Citation Nr: 20046959 Decision Date: 07/14/20 Archive Date: 07/14/20 DOCKET NO. 15-14 987 DATE: July 14, 2020 REMANDED Entitlement to an initial compensable rating for trauma-induced onychauxis with onychomycosis of the left great toe is remanded. Entitlement to an initial rating in excess of 10 percent for coronary artery disease (CAD) prior to October 15, 2015 is remanded. REASONS FOR REMAND The Veteran, who is the appellant in this case, served on active duty from March 1966 to March 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions dated October 2013, May 2014, and November 2015 of a Department of Veterans Affairs (VA) Regional Office (RO). By way of procedural background, these claims were previously before the Board in January 2019, at which time the Board, in pertinent part, denied entitlement to an initial compensable rating for trauma-induced onychauxis with onychomycosis of the left great toe and denied entitlement to an initial rating in excess of 10 percent for CAD prior to October 15, 2015 and in excess of 30 percent thereafter. The Veteran then appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (Court). In March 2020, the Court granted a March 2020 Joint Motion for Partial Remand (JMPR) by counsel for the Veteran and VA and remanded the matter to the Board for further development and readjudication consistent with the JMPR. Notably, in the March 2020 JMPR, counsel for the Veteran and VA requested that the Court dismiss the appeal of the denial of a rating in excess of 30 percent for CAD beginning October 15, 2015. Therefore, the only issue remaining before the Board regarding the Veteran’s CAD claim is entitlement to an initial rating in excess of 10 percent prior to October 15, 2015. The remaining appellate claims (service connection for right great toe and tinnitus, and entitlement to a TDIU) that the Board remanded in 2019 were granted by the RO in subsequent rating decisions and are no longer in appellate status. 1. Entitlement to an initial compensable rating for trauma-induced onychauxis with onychomycosis of the left great toe is remanded. The March 2020 JMPR determined that the Board erred insofar as it failed to discuss: (1) whether the Veteran’s left great toe disability could be rated under either Diagnostic Code (DC) 7804 (applicable to unstable or painful scars) or DC 5284 (applicable to other unlisted foot injuries); and (2) whether the Veteran had two separate left great toe disabilities (based on his diagnoses of both onychauxis and onychomycosis of the left great toe) that must be rated separately. The Board finds that prior to appellate consideration of this claim, it requires clarification as to the symptoms and manifestations of each of the Veteran’s left great toe diagnoses. As past VA examiners seem to have considered the combined severity of the Veteran’s left great toe diagnoses, there is insufficient medical evidence as to the separate manifestations of each, or whether, indeed, it is possible to differentiate what symptoms are attributable to each diagnosis. See August 2013 and October 2015 VA examination reports. Therefore, remand is necessary to obtain a medical opinion addressing the foregoing. Additionally, the Board observes that the Veteran’s last VA examination for his left great toe disability was in October 2015. An October 2017 VA primary care note reflects that a diabetic foot examination revealed “abnormal” skin integrity results, and the provider noted “bilateral great toe dystrophy.” As it is unclear whether this is evidence of worsening or perhaps an additional diagnosis pertaining to the Veteran’s left great toe, the RO should afford the Veteran a contemporaneous examination to determine the current severity of his left great toe disability. See Allday v. Brown, 7 Vet. App. 517, 526 (1995) (indicating that, where the record does not adequately reveal the current state of the claimant's disability, fulfillment of the statutory duty to assist requires a contemporaneous medical examination, particularly if there is no additional medical evidence that adequately addresses the level of impairment of the disability since the previous examination). 2. Entitlement to an initial rating in excess of 10 percent for CAD prior to October 15, 2015 is remanded. The March 2020 JMPR also determined that the Board erred when it did not ensure that VA satisfied the duty to assist the Veteran in obtaining private treatment records relevant to his claim. Specifically, the JMPR found that an October 2013 private treatment record from Dr. M.B. of Cardiovascular Consultants, LTD. (indicating that the Veteran reported to the clinic for a “follow up”), a November 2013 private “Ischemic Heart Disease” Disability Benefits Questionnaire (DBQ) completed by Dr. M.B. (indicating that the Veteran underwent diagnostic testing in March, April, and September of 2013), and a November 2015 VA examination report (indicating that the Veteran had additional visits with his cardiologist), collectively indicate that there are outstanding private treatment records from Dr. M.B. concerning the Veteran’s CAD. Thus, on remand, a VA Form 21-4142 Authorization for Release of Information should be provided to the Veteran, for completion, so that VA may obtain any outstanding records relating to his private treatment for CAD. Accordingly, the matters are REMANDED for the following action: 1. Ensure that all outstanding VA treatment records are associated with the claims file, then provide the Veteran with an additional VA examination, if possible, to determine the current severity of his trauma-induced onychauxis with onychomycosis of the left great toe. The claims file, including a copy of this Remand, must be made available to and be reviewed by the examiner. ** IF an in-person examination is not feasible given the circumstances surrounding the recent pandemic, refer the case to an appropriate examiner for a thorough review of the record, possible telephone/virtual interview with the Veteran, and medical opinion. After a thorough review of the record and examination of the Veteran (if possible), the examiner is asked to respond to the following: (a) Elicit from the Veteran all signs and symptoms pertaining to his left great toe. (b) Identify all current diagnoses pertaining to the Veteran’s left great toe, to include onychauxis and onychomycosis. ** Specifically, address whether an October 2017 VA primary care note reflecting that a diabetic foot examination revealed “abnormal” skin integrity results and “bilateral great toe dystrophy” represents an additional diagnosis pertaining to the Veteran’s left great toe. (c) Indicate whether it is possible to differentiate what symptoms are attributable to each diagnosis pertaining to the Veteran’s left great toe. If so, list which symptoms are attributable to each diagnosis. A complete rationale should be provided for all opinions. 2. Send the Veteran a VA Form 21-4142 Authorization for Release of Information, for completion, to obtain records relating to his private treatment for coronary artery disease, to include by Dr. Mayur Bhakta of Cardiovascular Consultants, LTD. 3. Lastly, readjudicate the remanded claims. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. M. Gill, 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.