Citation Nr: 21064796 Decision Date: 10/21/21 Archive Date: 10/21/21 DOCKET NO. 17-30 781 DATE: October 21, 2021 REMANDED Entitlement to an evaluation in excess of 30 percent for Parkinson's disease prior to June 2, 2016 is remanded. Entitlement to an evaluation in excess of 60 percent for bladder dysfunction as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to an evaluation in excess of 30 percent for difficulty swallowing as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to an evaluation in excess of 30 percent for right upper extremity tremors as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to an evaluation in excess of 20 percent for right lower extremity tremors with balance impairment as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to an evaluation in excess of 10 percent for loss of smell as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to an evaluation in excess of 10 percent for speech changes as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for constipation as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for loss of autonomic movements, right, as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for loss of autonomic movements, left, as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for loss of right side stooped posture as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for loss of left side stooped posture as a complication of Parkinson's disease from June 2, 2016 is remanded. Entitlement to a compensable evaluation for erectile dysfunction as a complication of Parkinson's disease from June 2, 2016 to August 1, 2021 is remanded. REASONS FOR REMAND The Veteran served on active duty from March 1967 to October 1969. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an April 2015 rating decision by the Department of Veterans Affairs (VA). This case was remanded in February 2019 for further development; it has since been re-assigned to the undersigned. Since the last Board remand, the rating for the Veteran's Parkinson's disease was separated into evaluations based on the residuals, effective June 2, 2016. See August 2020 rating decision; see also 38 C.F.R. § 4.124a, Diagnostic Code (Code) 8004. The appeal has been recharacterized accordingly. The Board notes that a separate evaluation for erectile dysfunction was granted in the August 2020 rating decision but was later severed, effective August 1, 2021. See May 2021 rating decision. The issue has been recharacterized accordingly. All issues are remanded. As discussed above, the rating for the Veteran's Parkinson's disease was separated into evaluations and the residuals of his disability are rated individually pursuant to their own Code. See 38 C.F.R. § 4.124a, Code 8004. He underwent a VA examination in October 2019, wherein the examiner discussed his residuals and assessed whether such residuals were "mild," "moderate," or "severe," for most residuals. The rating criteria for several of the Parkinson's disease residuals are more detailed than merely "mild," "moderate," or "severe." For example, the Veteran's speech changes are rated at 10 percent by analogy pursuant to Code 6516, which is for chronic laryngitis. Pursuant to the Code, a 30 percent rating may be warranted for hoarseness with thickening or nodules of cords, polyps, submucous infiltration, or pre-malignant changes on biopsy. 38 C.F.R. § 4.97. It is unclear whether the Veteran's speech changes more closely approximate the criteria for a 10 percent rating or the 30 percent criteria. As a result, the October 2019 VA examination is inadequate and remand for a new examination is necessary. In addition to any specific criteria that may be unknown, several of the Veteran's Parkinson's disease residuals are rated by analogy pursuant to nerve disabilities. For example, the Veteran's left-sided stooped posture is rated by analogy pursuant to Code 8411, which is for neuralgia of the eleventh (spinal accessory, external branch) cranial nerve. See 38 C.F.R. § 4.124a. It's unclear whether the criteria for this specific nerve is the most appropriate analogous Code for the Veteran. As a result, remand is necessary to clarify which nerve disabilities the Veteran's residuals most closely approximate. The matters are REMANDED for the following action: 1. The AOJ should obtain copies of VA treatment records from August 2021 to the present. 2. After the above development is completed, the AOJ should arrange for examinations of the Veteran to assess the current severity of his service-connected Parkinson's disease. The examiner must review the entire record (including this remand) in conjunction with the examination and note such review was conducted. The examiner should provide a full description of the disability and report all signs and symptoms associated with the Veteran's disability. The following examinations should be conducted: (a.) A Parkinson's disease examination. The examiner must discuss: 1. whether the Veteran's difficulty swallowing permits liquids only and/or has marked impairment of general health; 2. whether the Veteran has hoarseness with thickening or nodules of cords, polyps, submucous infiltration associated with his speech changes; 3. whether the Veteran's constipation manifests in disturbances of bowel function with occasional episodes of abdominal distress; frequent episodes of bowel disturbance with abdominal distress; or with more or less constant abdominal distress; and 4. for each disability and symptoms discussed, whether the symptoms were of such severity during the entire appeal period (from May 2014); if not, when the severity increased and what the severity was before the increase. (b.) A peripheral nerves examination for the Veteran's right upper extremity tremors, right lower extremity tremors, right and left loss of autonomic movements, and right and left sided stooped posture. The examiner must identify the appropriate analogous nerve for each Parkinson's disease residual. The examiner should state whether the symptoms were of such severity during the entire appeal period, and, if not, when the severity increased and what the severity was before. 3. If upon completion of the above action the issues remain denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Sandler, 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.