Citation Nr: 21074576 Decision Date: 12/15/21 Archive Date: 12/15/21 DOCKET NO. 07-37 351 DATE: December 15, 2021 REMANDED Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty September 1990 to February 1991, January 1992 to January 1993 and from May 2002 to April 2005. This case is on appeal before the Board of Veterans' Appeals (Board) from an April 2005 rating decision. The Veteran testified before the undersigned Veterans Law Judge at a November 2010 Board hearing. The Board remanded this claim in March 2011, June 2015, June 2017 and February 2021. Entitlement to a TDIU. The Veteran is service-connected for multiple disabilities. In June 2015, the Board remanded this claim, with the relevant remand directives stating "[s]chedule the Veteran for a VA examination as to the functional limitations caused by the combined impact of her service connected disabilities" and "[t]he examiner should indicate the degree of impairment caused by the combined effect of the Veteran's service connected disabilities...as it relates to h[er] ability to obtain and maintain substantially gainful employment" (emphasis added). In June 2017, the Board remanded this claim, with substantively the same the remand directives as quoted from the June 2015 remand. In February 2021, the Board remanded this claim, stating that "[t]he Board finds that there was not substantial compliance with the Board's June 2017 remand directives, wherein it was directed to obtain a 'combined effects' VA medical opinion." The Board included different remand directives than the June 2015 and June 2017 remands and stated, as relevant, "[f]ollowing review of the claims file and examination of the Veteran, if necessary, and after considering the Veteran's reported work history, the examiner should offer an opinion discussing the impact of the Veteran's service-connected disabilities...collectively on h[er] ability to secure or follow a substantially gainful occupation" (emphasis added). In review, the Board has remanded this claim three times to obtain a "combined impact," "combined effect" or "collective[]" TDIU opinion. Following the most recent February 2021 VA opinion, various VA opinions and examinations were conducted. The examinations and opinions obtained, essentially, addressed the Veteran's service-connected disabilities individually and not combined or collectively, as was requested by the Board in the previous remands. As such, the Board finds that remand is again warranted to attempt to obtain an opinion that substantially complies with the prior Board remand directives that requested a "combined impact," "combined effect" or "collective[]" TDIU opinion. See Stegall v. West, 11 Vet. App. 268 (1998). The Board additionally notes that, subsequent to the February 2021 Board remand, the Veteran was service-connected for additional disabilities: hypothyroidism, benign skin lesions and chronic urticaria, and Sjogren's syndrome. See August 2021 and November 2021 Rating Decisions. The requested opinion will have the opportunity to address these newly service-connected disabilities. The matters are REMANDED for the following action: Obtain an opinion from a medical professional that addresses the Veteran's TDIU claim. If the medical professional determines that additional examination of the Veteran is necessary to provide an adequate opinion, such examination must be scheduled. The medical professional must provide an opinion: Discussing the impact of the Veteran's service-connected disabilities collectively on her ability to secure or follow a substantially gainful occupation. The clinician's opinion should include an evaluation of the limitations and restrictions imposed by his service-connected impairments on such routine work activities as interacting with coworkers, sitting, standing, walking, lifting, carrying, pushing, and pulling. All findings and conclusions should be supported with a complete rationale that considers the relevant medical and lay evidence of record. If unable to opine without speculation, the reason that is so should be explained, indicating whether there is additional evidence that could enable an opinion to be provided or whether the inability to provide an opinion is based on the limits of medical knowledge or the medical professional themselves. K.A. KENNERLY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Hoopengardner, 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.