Citation Nr: 21076298 Decision Date: 12/23/21 Archive Date: 12/23/21 DOCKET NO. 17-20 643 DATE: December 23, 2021 REMANDED Entitlement to an increased initial rating for antiphospholipid antibody syndrome, to include residuals thereof is remanded. Entitlement to a rating of total disability based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from June 1999 to May 2005. This case comes on appeal of a March 2012 rating decision. The Veteran testified before the Board at a virtual hearing in February 2021. This case was previously before the Board in May 2021, at which time the Board remanded the issues below for further development. Notably, in November 2021, the agency of original jurisdiction (AOJ) issued a rating decision in which it increased the initial rating of the Veteran's service-connected antiphospholipid antibody syndrome from 0 to 10 percent, effective the day after the Veteran's separation from service. However, the Veteran is presumed to seek the highest available rating. AB v. Brown, 6 Vet. App. 35, 38 (1993). As the November 2021 decision represented only a partial grant of benefits sought, the issue remains on appeal. 1. Entitlement to an increased initial rating for antiphospholipid antibody syndrome, to include residuals thereof is remanded. Throughout the period on appeal, the Veteran has contended that her service-connected antiphospholipid antibody syndrome has manifested in a variety of symptoms that are not encompassed by a single rating code. Indeed, antiphospholipid antibody syndrome is not specifically considered under VA's rating schedule. Accordingly, the AOJ has rated the disability analogously under 38 C.F.R. § 4.88b, Diagnostic Code 6350, which is the diagnostic code for systemic lupus erythematosus. The Note to Diagnostic Code 6350 instructs the rater to evaluate the condition either by combining the evaluations for residuals under the appropriate system, or by evaluating Diagnostic Code 6350, whichever method results in a higher evaluation. In turn, Diagnostic Code 6350 relies on the frequency and severity of exacerbations to determine the appropriate rating. In July 2021, the Veteran underwent an examination of autoimmune diseases. There, the examiner reported that, due to antiphospholipid antibody syndrome, the Veteran experienced joint pain in the hips, memory issues, fatigue, anemia, migraines, shortness of breath, speech changes, and nausea. From that examination, the Veteran was then afforded examinations of hip and thigh conditions, gynecological conditions, and hematologic and lymphatic conditions. The results of those examinations were considered in the evaluation of antiphospholipid antibody syndrome. However, the examiner reported that "memory issues, fatigue, migraines, and shortness of breath and speech changes are all symptoms subsumed under the antiphospholipid antibody syndrome, but are not separate conditions and do not require individual evaluations." Although the examiner's statement may be true from a medical perspective, the rating criteria do not necessarily preclude the award of separate ratings for various manifestations or residuals of a disability. Thus, on remand, the Veteran should be afforded examinations to evaluate the severity of her memory issues, fatigue, migraines, shortness of breath, speech changes, and nausea to determine whether the disability is appropriately rated. 2. Entitlement to a rating of total disability based on individual unemployability (TDIU) is remanded. As memory issues, fatigue, migraines, shortness of breath, speech changes, and nausea are all symptoms that may affect the Veteran's ability to secure or maintain gainful employment, the issue of entitlement to a TDIU is inextricably intertwined with the evaluation of antiphospholipid antibody syndrome. Therefore, entitlement to a TDIU must be remanded as well. The matters are REMANDED for the following action: 1. Schedule the Veteran for appropriate examinations of the current severity of the residuals of antiphospholipid syndrome identified in the July 2021 autoimmune diseases examination. This should specifically include examinations to evaluate: memory issues, fatigue, migraines, shortness of breath, speech changes, and nausea. The examiner or examiners should provide full descriptions of each listed disability and report all signs and symptoms necessary for evaluating the Veteran's disability under the rating criteria. All indicated tests should be performed and results should be documented in a printed report. 2. Once the above development has been achieved, as well as any other development deemed necessary thereafter, readjudicate the appeal with consideration as to whether separate compensable ratings may be warranted for manifestations or residuals of antiphospholipid antibody syndrome. If any benefits sought remain denied, issue a supplemental statement of the case. V. Chiappetta Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Giaquinto, 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.