Citation Nr: 21072372 Decision Date: 12/02/21 Archive Date: 12/02/21 DOCKET NO. 18-06 238 DATE: December 2, 2021 ORDER The appeal for service connection for carpal tunnel syndrome of the right upper extremity is dismissed. The appeal for service connection for carpal tunnel syndrome of the left upper extremity is dismissed. The appeal for service connection for peripheral neuropathy of the right lower extremity is dismissed. The appeal for service connection for peripheral neuropathy of the left lower extremity is dismissed. The appeal for a rating in excess of 20 percent for the service-connected post-operative right shoulder recurrent dislocation with limitation of motion and mild weakness is dismissed. REMANDED Entitlement to a rating in excess of 30 percent for the service-connected ischemic heart disease (IHD) is remanded. Entitlement to an initial compensable rating for the service-connected dermatitis is remanded. FINDING OF FACT At the August 2021 hearing, and before the promulgation of a decision in the appeal, the Veteran explicitly, unambiguously, and with a full understanding of the consequences, notified the Board of Veterans' Appeals (Board) that he wished to withdraw his appeals for service connection for bilateral upper extremity carpal tunnel syndrome and bilateral lower extremity peripheral neuropathy and for a rating in excess of 20 percent for the service-connected post-operative right shoulder recurrent dislocation with limitation of motion and mild weakness. CONCLUSION OF LAW The criteria for withdrawal of the appeals for service connection for carpal tunnel syndrome of both upper extremities and for peripheral neuropathy of both lower extremities and for a rating in excess of 20 percent for the service-connected post-operative right shoulder recurrent dislocation with limitation of motion and mild weakness are met. 38 U.S.C. § 7105; 38 C.F.R. § 19.55. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from September 1968 to November 1976. In August 2021, he testified at a hearing before the undersigned Veterans Law Judge. Dismissal Service Connection for Bilateral Upper Extremity Carpal Tunnel Syndrome and Bilateral Lower Extremity Peripheral Neuropathy and Increased Rating for the Service-Connected Right Shoulder Disability The Board may dismiss any appeal which fails to allege specific error of fact or law in the determination being appealed. 38 U.S.C. § 7105. An appeal may be withdrawn as to any or all issues involved in the appeal at any time before the Board promulgates a decision. 38 C.F.R. § 20.204. A veteran or his/her authorized representative may make the withdrawal. 38 C.F.R. § 20.204. Here, at the August 2021 hearing, the Veteran explicitly and unambiguously, and with a full understanding of the consequences, withdrew his appeals for service connection for carpal tunnel syndrome of both upper extremities and for peripheral neuropathy of both lower extremities and for a rating in excess of 20 percent for the service-connected right shoulder disability. The undersigned clearly identified the withdrawn issues, and the Veteran affirmed that he was requesting a withdrawal as to these appeals. As the Veteran has withdrawn these appeals, there remain no allegations of errors of fact or law for appellate consideration of these issues. The Board does not have jurisdiction to review them, and they are dismissed. REASONS FOR REMAND Entitlement to a rating in excess of 30 percent for the service-connected IHD The Veteran seeks a rating greater than 30 percent for his service-connected IHD. At the August 2021 hearing, he testified that, a few weeks prior to the hearing, his cardiologist wanted him to undergo a stress test on a treadmill, but, because he had not been vaccinated against COVID, the technicians would not allow him to do a treadmill test. Rather, a chemical stress test was recommended. The Veteran and his representative argue that the chemical stress test does not allow for a true assessment of the Veteran's cardiac disability and that his disability has worsened in severity over the prior years. Notably, the Veteran's VA treatment records, which were last uploaded into the claims file later in July 2021, contain a July 13, 2021 note that he was to undergo a stress test on July 15, 2021. A July 16, 2021, test results/notice letter in the VA treatment records generally states that he recently underwent a stress test of the heart and that the results showed no significant abnormality. However, no details as to the test results are in the claims file and must be obtained before the Board can decide this issue. Further, given the issue the Veteran and his representative have raised with regard to the most recent stress test he underwent, the Veteran should be afforded a thorough VA examination with a treadmill stress test to determine the severity of his service-connected ischemic heart disease. If COVID restrictions prevent such a test from being performed, the examiner should address the Veteran's argument that other stress test methods are not as accurate as the treadmill stress test and explain the significance, if any, of the different methods of stress testing in arriving at accurate measurements of METs or ejection fraction. Entitlement to an initial compensable rating for service-connected dermatitis The Veteran also seeks a compensable rating for his service-connected skin disability. At the August 2021 hearing, he testified that, when he was last examined by VA for this disability in 2015, the examiner did not fully examine the affected areas of his body in determining that less than five percent of his body was affected by his skin condition. The Veteran asserts that this disorder affects 35 to 40 percent of his body, but the examiner did not look at all his affected areas to confirm this. As such, the Board finds that a new VA examination with a thorough skin examination is needed before it can decide this claim. Accordingly, these matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records related to the Veteran's IHD and dermatitis, to include specifically detailed results of his July 2021 cardiac stress test. 2. Then, schedule the Veteran for an appropriate examination to determine the current severity of his IHD. The examiner should review the claims file, to include the Veteran's August 2021 hearing transcript and a copy of this Remand, in conjunction with the examination. All necessary tests should be completed, including a treadmill stress test of the heart, and all pertinent pathology associated with this service-connected disability should be annotated in the examination report. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran's service-connected heart disability and discuss the effect of this disability on any occupational functioning and activities of daily living. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. If, due to COVID limitations, the Veteran is not able to undergo a treadmill stress test of his heart, the examiner should address the Veteran's assertions that other stress test methods do not provide as accurate depictions of the severity of a cardiac disability as the treadmill stress test, and explain the significance, if any, of the different methods of stress testing in arriving at accurate measurements of METs or ejection fraction. 3. Also after completion of the action requested in paragraph 1 of this Remand, schedule the Veteran for an appropriate VA examination to determine the current severity of his service-connected dermatitis. His claims file should be made available to the examiner in conjunction with this examination, and the examiner's review of the folder should be annotated in the examination report. The examiner should provide a full description of the Veteran's dermatitis and report all signs and symptoms associated with this disorder. The examiner should take care to ensure that a thorough examination of all affected areas of the Veteran's body is completed, to include areas which are under his clothing. To the extent possible, the examiner should identify any symptoms and functional impairments due to the Veteran's service-connected skin disability and discuss the effect of this disability on any occupational functioning and activities of daily living. A rationale for all requested opinions shall be provided. If the examiner cannot provide an opinion without resorting to mere speculation, he or she shall provide a complete explanation stating why this is so. In so doing, the examiner shall explain whether the inability to provide a more definitive opinion is the result of a need for additional information or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. No action is required of the Veteran until he is notified by VA. However, he is advised of his obligation to cooperate in ensuring the duty to assist is satisfied. Kowalski v. Nicholson, 19 Vet. App. 171 (2005). His failure to report for a VA medical examination may impact the determination made. 38 C.F.R. § 3.655. The Veteran also is advised that he has the right to submit additional evidence and argument with respect to this matter. Kutscherousky v. West, 12 Vet. App. 369 (1999). This appeal must be afforded prompt treatment. THERESA M. CATINO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Davidoski, 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.