Citation Nr: 21001110 Decision Date: 01/07/21 Archive Date: 01/07/21 DOCKET NO. 14-16 385 DATE: January 7, 2021 REMANDED Entitlement to an initial rating higher than 10 percent for the service-connected residuals of left wrist ligamental injury, status post-operative stabilization procedure, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 2006 to September 2009. In February 2018, the Board remanded the claim to obtain outstanding records and to provide the Veteran with a new VA examination. In October 2019, the Board remanded the claim for the RO to mail all communication to the Veteran’s representative, which was removed in error. The case has since returned to the Board for further appellate review. Upon review, the Board finds that an additional remand is necessary to provide the Veteran with an adequate VA examination. Notably, the Veteran underwent a VA examination in August 2018, at which time he reported functional loss, which was described as pain when gripping with the left wrist. On examination, range of motion of the left wrist was abnormal and the examiner noted that the Veteran was not examined immediately after repetitive use over time and that the examination was neither medically consistent nor inconsistent with the Veteran’s statements describing functional loss with repetitive use over time. The examiner then indicated that it was not possible to describe any additional loss in terms of range of motion; however, to the question indicating, “If no, please describe:” the examiner simply noted “N/A” without providing any explanation. Significantly, the examiner did not use the information provided by the Veteran or obtain additional information from the Veteran or the treatment records with respect to the frequency, duration, characteristics, severity, or functional loss after repetitive use. The Court held that “before the Board can accept an examiner’s statement that an opinion cannot be provided without resorting to speculation, it must be clear that this is predicated on a lack of knowledge among the “medical community at large” and not the insufficient knowledge of the specific examiner.” See Sharp v. Shulkin, 29 Vet. App. 26, 36 (2017) (quoting Jones v. Shinseki, 23 Vet. App. 382, 390 (2010)). Here, the examiner provided no reasoning to the determination that such could not be estimated. As such, a new VA examination is warranted. The matters are REMANDED for the following action: 1. Ensure all outstanding VA treatment records are associated with the claims file. 2. Thereafter, provide the Veteran with a VA examination to help identify the current severity of the left wrist disability. The claims file and a copy of this remand will be made available to the examiner, who will acknowledge receipt and review of these materials. All indicated studies, tests, and evaluations must be conducted, and all findings reported in detail. After a review of the record and examination of the Veteran, the examiner is asked to respond to the following: (a) Elicit from the Veteran all signs and symptoms of the left wrist disability throughout the pendency of the appeal. In doing so, obtain information from the Veteran (and the treatment records) as to the frequency, duration, characteristics, severity, or functional loss with any repetitive use or during any flare-ups. (b) Full range of motion testing must be performed where possible. The joint in question and the paired joint should be tested in (1) active motion, (2) passive motion, (3) in weight-bearing, and (4) in nonweight-bearing. 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. If pain is found during the examination, the examiner should note when the pain begins. (c) In assessing functional loss, flare-ups and increased functional loss on repetitive use must be considered. The examiner must consider all procurable and ascertainable data and describe the extent of any pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report functional impairment due to such factors in terms of additional degrees of limitation of motion. **If the examiner is unable to provide such an opinion without resort to speculation, the examiner must provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician’s Guide to estimate, “per [the] veteran,” what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. 3. Then readjudicate the claim. S. B. MAYS Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Yaffe, 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.