Citation Nr: 20039993 Decision Date: 06/11/20 Archive Date: 06/11/20 DOCKET NO. 20-03 988 DATE: June 11, 2020 ORDER Entitlement to a disability rating in excess of 70 percent for loss of use of the left hand with sensory loss of the left median, status post laceration, since May 9, 2008, is denied. REMANDED Entitlement to service connection for left wrist arthritis, to include as secondary to the service-connected loss of use of the left hand with sensory loss of the left median, status post laceration, is remanded. Entitlement to special monthly compensation (SMC) based on aid and attendance or housebound benefits is remanded. FINDING OF FACT Throughout the entire appeal period, the Veteran is assigned the maximum schedular rating of 70 percent for his service-connected loss of use of the left hand with sensory loss of the left median, status post laceration, and there is no indication that his disability picture warrants consideration of an extraschedular rating. CONCLUSION OF LAW The criteria for a disability rating in excess of 70 percent for loss of use of the left hand with sensory loss of the left median, status post laceration, since May 9, 2008, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.71a, 4.124a, Diagnostic Codes 8515-5125. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1972 to March 1974. These matters are on appeal from March 2007, November 2008, September 2011, March 2017, December 2017, and May 2020 rating decisions. The increased rating claim was previously remanded by the Board of Veterans’ Appeals (Board) in September 2011, January 2014, March 2015, July 2018, and February 2019. The Board previously denied the increased rating claim in January 2016 and April 2017 decisions, which were appealed and remanded back from the U.S. Court of Appeals for Veterans Claims (Court) in September 2016 and December 2017 Joint Motions for Remand. Additional pertinent medical evidence was added to the record by the Agency of Original Jurisdiction (AOJ) since the January 2019 Supplemental Statement of the Case. However, in an April 2020 statement, the Veteran’s representative waived the Veteran’s right to have this new evidence reviewed by the AOJ in the first instance. The issues of entitlement to a total disability rating due to individual unemployability (TDIU) and entitlement to SMC pursuant to 38 U.S.C. § 1114(k) for loss of use of the left hand were previously remanded by the Board in February 2019. Upon remand, both of these issues were granted in full in the February 2020 rating decision, and a Notice of Disagreement (NOD) has not been filed by the Veteran or his representative. In particular, the TDIU was granted effective August 1, 2009, the first day of the Veteran’s unemployment. The SMC for the loss of use of the left hand was granted for the entire appeal period (i.e., since May 9, 2008). Accordingly, the Board finds that these issues are no longer on appeal. 1. Entitlement to a disability rating in excess of 70 percent for loss of use of the left hand with sensory loss of the left median, status post laceration, since May 9, 2008. The Veteran generally asserts that he is entitled to a higher rating for his service-connected loss of use of the left hand with sensory loss of the left median, status post laceration. The Veteran is currently in receipt of the maximum schedular disability rating under both Diagnostic Codes 5125 and 8515. 38 C.F.R. §§ 4.71a, 4.124a. The Veteran is also in receipt of SMC for the loss of use of the left hand for the entire appeal period. The Veteran is also in receipt of a TDIU for this disability, effective the first day of his unemployment. The Veteran is also already in receipt of a separate compensable disability rating for his associated scar of his left wrist. Consequently, he is not entitled to a disability rating higher than 70 percent at any point during the appeal period. Moreover, there are no other diagnostic codes that apply to this disability. See Butts v. Brown, 5 Vet. App. 532, 538 (1993). The Veteran and his representative have also not asserted, and the evidence does not establish, that an extraschedular rating is warranted for the loss of use of the left hand with sensory loss of the left median, status post laceration. Accordingly, the claim is denied. REASONS FOR REMAND 1. Entitlement to service connection for left wrist arthritis, to include as secondary to the service-connected loss of use of the left hand with sensory loss of the left median, status post laceration, is remanded. The Board cannot make a fully-informed decision on the left wrist arthritis issue because no VA examiner has opined whether the Veteran’s left wrist arthritis (as documented on the July 2012 VA X-ray) is related to his active military service, to include the in-service left wrist complaints and treatment. This opinion was not provided by the September 2017 VA examiner. The September 2017 VA examiner also did not address the aggravation element of secondary service connection. 38 C.F.R. § 3.310. The September 2017 VA examiner also did not provide adequate rationale for the opinion that the left wrist arthritis is not proximately due to the result of the service-connected disability. Upon remand, a VA addendum medical opinion must be obtained. 2. Entitlement to SMC based on aid and attendance or housebound benefits is remanded. Finally, because a decision on the remanded issue could significantly impact a decision on the SMC issue if service connection is awarded, the issues are inextricably intertwined. A remand of the SMC claim is thus required. The matters are REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s left wrist arthritis (as documented on the July 2012 VA X-ray) is at least as likely as not related to an in-service injury, event, or disease, including the left wrist complaints and treatment in service. The examiner must also opine whether the Veteran’s left wrist arthritis at least as likely as not (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. The examiner must also opine whether the Veteran’s left wrist arthritis is at least as likely as not (1) proximately due to the service-connected loss of use of the left hand with sensory loss of the left median, status post laceration, or (2) aggravated by the service-connected loss of use of the left hand with sensory loss of the left median, status post laceration. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to SMC based on aid and attendance or housebound benefits. If the benefits sought are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. MARJORIE A. AUER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Shauna M. Watkins, 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.