Citation Nr: 20073353 Decision Date: 11/16/20 Archive Date: 11/16/20 DOCKET NO. 14-12 571 DATE: November 16, 2020 REMANDED Entitlement to an initial rating in excess of 40 percent for degenerative changes to the left wrist on an extraschedular basis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Navy from June 2005 to September 2011. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) of the Veteran’s Benefits Administration (VBA), which is the Agency of Original Jurisdiction (AOJ). The Veteran expressed disagreement with this determination, and the present appeal ensued. In March 2011 service connection was granted for degenerative arthritic changes of the left wrist, rated under 38 C.F.R. § 4.71a, Diagnostic Code 5214, and a 20 percent rating was assigned, effective September 28, 2011. An increased rating of 40 percent, effective January 22, 2014, was granted in June 2016. In October 2015, the Board expanded the appeal to include the matter of entitlement to a TDIU, noting that it was part of the Veteran’s initial rating claim for a left wrist disability (consistent with Rice v. Shinseki, 22 Vet. App. 447 (2009)). At that time, the Board granted a 40 percent disability rating, but no higher, for degenerative changes of the left wrist, effective September 28, 2011, and remanded the issues of entitlement to an initial rating in excess of 40 percent on an extra-schedular basis and entitlement to a TDIU to the AOJ for further development. After accomplishing further development, the AOJ continued the denial of each claim (as reflected in the September 2016 supplemental statement of the case (SSOC)) and returned the matters to the Board for further appellate consideration. In January 2018, the Board issued a decision denying entitlement to TDIU and remanding the claim for an initial rating in excess of 40 percent for degenerative changes of the left wrist on an extraschedular basis. The Board’s remand directed the RO to refer the claims file to the VA Under Secretary for Benefits or the Director of Compensation Service for consideration of entitlement to an extraschedular rating for degenerative changes of the left wrist, and based on the combined effects of his service connected disabilities. In September 2020 the Director of Compensation Service issued a negative advisory opinion on the Veteran’s claim for an extraschedular rating. The matter was then returned to the Board for further appellate consideration. Entitlement to an initial rating in excess of 40 percent for degenerative changes to the left wrist on an extraschedular basis is remanded. While the Board sincerely regrets further delay, additional development is required before the Veteran’s claim may be adjudicated on the merits. The Veteran was most recently provided a VA examination for the purpose of determining the frequency and severity of his symptoms in January 2014 – nearly seven years ago. The Board finds the January 2014 VA medical examination inadequate to resolve the Veteran’s appeal. To determine whether the Veteran’s symptoms are such that should be rated on an extraschedular basis, the Board requires an adequate opinion that addresses the Veteran’s functional loss and all wrist related symptoms which are not accounted for in the disability benefit questionnaire (DBQ). In an April 2014 statement, the Veteran contended that his wrist disability had only gotten worse with time, as it is a degenerative condition, and that the initial medical examination he had received in March 2011 did not demonstrate the extent of his disability, whereas the more recent, January 2014 examination more accurately represented the disability. The January 2014 examination may more accurately demonstrate the Veteran’s disability; however, it does not adequately address the Veteran’s symptoms which are not considered by the rating criteria. The Board finds it necessary that an updated medical examination be provided to take into account the Veteran’s disability and the symptoms that are not considered in the rating criteria to better understand the extent of the Veteran’s disability. As the January 2014 medical examination is inadequate, the Board finds that another VA examination is needed to determine the extent of the Veteran’s symptoms. Barr v. Nicholson, 21 Vet. App. 303 (2007). In light of this, the Board therefore finds that the issue of increased initial rating should be remanded, first, for a VA examination, and then for referral to the AOJ’s Director of Compensation Service for a supplemental opinion with respect to extraschedular consideration. Since the claims file is being returned it should be updated to include any recent VA treatment records that are not of record. See 38 C.F.R. § 3.159(c)(2); see also Bell v. Derwinski, 2 Vet. App. 611(1992). The matters are REMANDED for the following action: 1. After obtaining updated pertinent VA and private treatment records (with the Veteran’s assistance regarding the latter), the AOJ must provide the Veteran’s claims file to an appropriate examiner for a medical examination and opinion. The Veteran should be provided a functional assessment of the left wrist disability. In this regard, the examiner is asked to consider all of the Veteran’s lay statements regarding the impact of his service-connected left wrist disability. As propriety of an extraschedular evaluation of the Veteran’s service-connected wrist disability will be considered by the AOJ, the examiner is encouraged to utilize the “free text” section of the provided DBQs to document all wrist-related symptoms reported by the Veteran and identified by the examiner, including the frequency and severity of such. In doing so, the examiner is encouraged to distinguish (where possible) between the symptoms and manifestations of each disability affecting either wrist (service-connected or not) and the functional impairment stemming therefrom. The examiner should provide a complete rationale for any opinions offered. If the examiner is unable to provide any requested opinion without resort to speculation, he or she should explain why this is so and note what, if any, additional evidence would permit such an opinion to be made. 2. Upon completion of (1), refer the case to the Director of Compensation Service for a supplemental opinion regarding whether the Veteran is entitled to an extraschedular rating under the provisions of 38 C.F.R. § 3.321(b)(1). 3. Then readjudicate the Veteran’s claim on appeal. If the benefit sought on appeal is not granted to the Veteran’s satisfaction, a supplemental statement of the case should be issued to the Veteran and he should be afforded the requisite opportunity to respond. Michael J. Skaltsounis Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. W. Morgan, 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.