms, additional symptoms noted, including: sleep disturbances including insomnia with persistent daytime hypersomnolence; a voiding dysfunction with a slow or weak stream that is markedly slow or weak; and erectile dysfunction. However, the examiner did not indicate whether these symptoms were related to the CVA that the Veteran suffered in November 2014. Consequently, the Board requires additional clarification to determine whether these conditions need to be accounted for as residuals of the CVA. Additionally, in his statements to VA or his reports to VA examiners, the Veteran has complained of some cognitive problems that he has characterized as either brain damage or memory loss. No development of these claimed symptoms has been accomplished. An opinion or explanation is needed as to whether any brain damage or memory loss exists or is attributable to the Veteran’s CVA. 2. Entitlement to a disability rating in excess of 20 percent for left upper extremity weakness associated with being status post CVA is remanded. According to his claim, notice of disagreement, and other statements, the Veteran is seeking compensation for a lack of fine motor skills or decrease dexterity in his left hand. However, both the July 2015 and March 2016 VA examinations provide scant information about the limitations on the Veteran’s dexterity or motor skills and focus primarily on strength. The March 2016 VA examination also appears to provide conflicting information, simultaneously describing relatively minor symptoms (a slight decrease in left hand grip strength) while also indicating that the Veteran’s functioning in his left upper extremity is so diminished that amputation with prosthesis would serve the Veteran equally well. This raises the possibility that additional compensation comparable to the amputation of one or more fingers may be appropriate. However, it is not possible to evaluate this without a more specific evaluation of the Veteran’s fine motor skills or dexterity. 3. Entitlement to a disability rating in excess of 10 percent for a seizure disorder associated with being stats post CVA is remanded. The Veteran’s seizure condition is a residual of the Veteran’s CVA. The opinions and evaluations of the some of the symptoms, particularly the Veteran’s claimed symptom of brain damage, may provide information relevant to the symptoms of the Veteran’s seizure disorder. Consequently, this issue is being remanded as inextricably intertwined. The matters are REMANDED for the following actions: 1. Schedule the Veteran for an examination or examinations with an appropriate clinician or clinicians to determine whether the insomnia, voiding dysfunction, and erectile dysfunction symptoms identified in the July 2015 VA examination are at least as likely as not residuals of the Veteran’s November 2014 CVA. For any of these symptoms that are identified as residuals of the Veteran’s November 2014 CVA, the clinician or clinicians should provide a complete description of the condition. 2. Schedule the Veteran for an examination or examinations with an appropriate clinician or clinician to determine whether any condition or symptoms of brain damage or memory problems that the Veteran may have are at least as likely as not residuals of the Veteran’s November 2014 CVA. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left upper extremity condition. 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 evaluation should particularly include information regarding any loss of fine motor skills, lack of physical dexterity, or inability to control or use his left hand or individual fingers. The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran’s left upper extremity disability alone and discuss the effect of the Veteran’s let upper extremity disability on any occupational functioning and activities of daily living. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 3. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issues of entitlement to an increased rating for a seizure disorder. If the benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. A. ISHIZAWAR Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Steven H. Johnston, Associate Counsel