Citation Nr: 21073325 Decision Date: 12/08/21 Archive Date: 12/08/21 DOCKET NO. 18-17 464 DATE: December 8, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for service-connected posttraumatic arthritis of the left wrist, radiocarpal and radioulnar joints, open comminuted fracture left distal radius, status post-surgery with skin graft proximal volar left forearm (hereinafter, "left wrist disability"), is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 1972 to October 1974, and from November 1974 to July 1981. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an August 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). This matter was previously remanded by the Board in October 2018 and September 2021 for further evidentiary development. Although the Board regrets the additional delay, for the reasons detailed below, further remand is required. Entitlement to an initial rating in excess of 10 percent for service-connected left wrist disability The September 2021 Board remand found that remand was necessary to afford the Veteran a new VA examination to evaluate the full disability picture of his service-connected left wrist disability, to include any involvement of supination and pronation of the left wrist and/or forearm. Additionally, the September 2021 Board remand found the July 2021 VA examiner did not address the Board's note that the Veteran's left forearm was noted to be ankylosed in a position of 20 degrees of supination with no active or passive pronation or supination. The September 2021 Board remand directed the RO to obtain a new VA examination. A new examination was obtained in October 2021. At that time, the examiner explained that during the examination the Veteran was found to have full left wrist/elbow pronation and about 45 degrees of supination (more than 50 percent of the normal range of motion for wrist/forearm supination). This impairment is part and parcel of his left wrist service-connected disability. He was also found with normal muscles (no muscle atrophy) and normal muscle strength on left forearm/elbow and wrist. His left forearm/elbow were not ankylosed on supination. He had a left forearm/elbow/wrist active range of motion on supination from zero degrees to 45 degrees (more than 50 percent) for a normal supinated range of motion. The Veteran still had a functional left forearm/elbow/wrist active range of motion. The Board finds that substantial compliance with the prior remand has been achieved. See Stegall v. West, 11 Vet. App. 268 (1998). However, an addendum opinion is warranted considering the VA examinations do not comply with the requirements in Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). The July 2015 VA examiner indicated that pain significantly limited functional ability with repeated use over a period of time. She indicated she could not describe this limited functional ability in terms of range of motion because it would be speculative considering the Veteran was not experiencing a flare up at the time of the examination. While the examiner stated that an opinion could not be provided without resort to speculation, the examiner did not indicate that the speculation was due to lack of knowledge within the medical community. In the July 2021 and October 2021 VA examination reports, it was noted the Veteran did not report flare ups of the wrist, elbow, or forearm. Additionally, it was noted procured evidence did not suggest pain, fatigability, weakness, lack of endurance, or incoordination significantly limited functional ability with repeated use over time. However, considering the discussion of pain with repeated use over a period of time in the July 2015 VA examination, the Board finds that an addendum opinion is warranted to obtain an estimate, if at all possible, of the additional impairment due to repeated use over a period of time. The matter is REMANDED for the following actions: 1. Obtain an addendum opinion from an appropriate clinician. The need to obtain a new examination and/or interview the Veteran is left to the discretion of the clinician. To the extent possible, based on information from the record and the Veteran regarding the degree of functional loss caused by repeated use over time, the clinician should provide an assessment of the left wrist functional loss with repeated use over time, expressed in an estimate of motion loss in terms of degrees. If it is not possible to provide a specific measurement without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Readjudicate the claim. L. CHU Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Vemulapalli, Associate 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.