Citation Nr: 18157788
Decision Date: 12/13/18	Archive Date: 12/13/18

DOCKET NO. 16-34 939
DATE:	December 13, 2018
REMANDED
The claim of entitlement to an initial disability rating in excess of 10 percent for right neurogenic thoracic outlet syndrome is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the United States Army from March 1980 to March 1983 and from February 2003 to June 2004.  
In July 2011, the Veteran submitted a VA Form 21-22a in favor of Kathy Lieberman. The scope of representation was limited solely to the thoracic outlet syndrome claim. Therefore, the Board will address only that issue in this decision and will issue a separate decision as to the other ten issues that the Veteran decided to pursue without representation. 
Entitlement to an initial disability rating in excess of 10 percent for right neurogenic thoracic outlet syndrome.
The Board finds that a remand is required to obtain an adequate VA examination. The Veteran’s March 2016 VA peripheral nerves examination report indicates that his right neurogenic thoracic outlet syndrome was manifested by moderate intermittent pain, paresthesias/dysesthesias, and numbness. The examination report shows normal muscle strength testing, reflex examination, and sensory examination. The examiner also found that the upper extremity nerves and radicular groups were not affected.
The Board notes that the Veteran’s service-connected right neurogenic thoracic outlet syndrome is rated under 38 C.F.R. § 4.124a, Diagnostic Code 8615, applicable to neuritis involving the median nerve. The March 2011 VA examination report and electromyography report indicated that the right median and ulnar nerves were involved. In light of the conflicting evidence, the Board finds that a remand is required to obtain another VA examination to determine the severity of the Veteran’s right neurogenic thoracic outlet syndrome. 
The matter is REMANDED for the following action:
1. The RO or the AMC should undertake appropriate development to obtain any outstanding, pertinent VA and private medical records. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 
2. Then, the RO or the AMC should afford the Veteran a VA examination by an examiner with sufficient expertise to fully assess the severity of the Veteran’s service-connected right neurogenic thoracic outlet syndrome. All pertinent evidence of record should be made available to and reviewed by the examiner. Any indicated studies should be performed. 
The examiner must identify the nerves affected and express an opinion as to the severity of the nerve involvement in terms of being “mild,” “moderate,” or “severe” for incomplete paralysis. 
In addition, the examiner must reconcile the findings found in the March 2016 VA examination report with the other medical evidence of record.
The RO or the AMC should ensure that the examiner provides all information required for rating purposes.
3. Then, the RO or the AMC should readjudicate the issue on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate action. 

 
B. MULLINS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	A. N. Nolley, Associate Counsel