Citation Nr: 18160753 Decision Date: 12/27/18 Archive Date: 12/27/18 DOCKET NO. 16-51 508 DATE: December 27, 2018 REMANDED Entitlement to a rating in excess of 10 percent for atrial fibrillation is remanded. Entitlement to a compensable rating for fatty liver disease is remanded. Entitlement to an initial rating in excess of 10 percent for carpal tunnel syndrome (CTS) of the left upper extremity is remanded. Entitlement to an initial rating in excess of 10 percent for CTS of the right upper extremity is remanded. Entitlement to a rating in excess of 50 percent for anxiety disorder with features of posttraumatic stress disorder (PTSD), depression, and alcohol abuse is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1981 to August 1981, December 1982 to March 1983, March 1983 to February 2012. These matters come before the Board of Veterans’ Appeals (Board) on appeal from September 2015, June 2016, and December 2016 rating decisions. In April 2017, the Veteran submitted an affidavit regarding his atrial fibrillation, anxiety disorder, and bilateral carpel tunnel syndrome. The Veteran testified that these conditions were more severe than reflected in his current ratings and had increase in severity since the rating decisions on appeal. Additionally, in July 2017, the Veteran, through his representative, submitted a private examination report from a vocational rehabilitation counselor regarding his service connected disabilities. The examiner indicated that the Veteran’s numerous service connected disabilities had rendered the Veteran unable to secure gainful employment and were more severe than was reflected in the Veteran’s current ratings. The Veteran last underwent VA examinations regarding his service connected disabilities in 2016, over 2 years ago and prior to his statements and vocational rehabilitation report indicating his service connected conditions had worsened in severity. Therefore, more contemporaneous examinations for these conditions are warranted. See Green v. Derwinski, 1 Vet. App. 121, 124 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination) and Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (an examination too remote for rating purposes cannot be considered “contemporaneous”). Additionally, the Board finds that the Veteran’s claim for TDIU is inextricably intertwined with his claims for increased ratings on appeal. The appropriate remedy where a pending claim is inextricably intertwined with a claim currently on appeal is to remand the claim on appeal pending the adjudication of the inextricably intertwined claim. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: 1. Associate with the record any VA clinical documentation not already of record pertaining to treatment of the Veteran. 2. Thereafter, schedule the Veteran for a VA examination by a physician (M.D.) to determine the current nature and severity of his service-connected atrial fibrillation. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is specifically asked to determine whether there is, or has been: (1) paroxysmal atrial fibrillation or other supraventricular tachycardia, with more than four episodes per year documented by ECG or Holter monitor; or (2) permanent atrial fibrillation (lone atrial fibrillation) or one to four episodes per year of paroxysmal atrial fibrillation or other supraventricular tachycardia documented by ECG or Holter monitor. The Veteran’s lay statements regarding his symptomology, specifically including his April 2017 affidavit, and the July 2017 vocational rehabilitation report, must be recorded and taken into consideration. The examiner should comment on the effect the Veteran’s atrial fibrillation has on his ability to secure and follow substantially gainful employment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 3. Thereafter, schedule the Veteran for a VA examination, by a physician (M.D.), to determine the current nature and severity of his service-connected liver disorder. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. In particular, he or she should identify all current residuals of the Veteran’s liver disorder and assess the severity of each symptom. The examiner should state the frequency and severity of any abdominal pain. He or she should also state whether there is loss of normal body weight and other findings showing continuing pancreatic insufficiency; and whether there is any steatorrhea, malabsorption, diarrhea, and severe malnutrition. The Veteran’s lay statements regarding his symptomology, specifically including his April 2017 affidavit, and the July 2017 vocational rehabilitation report, must be recorded and taken into consideration. The examiner should comment on the effect the Veteran’s liver disorder has on his ability to secure and follow substantially gainful employment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 4. Thereafter, schedule the Veteran for a VA examination by a physician (M.D.) to determine the current nature and severity of his bilateral CTS. The claims folder must be made available to and be reviewed by the examiner in conjunction with the examination. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner should indicate whether his bilateral CTS is more closely approximate to complete or incomplete paralysis of the median nerve, and if incomplete, whether such paralysis is mild, moderate or severe in nature. The Veteran’s lay statements regarding his symptomology, specifically including his April 2017 affidavit, and the July 2017 vocational rehabilitation report, must be recorded and taken into consideration. The examiner should comment on the effect the Veteran’s bilateral CTS has on his ability to secure and follow substantially gainful employment. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 5. Thereafter, schedule the Veteran for a VA examination to ascertain the current nature and severity of his service-connected anxiety disorder. The examiner should review the claims file and should note that review in the report. After examining the Veteran and conducting any studies and/or tests deemed necessary, the examiner should fully describe all symptomatology and functional deficits associated with the Veteran’s service connected anxiety disorder and should opine as to their severity. The examiner should also comment on the Veteran’s current level of social and occupational impairment due to his service-connected anxiety disorder. The Veteran’s lay statements regarding his symptomology, specifically including his April 2017 affidavit, and the July 2017 vocational rehabilitation report, must be recorded and taken into consideration. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. 6. After ensuring compliance with the development requested above, readjudicate the claims, specifically including the Veteran’s claim for a TDIU. If any decision is adverse to the Veteran, issue a supplemental statement of the case and allow the appropriate time for response. Then, return the case to the Board. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD A. Parrish, Associate Counsel