Citation Nr: 20021898 Decision Date: 03/27/20 Archive Date: 03/27/20 DOCKET NO. 12-97 897A DATE: March 27, 2020 REMANDED A compensable initial rating for service-connected right-hand burn residuals is remanded. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. Special monthly compensation (SMC) based on the need for regular aid and attendance of another person or housebound status is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from March 1974 to March 1977, October 1994 to March 1995, November 1995 to July 1997, and November 2003 to October 2004. These matters are before the Board of Veterans’ Appeals (Board) on appeal from an April 2007 rating decision. In November 2018, a hearing was held before the undersigned; a transcript of the hearing is associated with the record. The Board remanded these matters in April 2019. 1. A compensable initial rating for service-connected right-hand burn residuals is remanded. 2. A total disability rating based on individual unemployability due to service-connected disabilities (TDIU) is remanded. 3. Special monthly compensation (SMC) based on the need for regular aid and attendance of another person or housebound status is remanded. These matters were previously remanded to obtain examinations assessing the current severity and functional impact of the Veteran’s service-connected disabilities, but it does not appear that those examinations were conducted (though multiple examination requests appearing to reference them are of record). The most recent supplemental statement of the case (SSOC) appears to reference a January 2020 examination as satisfying the Board’s remand orders, but that report is related to a separate service connection claim not included in this appeal. Corrective action is needed. The matters are REMANDED for the following action: 1. Please note that, by law, ALL remanded claims MUST be processed expeditiously. 2. Arrange for the Veteran to be examined by an appropriate physician (or physicians) to determine the current severity of his service-connected right-hand burn residuals. Based on an examination, review of the record, and any tests or studies deemed necessary, the examiner should describe all pathology, symptoms (frequency and severity), and functional impairment associated with such disabilities in enough detail to allow for application of the pertinent rating criteria. The examiner MUST SPECIFICALLY CONSIDER the Veteran’s various allegations insofar as they suggest symptoms BEYOND MERE SCARRING, to include (but not limited to) pain, instability, or other functional limitations (limitation of motion, impaired ability to carry or lift things, impairment of activities of daily living, etc.). The examiner MUST ALSO comment on or describe, to the extent possible, the impact the Veteran’s service-connected right-hand burn residuals have on his functioning during flare-ups or other such circumstances (e.g., when shedding, when wounds open, etc.) EVEN IF not personally observable on examination. In so doing, the examiner should elicit from the Veteran subjective reports of his functioning under such conditions and consider such reports along with all other pertinent evidence. If the examiner is unable to provide such an opinion, he or she MUST explain why that is so in specificity. The examiner should note that, by law, the inability to directly observe functioning under such conditions IS NOT a valid reason to avoid providing an opinion in this matter. Finally, the examiner should consider and discuss whether it is possible to separate and distinguish the diagnoses of bilateral hand dermatitis, eczema, or his service-connected right-hand burn residuals in the record from one another, with citation to their specific symptoms, presentation, or associated impairment. If they are felt to be separate and distinct disabilities affecting the Veteran, the examiner should also opine as to whether their resultant symptoms, pathology, or impairment may be meaningfully distinguished from one another (i.e., whether it is possible to attribute the resultant symptoms, pathology, or impairment to each applicable diagnosis). All opinions must include a detailed rationale. Providing an opinion without one will delay processing of the claim and may require clarification. 3. Schedule the Veteran for an examination by an appropriate physician (or physicians) to determine the impact of ALL service-connected disabilities (right hand burn residuals, migraine headaches, anxiety disorder, right knee osteoarthrosis, postoperative left knee residual of meniscectomies and anterior cruciate ligament tear, right knee chondrocalcinosis, bilateral hand dermatitis, left knee osteoarthritis, right knee surgical scars, tinnitus, lumbar spine spondylosis and arthritis with sciatic impingement of the right lower extremity, right hip osteoarthropathy, hemorrhoids, and bilateral hearing loss), both independently and together, on his OCCUPATIONAL AND DAILY functioning. The examiner must review the entire record, conduct an examination of the Veteran, and order any tests or studies deemed necessary. The report should describe, with citation to specific disabilities, pathology, symptoms, or functional impairment, the expected impact of such disabilities on: (a.) his ability to function adequately in an occupational setting, to include identifying the types of tasks that would be precluded by such disabilities and those that would remain feasible; AND (b.) his ability to perform various activities of daily living or travel independently In so finding, the examiner should consider whether the Veteran’s service-connected disabilities would likely render him substantially confined to his or her dwelling and the immediate premises (or, if institutionalized, to the ward or clinical areas) for the rest of his life OR so helpless as to need the regular aid and attendance of another person. The examiner should also consider factors such as (but not limited to) inability to dress or undress or keep ordinarily clean and presentable; inability to feed himself; inability to attend to the wants of nature; incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his daily environment; or being bedridden. For purposes of this examination, “bedridden” will be that condition which, through its essential character, requires that the claimant remain in bed. The fact that claimant has voluntarily taken to bed or that a physician has prescribed rest in bed for the greater or lesser part of the day to promote convalescence or cure will not suffice. All opinions must include a detailed rationale. Providing an opinion without one will delay processing of the claim and may require clarification. VICTORIA MOSHIASHWILI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Yuan, 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.