Citation Nr: 19190825 Decision Date: 12/03/19 Archive Date: 12/03/19 DOCKET NO. 13-31 405A DATE: December 3, 2019 REMANDED Entitlement to a disability rating in excess of 30 percent for chronic extensor tendonitis of the left forearm is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1969 to February 1969 and from September 1990 to April 1991, with additional Naval Reserve service. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2009 rating decision. In December 2015, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at Travel Board hearing. A transcript of that hearing is of record. The Veteran’s claim for an increased disability rating was previously remanded by the Board in February 2016 and December 2017. Additionally, the issue of a TDIU rating was remanded in December 2017. Unfortunately, the above issues must be remanded for further development. Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide the issues, so that the Veteran is afforded every possible consideration. 1. Entitlement to a disability rating in excess of 30 percent for chronic extensor tendonitis of the left forearm is remanded. Pursuant to the Board’s December 2017 remand, the Veteran was afforded a new VA Elbow and Forearm Conditions Disability Benefits Questionnaire in June 2019 to comply with Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). However, the Board finds that the June 2019 VA examination is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate); D’Aries v. Peake, 22 Vet. App. 97, 104 (2008) (holding that an examination must be based on consideration of the claimant’s medical history and must describe the disability in sufficient detail so that the Board’s evaluation of the disability will be a fully informed one). The June 2019 VA examination report states that the Veteran reports flare-ups and that he experiences constant pain and weakness. The examination report further states that a flare-up is not directly observed during the examination and the provided medical records make no specific references to flare-up frequency, duration, or severity of decreased range of motion in degrees. The examination report provides that after examination of the Veteran, listening to his complete history and current subjective complaints, combined with a review of the available records, the examiner has no basis to offer additional losses of function or motion during a flare-up. The June 2019 VA examination is inadequate because the VA examiner failed to obtain information concerning the severity of his flare-ups, as well as precipitating and alleviating factors. Sharp, 29 Vet. App. at 32. The VA examiner also did not estimate the additional loss of range of motion during a flare-up based on all procurable information from the record, as well as the Veteran’s own statements. Id. at 34-35. Therefore, the Veteran must be afforded a new VA examination to determine the current severity of his service-connected chronic extensor tendonitis of the left forearm. Should the new VA examination be conducted while the Veteran is not experiencing a flare-up of his chronic extensor tendonitis of the left forearm, the estimation of additional functional loss and additional loss of range of motion during a flare-up must be made after obtaining information concerning the severity, frequency, and duration of flare-ups, as well as precipitating and alleviating factors. As noted above, because the 2019 VA examination report shows that the Veteran experiences flare-ups and there is no estimation of the additional loss of range of motion during a flare-up, a retrospective medical opinion is necessary to capture the severity of the Veteran’s chronic extensor tendonitis of the left forearm during this time period. See Chotta v. Peake, 22 Vet. App. 80 (2008) (when there is an absence of medical evidence during a certain period of time, a retroactive medical evaluation may be warranted). 2. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. The evidence indicates that the Veteran’s service-connected chronic extensor tendonitis of the left forearm impacts his employment as he is limited due to pain and weakness with grasping, writing, and lifting. Thus, the issue of entitlement to a TDIU rating is inextricably intertwined with the claim for an increased rating for chronic extensor tendonitis of the left forearm being remanded herein, and the issues should be considered together. See 38 C.F.R. § 4.16(a); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, the issue of a TDIU rating must be remanded as well. The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from August 2019 to the present. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected chronic extensor tendonitis of the left forearm. (a.) 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. (b.) The examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 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.) 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. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. If it is not possible to provide a specific measurement 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). All examination findings, along with the complete rationale for all opinions expressed, must be set forth in the examination report. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, Associate Counsel The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.