Citation Nr: 20005363 Decision Date: 01/22/20 Archive Date: 01/22/20 DOCKET NO. 14-32 347A DATE: January 22, 2020 REMANDED Entitlement to an initial compensable rating prior to July 8, 2013, and in excess of 10 percent thereafter for residuals of a left wrist fracture is remanded. REASONS FOR REMAND The Veteran had active duty service from March 1983 to September 1983, and November 1987 to June 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a rating decision issued in June 2013 by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran was scheduled for an August 2019 Board hearing in accordance with his request. However, the Veteran was deemed a no-show for the hearing and to date the Veteran has not requested that the hearing be rescheduled. As such, the Veteran’s hearing request is withdrawn. 38 C.F.R. § 20.704 (d). Entitlement to an initial compensable rating prior to July 8, 2013, and in excess of 10 percent thereafter for residuals of a left wrist fracture. The Veteran is seeking a higher rating for his service-connected left wrist disability. He was most recently afforded a VA examination for such disabilities in March 2013. However, in his September 2014 Substantive Appeal, the Veteran reported that he has had more problems with his wrist since he filed his claim in 2012. Furthermore, a July 2013 VA treatment record notes that the Veteran reported pain in his wrist. It was also noted that, since his VA examination, the Veteran fell with his hand extended and injured his wrist again. Additionally, the VA physician noted that an X-ray of the Veteran’s wrist showed some abnormalities, and an MRI revealed osteoarthritis of his wrist. Furthermore, a September 2017 VA treatment record indicates that the Veteran had pain and neuropathy in his left hand. As such, the record indicates that the Veteran’s left wrist symptoms may have worsened since his last examination. Therefore, the Board finds that a remand is necessary in order to afford the Veteran a contemporaneous VA examination so as to determine the current nature and severity of his left wrist disability. See Snuffer v. Gober, 10 Vet. App. 400 (1997). Furthermore, the examination should be conducted in accordance with Correia v. McDonald, 28 Vet. App. 158 (2016) and Sharp v. Shulkin, 29 Vet. App. 26 (2017). The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the current nature and severity of his service-connected left wrist disability. All necessary diagnostic testing and evaluation should be performed, and all clinical findings reported in detail. If possible, the appropriate Disability Benefits Questionnaires (DBQs) should be completed. The record, including a complete copy of this remand, must be made available for review in connection with the examination. If possible, such examination should be conducted during a flare-up. (A) The examiner should identify the current nature and severity of all manifestations of the Veteran’s left wrist disability. Please consider the Veteran’s claim that he experiences pain and numbness in his left hand and left wrist. The examiner should also consider the Veteran’s diagnosis of neuropathy in his left hand. The examiner should determine if such symptoms result in additional diagnoses. If so, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that such diagnoses are caused or aggravated by his left wrist disability. For symptoms that do not result in additional diagnoses, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., a 50 percent or greater probability) that the Veteran’s symptoms are caused or aggravated by his left wrist disability. If not, the examiner should determine the effects of his left wrist disability versus his additional symptoms. However, if such is not possible, the examiner should so state. (B) The examiner should record the range of motion of the left wrist observed on clinical evaluation in terms of degrees for flexion and extension. If there is evidence of pain on motion, the examiner should indicate the degree of range of motion at which such pain begins, and whether such pain on movement, as well as weakness, excess fatigability, or incoordination, results in any loss of range of motion. The examiner should record the results of range of motion testing for pain on both active and passive motion, on weight-bearing and nonweight-bearing and, if possible, with range of motion measurements 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) It is also imperative that the examiner comment on the functional limitations caused by flare-ups and repetitive use. In this regard, the examiner should indicate whether, and to what extent, the Veteran’s range of motion is additionally limited during flare-ups or on repetitive use, expressed, if possible, in terms of degrees, or explain why such details cannot be feasibly provided. (D) If the Veteran endorses experiencing flare-ups of his left wrist, the examiner must obtain information regarding the frequency, duration, characteristics, severity, and/or functional loss related to such flare-ups. Then, if the examination is not being conducted during a flare-up, the examiner should provide an opinion based on estimates derived from the information above as to the additional loss of range of motion that may be present during a flare-up. If the examiner cannot provide an opinion as to additional loss of motion during a flare-up without resorting to mere speculation, the examiner must make clear that s/he has considered all procurable data (i.e., the information regarding frequency, duration, characteristics, severity, and/or functional loss related to such flare-ups elicited from the Veteran), but any member of the medical community at large could not provide such an opinion without resorting to speculation. (E) The examiner also should comment upon the functional impairment resulting from the Veteran’s left wrist disability. (F) The examiner shall identify whether there is objective evidence of ankylosis of the left wrist, and if so, include findings regarding whether the ankylosis is at a favorable or unfavorable position; and describe the position of any ankylosis in terms of degrees of palmar flexion, dorsiflexion, pronation, supination, or any ulnar or radial deviation as indicated by position. If ankylosis of the left wrist is present, then the examiner shall opine as to whether such ankylosis is extremely unfavorable; and if so, then opine as to whether the left wrist disability results in no effective function of the hand remaining other than that which would be equally well served by an amputation stump at the site of election below the elbow with use of a suitable prosthetic appliance, based on the actual remaining function of the hand. A rationale for any opinion proffered should be provided. C. CRAWFORD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Brennae L. Brooks, 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.