Citation Nr: 21064162 Decision Date: 10/19/21 Archive Date: 10/19/21 DOCKET NO. 12-16 933 DATE: October 19, 2021 REMANDED The issue of entitlement to restoration of a 20 percent rating for lateral instability of the left knee effective February 1, 2014, is remanded. The issue of entitlement to a compensable evaluation since December 22, 2010, for right-hand ring (4th) finger is remanded. The issue of entitlement to a compensable evaluation since December 22, 2010, for right-hand little (5th) finger is remanded. The issue of entitlement to service connection for atrial fibrillation is remanded. The issue of entitlement to service connection for additional lumbar disabilities, to include stenosis and degenerative joint disease (DJD), as secondary to service-connected lumbar strain is remanded. The issue of entitlement to service connection for bilateral lower extremity (LE) radiculopathy (sciatica) is remanded. The issue of entitlement to a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) for the appeal period beginning January 1, 2011, to include consideration of special monthly compensation pursuant to 38 U.S.C. § 1114 (s) is remanded. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from July 1976 to July 1996. The case was remanded in April 2020 for evidentiary development. The Board has determined that additional development is needed for several claims. In addition, since the Board must remand the Veteran's claims for restoration of his left knee rating, increased ratings for right-hand fingers, and service connection for additional lumbar spine disabilities, his claims for service connection for bilateral LE sciatica, entitlement to TDIU, and entitlement to SMC are also remanded as inextricably intertwined with the remanded issues. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991); see also Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). REASONS FOR REMAND 1. Entitlement to a restoration of a 20 percent evaluation for left knee instability effective February 1, 2014, to include whether an increase rating is warranted. 2. Entitlement to a compensable evaluation since December 22, 2010, for Dupuytren's contracture of the right-hand ring (4th) finger. 3. Entitlement to a compensable evaluation since December 22, 2010, for a soft tissue contracture of the right-hand little (5th) finger. 4. Service connection for atrial fibrillation. 5. Service connection for additional lumbar disabilities, to include stenosis and degenerative joint disease (DJD), as secondary to service-connected lumbar strain. 6. Service connection for bilateral lower extremity (LE) radiculopathy (sciatica). 7. Entitlement to TDIU for the appeal period beginning January 1, 2011, to include consideration of special monthly compensation pursuant to 38 U.S.C. § 1114 (s). The matters are REMANDED for the following action: 1. BACKGROUND INFORMATION FOR THE RO ADJUDICATOR: The Board has determined that additional development is necessary for several claims, and that some claims are inextricably intertwined with others. Thus all claims are remanded for the following REMAND DIRECTIVES: 2. Obtain a copy of the February 2012 VA medical examination for knee and lower leg conditions. According to the July 2013 and November 2013 rating decisions, the decision to reduce the Veteran's rating for his left knee instability disability was based on the medical findings of February 2012 examination. However, a VA medical examination dated February 13, 2012, for knee and lower leg conditions is not currently in the record. Locate this examination report and associate it with the record. If there is no such examination, provide a detailed explanation on which examination the rating reduction was based, and annotate the file in order to further appellate review. 3. Schedule the Veteran for an appropriate VA examination, consistent with VA rating protocols, to determine the severity of his right-hand finger disabilities. The entire claims file, including a copy of the Remand, should be made available to, and be reviewed by, the VA examiner. All appropriate tests, studies, and consultations should be accomplished, INCLUDING RELEVANT IMAGING STUDIES, and all clinical findings should be reported in detail. An explanation should be given for all opinions and conclusions rendered. 4. Return the claims file to the February 2012, June 2018, or October 2020 VA examiner and request s/he re-review the claims file and respond to the inquiries below. If any of these examiners are not available, arrange for another appropriate VA examiner to provide an addendum opinion to assist in determining the relationship between the Veteran's service-connected disabilities and his atrial fibrillation condition. The electronic claims file, including a copy of the Remand, must be made available to, and be reviewed by, the VA examiner. The VA examiner must provide the following opinions: a) Is the Veteran's atrial fibrillation disability proximately due to any of the Veteran's service-connected sinus-related disabilities (i.e. deviated septum; obstructive sleep apnea)? b) Is the Veteran's atrial fibrillation disability aggravated (e.g. worsened, and if so, to what degree) by any of the Veteran's service-connected sinus-related disabilities (i.e. deviated septum; obstructive sleep apnea)? c) If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time. d) Given the medical evidence in this case, your experience and knowledge, and the state of medical science, is the Veteran's account that his atrial fibrillation is caused or aggravated by either of his sinus conditions consistent with the clinical findings? Please fully explain your opinion. e) The examiner MUST discuss medical research that indicates a relationship between sleep apnea and atrial fibrillation. The examiner must review the entire record in conjunction with rendering the requested opinions. IN ADDITION TO ANY RECORDS THAT ARE GENERATED BECAUSE OF THIS REMAND, the VA examiner's attention is drawn to the following: * December 2010 private opinion that the Veteran's sleep apnea disability is related to his nasal septum injury, or his cardiac condition, or both. See "Medical Opinion," received December 22, 2010. * February 2012 VA medical examination. See "VA Examination," received February 13, 2012. * April 2016 Board hearing testimony, when the Veteran testified that he felt his atrial fibrillation disability had something to do with his deviated septum and/or his sleep apnea. See "Hearing Testimony," received April 4, 2016. * June 2018 VA medical examination reports and opinion. The examiner did not diagnose the Veteran with atrial fibrillation. See "C&P Exam," received June 26, 2018. * October 2020 VA medical examination report and opinion. The examiner opined the Veteran's heart condition did not have its onset during service and that the medical evidence did not indicate a nexus to service. See "C&P Exam," received October 5, 2020. The examiner did not provide an opinion on secondary causation or aggravation. A thorough explanation must be provided for the opinion rendered. If the examiner cannot provide the requested opinion without resorting to speculation, s/he must expressly indicate this and provide supporting rationale as to why the opinion cannot be made without resorting to speculation. The examiner must schedule a new examination only if necessary to provide an adequate opinion. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED, AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION/OPINION SUFFICIENT. 5. Return the claims file to the December 2020 VA examiner and request s/he re-review the claims file and respond to the inquires below. If the examiner is not available, arrange for another appropriate VA examiner to provide an addendum medical opinion to assist in determining the relationship between the Veteran's lumbar stenosis and degenerative joint disease (DJD) disabilities and his service-connected musculoskeletal disabilities. The electronic claims file, including a copy of the Remand, must be made available to, and be reviewed by, the VA examiner. The VA examiner must provide the following opinions: a) Are either of the Veteran's current lumbar stenosis and/or DJD diagnoses proximately due to any of the Veteran's service-connected musculoskeletal disabilities [i.e. chronic lumbar strain; chronic cervical strain with DJD; bilateral upper extremity radiculopathy; left knee chondromalacia patella, ACL rupture, and instability; residuals of left knee meniscectomy; and right knee injury]? b) Are either of the Veteran's current lumbar stenosis and/or DJD diagnoses aggravated (e.g. worsened, and if so, to what degree) by any of the Veteran's service-connected musculoskeletal disabilities? [i.e. chronic lumbar strain; chronic cervical strain with DJD; bilateral upper extremity radiculopathy; left knee chondromalacia patella, ACL rupture, and instability; residuals of left knee meniscectomy; and right knee injury]? c) If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and by the Veteran's statements as to the nature, severity, and frequency of his observable symptoms over time. The examiner must review the entire record in conjunction with rendering the requested opinions. A thorough explanation must be provided for the opinion rendered. If the examiner cannot provide the requested opinion without resorting to speculation, s/he must expressly indicate this and provide supporting rationale as to why the opinion cannot be made without resorting to speculation. The examiner must schedule a new examination only if necessary to provide an adequate opinion. THE EXAMINER IS ADVISED THAT BY LAW, THE MERE STATEMENT THAT THE CLAIMS FOLDER WAS REVIEWED, AND/OR THE EXAMINER HAS EXPERTISE IS NOT SUFFICIENT TO FIND THE EXAMINATION/OPINION SUFFICIENT. 6. Following the review and any additional development deemed necessary, readjudicate the claims. If the RO does not grant the claims, issue a supplemental statement of the case (SSOC), and return the claims to the Board. The Veteran may submit additional evidence and argument. Kutscherousky v. West, 12 Vet. App. 369 (1999). (CONTINUED ON NEXT PAGE) These claims must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C. §§ 5109B, 7112 (West 2014). Vito A. Clementi Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Anwar, Attorney-Advisor The Board's decision is only binding on this case. This action is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.