Citation Nr: 21002157 Decision Date: 01/12/21 Archive Date: 01/12/21 DOCKET NO. 14-30 057 DATE: January 12, 2021 ORDER Entitlement to service connection for an acquired psychiatric disorder, to include an anxiety disorder is granted. Entitlement to an earlier effective date of August 26, 1987, for service connection of coronary artery disease is granted. From February 25, 2003 to May 25, 2003, entitlement to an initial 100 percent rating for coronary artery disease is granted, subject to the laws and regulations governing the payment of monetary benefits. From May 26, 2003 to July 28, 2010, entitlement to a rating in excess of 10 percent for coronary artery disease is denied. From July 29, 2010, entitlement to a 60 percent rating for coronary artery disease, but no higher, is granted, subject to the laws and regulations governing the payment of monetary benefits. Entitlement to a rating in excess of 20 percent for a left muscle group II injury is denied for the entire period on appeal. REMANDED Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. FINDINGS OF FACT 1. Resolving all reasonable doubt in favor of the Veteran, his current acquired psychiatric disorder, to include an anxiety disorder is related to the Veteran’s service-connected peripheral neuropathy of the bilateral lower and upper extremities (peripheral neuropathy). 2. The Veteran’s original claim of entitlement to service connection for a cardiovascular disease, which was filed in August 1987 and pending before the VA prior to May 3, 1989; was factually ascertainable as of that date. 3. The evidence of record reflects that the Veteran’s coronary artery disease resulted in a myocardial infarction on February 25, 2003. 4. From May 26, 2003 to July 28, 2010, the evidence of record does not reflect that the Veteran’s coronary artery disease resulted in workloads of 7 METs or less; there was no evidence of cardiac hypertrophy or dilation; and the Veteran’s coronary artery disease did not result in more than one episode of congestive heart failure. 5. From July 29, 2010, resolving all reasonable doubt in favor of the Veteran, his coronary artery disease resulted in an ejection fraction of at worst 30 to 50 percent and there was no evidence of cardiac hypertrophy or dilation; and did not result in workloads of less than 4 METs. 6. Throughout the entire period on appeal, the Veteran’s left muscle group II injury was not manifested by moderately severe or severe impairment of the nondominant extremity under Muscle Group II. CONCLUSIONS OF LAW 1. The criteria for service connection for an acquired psychiatric disorder to include an anxiety disorder are met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a), 3.310. 2. The criteria for an earlier effective date of August 24, 1987, for the award of service connection for coronary artery disease, have been met. 38 U.S.C. § 5110; 38 C.F.R. §§ 3.157, 3.400, 3.816. 3. From February 25, 2003 to May 25, 2003, the criteria for a 100 percent rating for coronary artery disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 7006. 4. From May 26, 2003 to July 28, 2010, the criteria for a rating in excess of 10 percent for coronary artery disease have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 7005. 5. From July 29, 2010, the criteria for a 60 percent rating, but no higher, for coronary artery disease have been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 4.85, 4.86, Diagnostic Code 7005. 6. Throughout the entire period on appeal, the criteria for a rating in excess of 20 percent for a left muscle group II injury have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. § 4.73, Diagnostic Codes 5399-5302. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served in the United States Navy from July 1963 to October 1966. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a Department of Veterans Affairs (VA) Agency of Original Jurisdiction (AOJ) rating decisions dated in June 2011, September 2011, and November 2011. The Board remanded the case to the AOJ in May 2018. In June 2020, the AOJ granted the following: service connection for peripheral neuropathy of the bilateral upper extremities with a rating of 10 percent effective January 8, 2010; service connection for peripheral neuropathy of the bilateral lower extremities with a noncompensable rating effective January 8, 2020; service connection for hypertension with a noncompensable rating effective May 21, 2010; service connection for erectile dysfunction with a noncompensable rating effective December 7, 2010; service connection for transient ischemic attacks (TIA) with a noncompensable rating effective December 7, 2010; and special monthly compensation (SMC) for the loss of use of creative organ from December 7, 2010; which represents a full grant of the benefits sought with respect to these disabilities, and these matters are no longer before the Board for consideration. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). In June 2020, the AOJ also increased the Veteran’s rating to 60 percent for coronary artery disease effective September 18, 2019. Because the increase in evaluation of the Veteran’s coronary artery disease does not represent the maximum evaluation available for the condition, the Veteran’s claim remains in appellate status. See AB v. Brown, 6 Vet. App. 35, 38 (1993). The Board finds the issue of entitlement to a TDIU was raised by the record. See November 2020 Application for increased compensation based on unemployability. Therefore, the issue is added to the issue on appeal. See Bradley v. Peake, 22 Vet. App. 280, 294 (2008). 1. Entitlement to service connection for an acquired psychiatric disorder The Veteran seeks service connection for a psychiatric disorder, which he asserts is related to service, or to his service-connected disabilities. Service connection will be granted if the evidence demonstrates that current disability resulted from an injury or disease incurred in active military service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service disease or injury; and (3) a causal relationship between the current disability and the in-service disease or injury. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after discharge when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The Board has carefully reviewed the evidence of record and finds that the Veteran’s service-connected peripheral neuropathy caused the Veteran’s psychiatric disorder to include an anxiety disorder. Thus, resolving all reasonable doubt in favor of the Veteran, the criteria for service connection for a psychiatric disorder as secondary to the Veteran’s service-connected peripheral neuropathy have been met. See 38 C.F.R. § 3.310. As previously noted, service connection for peripheral neuropathy of the bilateral lower and upper extremities was established in June 2020. The Veteran has a current diagnosis of a psychiatric disorder for the purposes of establishing service connection. See McClain v. Nicholson, 21 Vet. App. 319 (2007). The Veteran filed his claim of service connection for a psychiatric disorder in August 2010; and was diagnosed with an anxiety disorder, not otherwise specified (NOS) in February 2011. See also March 2009 private treatment record. But see September 2019 VA examination. Wise v. Shinseki, 26 Vet. App. 517, 531 (2014). Resolving all reasonable doubt in favor of the Veteran, and with consideration of the objective medical evidence as well as the subjective lay evidence, the Board finds that there is a nexus between the Veteran’s current acquired psychiatric disorder to include an anxiety disorder and his service connected peripheral neuropathy. The February 2011 VA examination establishes that the Veteran’s anxiety disorder is related to his service-connected peripheral neuropathy. Although the February 2011 VA examiner found that the Veteran did not have a current diagnosis of PTSD, the examiner found that the Veteran had a current diagnosis of an anxiety disorder; and opined that the Veteran’s recent psychiatric treatment for the past decade had been directed toward anxiety that stemmed from physical problems, which included peripheral neuropathy. The Board notes that the September 2019 VA examiner who opined that the Veteran did not have a current diagnosis of a psychiatric disorder which was related to service, applied the wrong standard in determining whether the Veteran had a current diagnosis of a psychiatric disorder for VA purposes. See McClain, supra. In addition, although the VA examiner did not specifically discuss whether the Veteran’s psychiatric disorder was related to service; the examiner repeated the February 2011 VA examiner’s finding that the Veteran’s past treatment had been directed toward anxiety that stemmed from his physical problems by the Veteran’s own admission. Thus, the Board finds that the February 2011 VA examiner’s opinion combined with the other evidence of record, establishes that the Veteran’s acquired psychiatric disorder to include an anxiety disorder is related to service. In determining the weight assigned to this evidence, the Board looks at factors such as the health care provider’s knowledge and skill in analyzing the medical data. See Guerrieri v. Brown, 4 Vet. App. 467, 470-471 (1993). In determining the probative value to be assigned to a medical opinion, the Board must consider three factors: whether a medical expert was fully informed of the pertinent factual premises (i.e., medical history) of the case; whether the medical expert provided a fully articulated opinion; and whether the opinion is supported by a reasoned analysis. The most probative value of a medical opinion comes from its reasoning. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008). Therefore, a medical opinion containing only data and conclusions is not entitled to any weight. In fact, a review of the claims file does not substitute for a lack of a reasoned analysis. See Nieves-Rodriguez, supra. Resolving all reasonable doubt in favor of the Veteran, the Board finds that the medical and lay evidence of record supports a finding that service connection for an acquired psychiatric disorder, to include an anxiety disorder as secondary to the Veteran’s service-connected peripheral neuropathy is warranted. See 38 U.S.C. § 5107(b); 38 C.F.R. §§ 4.3, 4.7; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). Effective Date 2. Entitlement to an effective date earlier than February 25, 2003, for the grant of service connection for coronary artery disease A claim for service connection for angina and high blood condition was received on August 26, 1987. In August 1988, the Veteran appealed an October 1987, which denied entitlement to service connection for a cardiovascular abnormality, if existent. In June 1990, the Board denied entitlement to service connection for a cardiovascular disability. The Veteran did not appeal this decision, and it is final. See 38 U.S.C. § 7104; 38 C.F.R. § 20.1103. In August 2003, the AOJ confirmed and continued the previous denial of service connection for a cardiovascular abnormality, which was currently claimed as a heart condition, which the Veteran did not appeal, and it is final. See 38 U.S.C. § 7105; 38 C.F.R. § 20.1103. In a June 2011 rating decision, the AOJ granted service connected for coronary artery disease with herbicide exposure, for purposes of entitlement to retroactive benefits, with a 10 percent rating effective February 25, 2003, pursuant to 38 C.F.R. § 3.816. After a review of the evidence, for reasons set forth below and resolving all reasonable doubt in favor of the Veteran, the Board finds that the criteria for entitlement to an earlier effective date of August 26, 1987, for the grant of service connection for coronary artery disease have been met. Generally, the effective date for an award of service connection for claims received within one year after separation from service shall be the day following separation from service, or date entitlement arose; otherwise, the effective date shall be the date of receipt of claim, or date entitlement arose, whichever is later. 38 U.S.C. § 5110(b)(1); 38 C.F.R. § 3.400(b)(2). The effective date of an award based on a claim reopened after final adjudication shall be fixed in accordance with the facts found but shall not be earlier than the date of receipt of application therefor. 38 U.S.C. § 5110; 38 C.F.R. § 3.400(q)(2), (r). However, pursuant to 38 C.F.R. § 3.816, Nehmer class members may be assigned earlier effective dates than the date of the law and regulations that established presumptive service connection for a “covered herbicide disease.” See 38 C.F.R. § 3.816(c)(2). In this case, the Veteran’s original claim of entitlement to service connection for cardiovascular disability was denied by VA prior to May 3, 1989; thus the effective date of the award of service connection is the later of the date such claim was received by VA or the date the disability arose, whichever is later. See 38 C.F.R. § 3.816(c)(1), (c)(2). As noted, the Veteran’s claim of entitlement to service connection for a cardiovascular disability was received on August 26, 1987. Further, based on the evidence as outlined below, and resolving all reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s cardiovascular disability had arisen from at least June 1987. The September 2019 VA examination supports a finding that the Veteran’s cardiovascular disability arose in June 1987. Although the examiner opined that the Veteran’s ischemic heart disease likely first manifested in 1999, based upon a September 1999 VA examination report which noted a history of heart problems and a March 2004 VA treatment record which showed a history of significant coronary artery disease subsequently treated with stents; the Board notes, however, that the September 2019 VA examiner also opined that the Veteran’s diagnoses of stable angina and valvular heart disease were etiologically related to the Veteran’s coronary artery disease, which supports a finding that the Veteran’s heart condition had been manifest from at least June 1987. Notably, the September 1999 VA examination reflects a diagnosis of history of cardiovascular problems; and the examiner noted that the last time the Veteran had been hospitalized with angina was in approximately September 1998; the Veteran reported shortness of breath for the last twenty-five to thirty years; and the Veteran reported that he could walk no further than one and one half blocks. The Board notes, that available post-service treatment records reflect that the Veteran had angina pain and shortness of breath from at least June 1987; and the Veteran competently and credibly reported that he had been diagnosed with angina from at least August 1987. See Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007); Buchanan v. Nicholson, 451 F.3d 1331, 1336-1337 (2006). Specifically, in June 1987 a VA treatment provider noted that the Veteran had a diagnosis of chest pain, rule out (R/O) coronary artery disease (CAD), rule out hiatal hernia; and prescribed the Veteran nitroglycerin. The treatment provider also requested that the Veteran be provided an electrocardiogram (EKG) as soon as possible (ASAP). In January 1989, a private treatment provider noted that the Veteran had a past diagnosis of mitral valve prolapse. But see July 2010 VA examination. In August 1993, a treatment provider noted that the discomfort that the Veteran experienced in his arms were compatible with angina and may have had an ischemic cause. In February 2003, the Veteran was diagnosed with coronary artery disease and acute myocardial infarction (MI) and an emergency stent was placed. See July 2010 VA examination. Thus, the Board finds that resolving all reasonable doubt in favor of the Veteran, his coronary artery disease arose in at least June 1987, based upon his symptoms of angina and shortness of breath, which had been chronic and continuous from at least June 1987 through to February 2003, when he was diagnosed with coronary artery disease; and based upon the September 2019 VA examiner’s opinion that the etiology of the Veteran’s angina and valvular heart disease was the Veteran’s coronary artery disease. Thus, resolving all reasonable doubt in favor of the Veteran, the Board finds that an earlier effective date of August 26, 1987, is warranted for the Veteran’s service-connected coronary artery disease, which had arisen from at least June 1987. See 38 U.S.C. § 5107; Gilbert, supra. Increased Rating Disability ratings are based on the average impairment of earning capacity resulting from disability. 38 U.S.C. § 1155; 38 C.F.R. § 4.1. Separate diagnostic codes identify the various disabilities. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability more closely approximates the criteria required for that rating. 38 C.F.R. § 4.7. Otherwise, the lower rating will be assigned. Id. In a claim for a higher original rating after an initial award of service connection, all of the evidence submitted in support of the Veteran’s claim is to be considered. See Fenderson v. West, 12 Vet. App. 119, 127 (1999). Although the Veteran’s entire history is reviewed when assigning a disability evaluation, where service connection has already been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55, 58 (1994), see also 38 C.F.R. § 4.1. 3. Entitlement to an initial rating in excess of 10 percent prior to September 18, 2019 for coronary artery disease, and a rating in excess of 60 percent thereafter The Veteran filed an appeal of a June 2011 rating decision, which granted service connection for coronary artery disease associated with herbicide exposure with a 10 percent rating effective February 25, 2003. In June 2020, the AOJ granted a 60 percent rating for the Veteran’s coronary artery disease from September 18, 2019. After a review of the evidence, for reasons set forth below, the Board finds that a 100 percent rating is warranted for the Veteran’s coronary artery disease from February 25, 2003 to May 25, 2003; a 10 percent rating is warranted from May 26, 2003 to July 28, 2010; and a 60 percent rating is warranted thereafter. The Veteran’s coronary artery disease is rated under 38 C.F.R. § 4.104, Diagnostic Code 7005. A September 2019 VA examination reflects a current diagnosis of coronary artery disease with myocardial infarction, stable angina, and valvular heart disease. But see November 2011 VA examination. Wise, supra. The medical evidence of record reflects that the Veteran had a myocardial infarction on February 25, 2003. See July 2010 VA Examination. Pursuant to Diagnostic Code 7006, a 100 percent rating is assigned during and for three months following a myocardial infarction documented by laboratory tests. Thus, the Board finds that the Veteran’s heart condition warrants a 100 percent rating from February 25, 2003 to May 25, 2003. Prior to July 2010, the evidence of record reflects that the Veteran had an ejection fraction of at worst 60 percent. See September 2007 VA treatment record. The preponderance of the evidence of record does not reflect that the Veteran had a METs less than 7 METs resulting in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram or x-ray prior to July 29, 2010, the date of the echocardiogram, which revealed that the Veteran had an ejection fraction of 54 percent. See also March 2011 VA examination. Under Diagnostic Code 7005, a 10 percent rating is assigned for documented coronary artery disease when a workload of greater than 7 METs but not greater than 10 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; continuous medication is required. A 30 percent rating is assigned for documented coronary artery disease when a workload of greater than 5 METs but not greater than 7 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; evidence of cardiac hypertrophy or dilatation on electrocardiogram, echocardiogram or x-ray. A 60 percent rating is assigned for documented coronary artery disease resulting in more than one episode of acute congestive heart failure in the past year, or; a workload of greater than 3 METs but not greater than 5 METs results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of 30 to 50 percent. A 100 percent rating is assigned for documented coronary artery disease resulting in chronic congestive heart failure, or; a workload of 3 METs or less results in dyspnea, fatigue, angina, dizziness, or syncope, or; left ventricular dysfunction with an ejection fraction of less than 30 percent. 38 C.F.R. § 4.104. For rating diseases of the heart, one MET is the energy cost of standing quietly at rest and represents an oxygen uptake of 3.5 milliliters per kilogram of body weight per minute. When the level of METs at which dyspnea, fatigue, angina, dizziness, or syncope develops is required for rating, and a laboratory determination of METs by exercise testing cannot be done for medical reasons, an estimation by a medical examiner of the level of activity (expressed in METs and supported by specific examples, such as slow stair climbing or shoveling snow) that results in dyspnea, fatigue, angina, dizziness, or syncope may be used. 38 C.F.R. § 4.104, Note 2. Thus, the Board finds that from May 26, 2003 to July 28, 2010, the preponderance of the evidence of record does not support a rating in excess of 10 percent for the Veteran’s coronary artery disease. Resolving all reasonable doubt in favor of the Veteran, the evidence of record reflects that the Veteran had an ejection fraction of at worst 30 to 50 percent from July 29, 2010. See July 2010 echocardiogram; March 2011 and September 2019 VA examination; and October 2019 private treatment record. Thus, the Board finds that the evidence of record supports a finding that the Veteran’s coronary artery disease warrants a 60 percent rating from July 29, 2010. Finally, the Board notes that from July 29, 2010, the evidence of record does not reflect that the Veteran had a coronary artery disease resulting in chronic congestive heart failure; or a workload of 3 METs or less, which resulted in dyspnea, fatigue, angina, dizziness, or syncope. Thus, the Board finds that from July 29, 2010, the evidence of record does not warrant a rating in excess of 60 percent. The Board has considered the lay testimony and statements of record regarding the severity of the Veteran’s coronary artery disease and has relied on these reports in determining the appropriate disability rating under the benefit-of-the-doubt doctrine. 38 C.F.R. §§ 4.3, 4.7. The Veteran is competent to report on factual matters of which he has firsthand knowledge and his statements regarding his symptoms are also credible, and thus, probative. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005); Jandreau, supra; see also Baldwin v. West, 13 Vet. App. 1 (1999). Where the Veteran has not discussed particular findings that are necessary for application to the rating criteria, the Board has accorded greater probative weight to objective medical findings of record which specifically address the rating criteria. See Guerrieri, supra. For the reasons set forth above, the Board finds that from February 25, 2003 to May 25, 2003 a 100 percent rating is warranted for the Veteran’s coronary artery disease; a rating in excess of 10 percent is not warranted for the Veteran’s coronary artery disease from May 26, 2003 to July 28, 2010; and a 60 percent rating is warranted for the Veteran’s coronary artery disease from July 29, 2010. In reaching this decision, the Board has considered the benefit of the doubt doctrine. 38 U.S.C. § 5107; Gilbert, supra. 4. Entitlement to a rating in excess of 20 percent for a left muscle group II injury The Veteran filed an appeal of a November 2011 rating decision, which continued the 20 percent rating for the Veteran’s service connected left muscle group II injury of a minor extremity. After a review of the evidence, for reasons set forth below, the Board finds that a rating in excess of 20 percent is not warranted for the Veteran’s left muscle group II injury for the entire period on appeal. The Veteran’s left muscle group II injury is rated under 38 C.F.R. § 4.73, Diagnostic Code 5399-5302, using the minor side ratings. Hyphenated diagnostic codes are used when a rating under one code requires use of an additional diagnostic code to identify the basis for the rating. See 38 C.F.R. § 4.27. The Board will consider whether the Veteran is entitled to receive higher ratings for his muscle disability under all applicable diagnostic codes. The medical evidence in this case indicates that the Veteran’s dominant hand is his right hand. 38 C.F.R. § 4.69. See September 2019 VA examination. The Veteran has a current diagnosis of left muscle group II injury of the muscles of the shoulder girdle. Id. Diagnostic Codes 5301 to 5306 provides ratings for muscle injuries of the shoulder girdle and arm. Diagnostic Code 5302 applies to impairment of Muscle Group II, which involves depression of arm from vertical overhead to hanging at side (1, 2); downward rotation of scapula (3, 4); 1 and 2 act with Group III in forward and backward swing of arm; extrinsic muscles of shoulder girdle: (1) pectoralis major II (costosternal); (2) latissimus dorsi and teres major (teres major, although technically an intrinsic muscle, is included with latissimus dorsi); (3) pectoralis minor; and (4) rhomboid. 38 C.F.R. § 4.73. Pursuant to Diagnostic Code 5302, moderate impairment of either extremity warrants a 20 percent rating; moderately severe impairment of the dominant extremity warrants a 30 percent rating; moderately severe impairment of the nondominant extremity warrants a 20 percent rating; severe impairment of the dominant extremity warrants a 40 percent rating; and severe impairment of the nondominant extremity warrants a 30 percent rating. 38 C.F.R. § 4.73. Under Diagnostic Codes 5301 through 5323, disabilities resulting from muscle injuries shall be classified as slight, moderate, moderately severe, or severe. A “moderate” muscle disability consists of a through and through or deep penetrating wound of short track from a single bullet, small shell or shrapnel fragment, without the explosive effect of a high velocity missile, residuals of debridement, or prolonged infection. In such cases, there will be a service department record or other evidence of inservice treatment for the wound and a record of consistent complaint of one or more of the cardinal signs and symptoms of muscle disability, particularly a lowered threshold of fatigue after average use, affecting the particular functions controlled by the injured muscles. Objective findings typically include entrance and (if present) exit scars, small or linear, indicating a short track of the missile through muscle tissue; some loss of deep fascia or muscle substance or impairment of muscle tonus and loss of power or a lowered threshold of fatigue when compared to the sound side. 38 C.F.R. § 4.56(d)(2). A “moderately severe” disability of the muscles is shown by a through and through or deep penetrating wound by a small high velocity missile or a large low velocity missile, with debridement, prolonged infection, or sloughing of soft parts, and intermuscular scarring. History and complaints of this injury typically include a record of hospitalization for a prolonged period for treatment of a wound, a record of consistent complaint of cardinal signs and symptoms of muscle disability, and, if present, evidence of an inability to keep up with work requirements. Objective findings of a moderately severe muscle wound are entrance and (if present) exit scars indicating the track of the missile through important muscle groups; indications on palpation of moderate loss of deep fascia, muscle substance, or normal firm resistance of muscles compared with the sound side; and tests of strength and endurance compared with the sound side demonstrating positive evidence of impairment. 38 C.F.R. § 4.56(d)(3). A “severe” muscle disability is a type of injury caused by a through and through or deep penetrating wound due to high-velocity missile, or large or multiple low velocity missiles, or with shattering bone fracture or open comminuted fracture with extensive debridement, prolonged infection, or sloughing of soft parts, and intermuscular binding and scarring. 38 C.F.R. § 4.56(d)(4). History includes service department records or other evidence showing hospitalization for a prolonged period for treatment of wound, a record of consistent complaints of cardinal signs and symptoms of muscle disability, as defined by 38 C.F.R. § 4.56(c), which are worse than those shown for moderately severe muscle injuries, and, if present, evidence of inability to keep up with work requirements. Id. Objective findings include ragged, depressed and adherent scars indicating wide damage to muscle groups in missile track; palpation shows loss of deep fascia or muscle substance, or soft flabby muscles in wound area; and muscles swell and harden abnormally in contraction. Id. The medical evidence of record reveals moderate impairment of the Veteran’s left muscle group II. Service treatment records reflect that the Veteran underwent a thoracostomy with draining in March 1965, which required chest tube drainage for four to five days; and underwent a left thoracostomy with wedge resection of the atypical posterior segment containing several pulmonary blebs and scarification of the atypical parietal pleura in November 1965 and was hospitalized for approximately one month. The treatment provider noted that the Veteran’s wound healed satisfactorily. The medical evidence of record reveals that the symptoms of the Veteran’s muscle group II injury include a lowered threshold of fatigue after average use; some left muscle atrophy causing asymmetry of his chest; and mildly decreased left muscle loss of strength. However, the Board finds that the Veteran’s left muscle group II injury does not meet the criteria for a moderately severe or severe impairment of the Veteran’s left muscle group II; the delineated symptoms or comparable symptoms are not shown to be characteristic of the Veteran’s service-connected disability. The evidence of record does not reflect that the Veteran’s surgical procedures during service resulted in debridement, prolonged infection, or sloughing of soft parts. The evidence of record does not reflect that the Veteran had prolonged hospitalization for treatment of the wound following the surgical procedures. Service treatment records reflect that the Veteran had been hospitalized for approximately two weeks from March 1965 to April 1965 and for approximately one month from November 1965 to December 1965 following his thoracostomy. The evidence of record does not reflect that the Veteran had an inability to keep up with work requirements due to his left muscle group II injury. Finally, although the evidence of record reflects moderate muscle atrophy and mildly decreased left muscle loss of strength, the evidence of record does not reflect that the Veteran had more than mild loss of strength and endurance of the left muscle group II compared to the right muscle group II. Therefore, the Board finds that moderately severe or severe impairment of left muscle group II has not been shown, and a rating in excess of 20 percent is not warranted under Diagnostic Code 5302. 38 C.F.R. § 4.73. Finally, the Board notes that the Veteran is currently service connection for peripheral neuropathy of the bilateral lower and upper extremities; and the evidence of record does not reflect that the Veteran has an additional nerve condition which does not impact the Veteran’s left muscle group II, thus an additional rating for a nerve condition is not warranted. 38 C.F.R. § 4.55(a). In determining whether a higher rating is warranted for service-connected disability, VA must determine whether the evidence supports the Veteran’s claim or is in relative equipoise, with the Veteran prevailing in either event, or whether a preponderance of the evidence is against the claim, in which case the claim is denied. 38 U.S.C. § 5107(a); Gilbert, supra. In this case, the evidence does not warrant a rating in excess of 20 percent throughout the period on appeal. REASONS FOR REMAND 1. Entitlement to a TDIU is remanded. The Veteran’s claim of entitlement to service connection is currently being developed by the AOJ. Thus, the Board finds that a remand is necessary to allow the AOJ to continue development of the Veteran’s claim. See January 2021 Subsequent Development Letter. The matters are REMANDED for the following action: Complete development and adjudicate the Veteran’s claim of entitlement to a TDIU. D. SMART Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Fleury Johnson, Gerline R. 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.