Citation Nr: 21068842 Decision Date: 11/15/21 Archive Date: 11/15/21 DOCKET NO. 18-51 660 DATE: November 15, 2021 REMANDED Entitlement to a rating in excess of 10 percent for fracture of the left wrist with aseptic necrosis and osteoarthritis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Marine Corps from June 1975 to May 1979 and the United States Army from February 1980 to April 1980. In January 2021, the Veteran testified at a Board hearing. The transcript is of record. 1. Entitlement to a rating in excess of 10 percent for fracture of the left wrist with aseptic necrosis and osteoarthritis is remanded. The Veteran last underwent a VA examination in August 2018 for his left wrist condition. At the hearing in January 2021, the Veteran testified that his symptoms have increased since his last VA examination. Based on the contention that his symptoms worsened, a new VA examination is warranted to determine the current severity of the Veteran's left wrist condition. The Board also notes that throughout the appeal period the Veteran reported flare-ups. While the June 2016 and August 2018 VA examiners concluded that pain, fatigue, and weakness causes functional loss during flare-ups neither attempted to provide an estimate loss of range of motion during flare-ups. An examiner must offer flare-ups estimates based on available information from all relevant sources, to include lay statements; however, the examiners did not attempt to ascertain adequate information from the Veteran such as frequency, duration, characteristics, and severity. Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). Accordingly, a VA examination is necessary to determine the current severity of the Veteran's left wrist condition. The matters are REMANDED for the following action: 1. In remanding this case, the Board makes no credibility determination, expressed or implied, at this juncture. 2. Obtain updated VA and/or private treatment records. If such records are unavailable, the Veteran's claim file must be clearly documented to that effect and the Veteran notified in accordance with 38 C.F.R. § 3.159(e). 3. Schedule the Veteran for a VA medical examination to determine the current severity of his service-connected left wrist. The electronic claims file must be reviewed in conjunction with the examination. All necessary testing must be conducted. In particular, the examination must include tests of all applicable ranges of motion in active motion, passive motion, weight-bearing, and non- weight-bearing in both wrists. 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. The examiner should consider and address the Veteran's testimony and lay statements reporting symptoms of weakened grip and feeling of pins and needles (paresthesias). 4. The examiner must describe whether pain, weakness, fatigue and/or incoordination significantly limits functional ability during flares or repetitive use, and if so, the examiner must estimate range of motion during flares or repetitive use. If the examination does not take place during a flare or repetitive testing cannot be performed, the examiner should have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use and provide the extent of motion loss described in terms of degrees. If there is no pain and/or no limitation of function, such facts must be noted in the report. The examiner should comment as to whether there is any medical reason to accept or reject the Veteran's description of reduced range of motion during flares or repetitive use. The Board recognizes the difficulty in answering the above questions precisely but is bound by the cited decision of the Court to ask them and requests that the examiner attempt to answer them as best as possible. The Board appreciates the examiner's efforts in doing so. The examiner must also provide an assessment of the Veteran's functional limitations due to his left wrist condition as it may relate to his ability to function in a work setting and to perform work tasks. However, the examiner should refrain from commenting on the Veteran's employability. A complete rationale for all medical opinions is required. The examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge, or literature, etc., relied upon in reaching the conclusion(s). If the examiner feels that a requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e., no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e., additional facts are required, or the examiner does not have the needed knowledge or training). G. A. WASIK Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. A. Prinsen 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.