Citation Nr: 21077352 Decision Date: 12/29/21 Archive Date: 12/29/21 DOCKET NO. 07-30 365 DATE: December 29, 2021 ORDER Prior to August 21, 2012, entitlement to an initial 20 percent disability rating, but no higher, for neurogenic bladder is granted. From August 21, 2012 to October 17, 2019, entitlement to a 60 percent disability rating, but no higher, for neurogenic bladder is granted. From October 17, 2019, entitlement to a disability rating in excess of 60 percent for neurogenic bladder is denied. Entitlement to an initial rating, in excess of 40 percent, for sciatic nerve neuropathy, left lower extremity is denied. Entitlement to an initial rating, in excess of 40 percent, for sciatic nerve neuropathy, right lower extremity is denied. Entitlement to an initial 10 percent rating, but no higher, scar, right upper extremity, status post fasciotomy is granted. REMANDED Entitlement to an initial rating in excess of 10 percent for shell fragment wound to the right upper extremity, status post fasciotomy of the right brachial artery with saphenous vein graft prior to October 17, 2019; and in excess of 30 percent, thereafter, is remanded. Entitlement to an initial rating in excess of 10 percent for through and through shell fragment wound to the right shoulder is remanded. FINDINGS OF FACT 1. Prior to August 21, 2012, the Veteran's neurogenic bladder manifested with requiring the wearing absorbent materials that needed to be changed less than 2 times per day; it did not manifest with a need to wear absorbent materials that needed to be changed two or more times per day, daytime voiding interval of less than one hour or awakening to void 5 or more times per night. 2. From August 21, 2012 to October 17, 2019, the Veteran's neurogenic bladder required him to change his absorbent materials more than 4 times per day; the Veteran's neurogenic bladder did not cause renal dysfunction. 3. From October 17, 2019, the Veteran's neurogenic bladder does not cause renal dysfunction. 4. The Veteran's sciatic nerve neuropathy, left lower extremity approximates no more than moderately severe incomplete paralysis of the sciatic nerve; severe incomplete paralysis with marked muscular atrophy and complete paralysis of the sciatic nerve have not been approximated. 5. The Veteran's sciatic nerve neuropathy, right lower extremity approximates no more than moderately severe incomplete paralysis of the sciatic nerve; severe incomplete paralysis with marked muscular atrophy and complete paralysis of the sciatic nerve have not been approximated. 6. The Veteran's scar, right upper extremity, status post fasciotomy manifests with a painful scar that is not unstable or disfiguring. CONCLUSIONS OF LAW 1. Prior to August 21, 2012, the criteria for an initial disability rating of 20 percent, but no higher, for neurogenic bladder have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7517. 2. From August 21, 2012 to October 17, 2019, entitlement to a 60 percent disability rating, but no higher, for neurogenic bladder have been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7517. 3. From October 17, 2019, entitlement to a disability rating in excess of 60 percent for neurogenic bladder have not been met. 38 U.S.C. §§ 1155, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 4.1, 4.2, 4.3, 4.6, 4.7, 4.10, 4.115a, 4.115b, Diagnostic Code 7517. 4. The criteria for a disability rating in excess of 40 percent for sciatic nerve neuropathy, left lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.124a, Diagnostic Code 8520. 5. The criteria for a disability rating in excess of 40 percent for sciatic nerve neuropathy, right lower extremity have not been met. 38 U.S.C. §§ 1155, 5107; 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.124a, Diagnostic Code 8520. 6. The criteria for an initial disability rating of 10 percent, but no higher, for scar, right upper extremity, status post fasciotomy have been met. 38 U.S.C. §§ 1155, 5103(a), 5103A, 5107(b); 38 C.F.R. §§ 3.102, 3.321, 4.1-4.7, 4.118, DC 7804. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from September 2003 to July 2006. In August 2012, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at the local VA Regional Office (RO). The Veteran's case was by the Board for additional development in December 2014 and July 2019. Review of the completed development reveals that, at the very least, substantial compliance with the remand directives was obtained. See Stegall v. West, 11 Vet. App. 268 (1998); see also Dyment v. West, 13 Vet. App. 141, 146-47 (1999). Subsequent to the July 2019 Board remand, in a September 2020 rating decision, the Veteran's claim for service connection for erectile dysfunction was granted with a noncompensable rating, effective July 14, 2006 and entitlement to Special Monthly Compensation for loss of use of a creative organ was granted, effective July 14, 2006; as such, these issues are no longer on appeal before the Board, as the awards represent a full grant of the benefits sought. The September 2020 rating decision also granted a 60 percent disability rating for the Veteran's neurogenic bladder, effective October 17, 2019, and a 30 percent rating for shell fragment wound to the right upper extremity, status post fasciotomy of the right brachial artery with saphenous vein graft, effective October 17, 2019. As these grants, however, did not represent a total grant of benefits sought for the entire period on appeal, the Veteran's claims for a higher initial rating remain pending before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Increased Ratings, Generally Disability evaluations (ratings) are determined by evaluating the extent to which a veteran's service-connected disability adversely affects his ability to function under the ordinary conditions of daily life, including employment, by comparing the symptomatology with the criteria set forth in the Schedule for Rating Disabilities (Rating Schedule). 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.2, 4.10. In evaluating a disability, the Board considers the current examination reports in light of the entire record to ensure that the current rating accurately reflects the severity of the condition. The Board has a duty to acknowledge and consider all regulations that are potentially applicable. Schafrath v. Derwinski, 1 Vet. App. 589 (1991). 38 C.F.R. §§ 4.1, 4.2, 4.10. Where there is a question as to which of two evaluations shall be applied, the higher evaluation will be assigned if the disability picture more nearly approximates the criteria required for that rating. Otherwise, the lower rating will be assigned. See 38 C.F.R. § 4.7. Reasonable doubt regarding the degree of disability will be resolved in the veteran's favor. 38 C.F.R. § 4.3. Staged ratings are appropriate when the factual findings show distinct time periods during the appeal period where the service-connected disability exhibits symptoms that would warrant different ratings. See Fenderson v. West, 12 Vet. App. 119, 126 (1999). 1. Prior to August 21, 2012, entitlement to an initial 20 percent disability rating, but no higher, for neurogenic bladder The Veteran's service-connected neurogenic bladder is rated under 38 C.F.R. § 4.115b, Diagnostic Code 7517, which instructs to rate injury of the bladder as voiding dysfunction. The Veteran has been assigned an initial rating of 10 percent, effective July 14, 2006, and a rating of 60 percent effective, October 17, 2019. Diseases of the genitourinary system generally result in disabilities related to renal or voiding dysfunctions, infections, or a combination of these. The following section provides descriptions of various levels of disability in each of these symptom areas. Where diagnostic codes refer the decisionmaker to these specific areas of dysfunction, only the predominant area of dysfunction shall be considered for rating purposes. Because the areas of dysfunction described below do not cover all symptoms resulting from genitourinary diseases, specific diagnoses may include a description of symptoms assigned to that diagnosis. 38 C.F.R. § 4.115a. Voiding dysfunction: The particular voiding condition is to be rated as urine leakage, urinary frequency, or obstructed voiding. Urine leakage (continual urine leakage, post-surgical urinary diversion, urinary incontinence, or stress incontinence): Requiring the wearing of absorbent materials which must be changed less than 2 times per day, 20 percent rating. Requiring the wearing of absorbent materials which must be changed 2 to 4 times per day, 40 percent rating. Requiring the use of an appliance or the wearing of absorbent materials which must be changed more than 4 times per day, 60 percent rating. 38 C.F.R. § 4.115a. Urinary frequency: Daytime voiding interval between two and three hours, or; awakening to void two times per night, 10 percent rating. Daytime voiding interval between one and two hours, or; awakening to void three to four times per night, 20 percent rating. Daytime voiding interval less than one hour, or; awakening to void five or more times per night, 40 percent rating. Id. In October 2006, the Veteran was afforded a general VA medical examination. The Veteran reported that he had been hospitalized for four months after suffering multiple injuries as a result of an explosion while serving in Iraq. He suffered injuries to his spine, including bladder problems. The Veteran reported symptoms of incontinence and needing to force himself to urinate at times. In November 2006, a genitourinary examination was provided related to his bladder condition. The Veteran reported daytime urination frequency as approximately three times per day with nocturia one per night. He reported significant hesitancy and must sit down and push to urinate. The Veteran stated that he occasionally has some stress incontinence with laughing or coughing but reported that he was not currently wearing any pads or absorbent material. In July 2008, the Veteran was afforded another VA examination regarding his bladder condition. The Veteran reported that during the day was urinating 6 time per day at intervals of every 3 hours and that he had no urination problem during the night. He reported problems starting urination and that his urine flow was hesitant and with decreased force. He did not report any urinary incontinence. He did not report symptoms of weakness, fatigue, loss of appetite, weight loss, limitation of exertion, or recurrent urinary tract infections. The examiner indicated that he did not report any functional impairment from this condition. In an October 2008 psychological evaluation, however, the Veteran reported problems with bladder incontinence that prevents him from going outside of his home for long periods of time. In August 2012, the Veteran provided testimony regarding his neurogenic bladder. The Veteran reported having to constantly have to like wash clothes because of problems with incontinence on a daily basis. The Veteran reported that this had been an ongoing problem and had to resort to wearing pads in his underwear on a regular basis. He stated that he had informed his physician about this problem but was trying to handle the problem on his own. Prior to August 21, 2012, the Board finds that the Veteran's neurogenic bladder has been manifested by voiding dysfunction. Based upon the forgoing, the Board finds that the Veteran is entitled to a 20 percent evaluation prior to August 21, 2012, due to voiding dysfunction that required the use of absorbent materials that needed to be changed less than 2 times per day. The Board finds the Veteran's statements during his 2012 Board hearing that he has needed to wear absorbent materials on a regular basis due to incontinence to be competent and credible. This is supported by the Veteran's reports of incontinence during his October 2006 VA examination and in October 2008. As such, the Board finds that a 20 percent rating based for a voiding dysfunction is warranted for the period on appeal prior to August 21, 2012. 38 C.F.R. § 4.115a, Diagnostic Code 7517; see Swain v. McDonald, 27 Vet. App. 219, 224 (2015). The Board, however, finds that a rating in excess of 20 percent is not warranted for the Veteran's bladder condition the period prior to August 21, 2012. The Board notes that the evidence does not demonstrate that the Veteran was required to wear absorbent materials that needed to be changed two or more times per day. The Veteran denied the use of absorbent materials for his incontinence during his VA examinations in October 2006 and July 2008. Further, the Veteran indicated that he was only concerned with his incontinence when outside of his home for long periods of time in October 2008. Further, the evidence does not establish that the Veteran's condition was causing daytime voiding more than once per hour or awakening to void 5 or more times per night. The Board finds the Veteran's reports to the October 2006 and July 2008 examiner probative regarding his urinary frequency. As such, the Board finds that the preponderance of the evidence weighs against a rating in excess of 20 percent for the Veteran's neurogenic bladder prior to August 21, 2012. 38 C.F.R. §§ 4.3, 4.7, 4.115a, Diagnostic Code 7517. 2. From August 21, 2012 to October 17, 2019, entitlement to a 60 percent disability rating, but no higher, for neurogenic bladder As noted above, during the Veteran's August 2012 Board hearing, the Veteran reported the recurrent use of absorbent materials for his incontinence. The Veteran was not specific as to how often he was replacing the absorbent materials at that time but stated that he was constantly doing laundry due to the problem. In October 2019, the Veteran reported the use of diapers all day due to his incontinence. The Board will resolve the benefit of the doubt in favor of the Veteran and finds that a rating of 60 percent, but no higher, is warranted for the Veteran's neurogenic bladder from August 21, 2012 to October 17, 2019. 38 C.F.R. §§ 4.3, 4.7, 4.115a, Diagnostic Code 7517. The Board, however, finds that a rating in excess of 60 percent is not warranted for the Veteran's neurogenic bladder from August 21, 2012 to October 17, 2019. The Board notes that a 60 percent rating is the highest schedular rating available for voiding dysfunction under 38 C.F.R. § 4.115a. The Veteran has not alleged, and the evidence does not show that he has had renal dysfunction during the appeal period. The Board finds probative the report of the October 2019 examiner that the Veteran's bladder condition has not caused renal dysfunction. Therefore, an evaluation in excess of 60 percent is not warranted from August 21, 2012 to October 17, 2019. 38 C.F.R. §§ 4.3, 4.7, 4.115a, Diagnostic Code 7517. 3. From October 17, 2019, entitlement to a disability rating in excess of 60 percent for neurogenic bladder The Board also finds that a rating in excess of 60 percent is not warranted for the Veteran's neurogenic bladder from October 17, 2019. The Board notes that a 60 percent rating is the highest schedular rating available for voiding dysfunction under 38 C.F.R. § 4.115a. The Veteran has not alleged, and the evidence does not show that he has had renal dysfunction during the appeal period. The Board finds probative the report of the October 2019 examiner that the Veteran's bladder condition has not caused renal dysfunction. Therefore, an evaluation in excess of 60 percent is not warranted from October 17, 2019. 38 C.F.R. §§ 4.3, 4.7, 4.115a, Diagnostic Code 7517. 4. Entitlement to an initial rating, in excess of 40 percent, for sciatic nerve neuropathy, left lower extremity 5. Entitlement to an initial rating, in excess of 40 percent, for sciatic nerve neuropathy, right lower extremity The Veteran's sciatic nerve neuropathy of both lower extremities has been rated under 38 C.F.R. § 4.124a, Diagnostic Code 8520 for paralysis of the sciatic nerve. Under this code, a 20 percent evaluation is warranted for incomplete paralysis of the sciatic nerve that is moderate. A 40 percent evaluation is warranted for incomplete paralysis of the sciatic nerve that is moderately severe. A 60 percent evaluation is warranted for incomplete paralysis of the sciatic nerve that is severe, with marked muscular atrophy. An 80 percent evaluation is warranted for complete paralysis; the foot dangles and drops, no active movement possible of muscles below the knee, flexion of knee weakened or (very rarely) lost. The words "mild," "moderate," and "severe" as used in the various Diagnostic Codes are not defined in the Rating Schedule. Regulations provide that ratings for peripheral neurological disorders are to be assigned based the relative impairment of motor function, trophic changes, or sensory disturbance. 38 C.F.R. § 4.120. Consideration is also given for loss of reflexes, pain, and muscle atrophy. See 38 C.F.R. §§ 4.123, 4.124. The term "incomplete paralysis" indicates a degree of lost or impaired function substantially less than the type picture for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. When the involvement is wholly sensory, the rating is for the mild, or at most, the moderate degree. The disability ratings for the peripheral nerves are for unilateral involvement; when bilateral, the ratings combine with application of the bilateral factor. 38 C.F.R. § 4.124a, Note at "Diseases of the Peripheral Nerves." The Veteran was initially granted entitlement to service connection for paresthesias, left lower extremity at 20 percent and paresthesias, right lower extremity at 10 percent in a December 2006 rating decision, effective July 14, 2006. After the Veteran appealed this determination, the conditions were recharacterized as sciatic nerve neuropathy of the left and right lower extremities and 40 percent ratings were assigned effective July 14, 2006. Turning to the evidence of record, the Veteran underwent a general VA medical examination in October 2006. The Veteran reported that he had been hospitalized for four months after suffering multiple injuries as a result of an explosion while serving in Iraq. He suffered injuries to his spine, and the Veteran reported muscle atrophy to the left lower extremity. He also reported weakness and numbness of the bilateral lower extremities. Examination of the spine indicated intermittent areas of decreased pinprick sensation in the medial aspect of bilateral feet. In July 2008, the Veteran was afforded another VA examination regarding his radiculopathy. The Veteran reported tingling, numbness, and abnormal sensation of the bilateral lower extremities. Upon examination, it was stated that there was no weakness or paralysis of the affected parts. The symptoms were reported to be constant. The examiner stated that the Veteran did not report any functional impairment from this condition. In October 2019, the Veteran was given a peripheral nerve examination. He was diagnosed with bilateral sciatic neuropathy. The examiner found that the Veteran has moderate constant pain in the right and left lower extremities and severe intermittent pain (usually dull) in the right and left lower extremities. The examiner also reported moderate paresthesias and/or dysesthesias and severe numbness in both lower extremities. The examiner opined that the Veteran was suffering from moderate incomplete paralysis of the sciatic nerve, bilaterally. The Veteran was noted to have normal muscle strength regarding bilateral ankle dorsiflexion and left knee extension, but right knee extension and bilateral ankle plantar flexion was reported to be 4/5. The examiner, however, denied evidence of muscle atrophy. Trophic changes of loss of hair and smooth shiny skin were reported. The Veteran reported that due to his sciatica he was barely walking and that he is unable to stand for long periods. Occasional use of a cane and a wheelchair was reported. After thorough consideration of the evidence of record, the Board finds that the preponderance of the evidence is against assignment of ratings in excess of 40 percent for the left and right lower extremity radiculopathy. The Veteran's radiculopathy of the bilateral lower extremities is best characterized as moderately severe incomplete paralysis of the sciatic nerve, which warrants the current 40 percent disability ratings during this period. 38 C.F.R. § 4.124a, Diagnostic Code 8520. In this regard, the most recent VA examiner characterized the Veteran's radiculopathy as moderate. While the Veteran's intermittent pain and numbness was reported to be severe, the Board notes that his constant pain and paresthesias were reported to be moderate. Moreover, the examiner expressly found that the Veteran did not have muscle atrophy, which is the criteria for a higher rating. The Board acknowledges that the Veteran, in advancing this appeal, believes that the disabilities on appeal have been more severe than the assigned disability ratings reflect. In this regard, he is competent to report observable symptoms. Layno v. Brown, 6 Vet. App. 465 (1994). While the Veteran is competent to report such symptoms, he is not competent, as a lay person to evaluate whether his incomplete paralysis of the sciatic nerve is considered severe or has resulted in marked muscle atrophy. Specifically, such a finding requires medical expertise as it involves a medical subject concerning an internal physical process extending beyond an immediately observable cause-and-effect relationship, i.e., knowledge of the nervous system and the impact that a damaged nerve has on muscle strength. Here, the VA examiner clearly had knowledge of the Veteran's symptoms, but still only characterized his radiculopathy as moderate. In this case, the competent medical evidence offering detailed specific specialized determinations pertinent to the rating criteria are the most probative evidence with regard to evaluating the pertinent symptoms for the disabilities on appeal; the medical evidence also largely contemplates the Veteran's descriptions of symptoms. Moreover, while the Veteran has previously reported muscle atrophy due to his condition, the Board finds the reports of the October 2019 examiner to be of greater probative value regarding whether muscle atrophy of the bilateral lower extremities is present. In sum, the lay evidence has been considered together with the probative medical evidence clinically evaluating the severity of the pertinent disability symptoms. In conclusion, the Board finds that the preponderance of the evidence is against ratings in excess of 40 percent for sciatic nerve neuropathy of the left and right lower extremities; thus, the benefit of the doubt doctrine is not applicable and the claims for increased ratings must be denied. 38 U.S.C. § 5107; 38 C.F.R. §§ 4.3, 4.7, 4.124a, Diagnostic Code 8520. The Board has considered whether further staged ratings are appropriate for the Veteran's service-connected radiculopathy of both lower extremities; however, the Board finds that, the Veteran's symptomatology had been stable. Therefore, assigning further staged ratings for such disability is not warranted. See Fenderson. 6. Entitlement to an initial 10 percent rating, but no higher, scar, right upper extremity, status post fasciotomy The Board finds that a 10 percent rating, but no higher, is warranted throughout the appeal period for the Veteran's scar, right upper extremity, status post fasciotomy. During the pendency of this appeal, VA amended the rating criteria for evaluating disabilities of the skin. See 73 Fed. Reg. 54,708 (Sept. 23, 2008). The Veteran's claim was received in August 2006; accordingly, the Board will review the Veteran's claim under the criteria in effect prior to October 23, 2008 and after the October 23, 2008 amendments. Under the rating criteria in effect prior to October 2008, Diagnostic Code 7802, a maximum 10 percent rating is warranted if a scar, other than the head face or neck, is superficial (not associated with soft tissue damage) and does not cause limited motion, affecting an area or areas of 144 square inches (929 sq. cm.) or greater. See 38 C.F.R. § 4.118 (2008). Under Diagnostic Code 7803, a superficial and unstable (involving frequent loss of covering of skin over the scar) scar may be assigned a maximum 10 percent rating. See 38 C.F.R. § 4.118 (2008). Under Diagnostic Code 7804, a scar that is superficial and painful on examination may be assigned a maximum 10 percent rating. See 38 C.F.R. § 4.118 (2008). Finally, under Diagnostic Code 7805, scars are rated according to limitation of function of the affected part. See 38 C.F.R. § 4.118 (2008). Under the post-October 2008 version of Diagnostic Code 7801, a 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are deep and nonlinear, at least 39 sq. cm. in area but less than 77 sq. cm. (or between 6 sq. inches and 12 sq. inches). Under the post-October 2008 version of Diagnostic Code 7802, a maximum 10 percent rating is warranted for burn scars or scars due to other causes, not of the head, face, or neck, that are superficial (not associated with soft tissue damage) and nonlinear, affecting an area or areas of 144 square inches (929 sq. cm.) or greater. Id. Under the post-October 2008 criteria, Diagnostic Code 7803 no longer exists, as it was incorporated into Diagnostic Code 7804. Under the post-October 2008 version of Diagnostic Code 7804, a 10 percent rating is warranted for one or two scars that are unstable (frequent loss of covering of the skin over the scar) or painful. A 20 percent rating is warranted for three or four scars that are unstable or painful, with a maximum 30 percent rating warranted for five or more scars that are unstable or painful. An unstable scar is one where, for any reason, there is frequent loss of covering of skin over the scar. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (1) (2019). If one or more scars are both unstable and painful, 10 percent is to be added to the evaluation based on the total number of unstable or painful scars. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (2). Scars can receive separate evaluations under Diagnostic Codes 7800, 7801, 7802, and 7805, despite also be rated under Diagnostic Code 7804. See 38 C.F.R. § 4.118, Diagnostic Code 7804, Note (3). Finally, under the post-October 2008 version of Diagnostic Code 7805, or other scars, a separate rating can also be warranted for any disabling effects not considered under Diagnostic Codes 7800-7804. Here, the Veteran's scar, right upper extremity, status post fasciotomy was assigned a noncompensable rating effective July 14, 2006 in a December 2006 rating decision under Diagnostic Code 7805. Here, the most probative evidence, indicates that the Veteran has had a painful, not unstable scar throughout the period on appeal. The Board notes that in the Veteran's October 2007 VA Form 9, the Veteran reported a scar on his upper arm that is painful to the touch. The Veteran is competent to report symptoms of pain upon touch. As such, the Board finds that throughout the period on appeal the Veteran has had a painful scar of the right upper extremity, status post fasciotomy and a rating of 10 percent is warranted for a single painful scar. 38 C.F.R. § 4.118, Diagnostic Code 7804. Under the pre-2008 version, a 10 percent rating is the maximum rating available. As such, a higher rating is not warranted. Under the post 2008 version of DC 7804, a rating in excess of 10 percent is not warranted without three or more painful or unstable scars or at least one scar that is both painful and unstable. None of the evidence demonstrates that the Veteran has multiple painful scars or any scars that are unstable. Rather, an examination in November 2019 reports that the Veteran's scars are not unstable. As such, the Board finds that a rating of 10 percent, but no higher, is warranted for the Veteran's scar, right upper extremity, status post fasciotomy throughout the appeal period. 38 C.F.R. §§ 4.3, 4.7, 4.118, Diagnostic Code 7804. REASONS FOR REMAND 1. Entitlement to an initial rating in excess of 10 percent for shell fragment wound to the right upper extremity, status post fasciotomy of the right brachial artery with saphenous vein graft prior to October 17, 2019; and in excess of 30 percent, thereafter, is remanded. 2. Entitlement to an initial rating in excess of 10 percent for through and through shell fragment wound to the right shoulder, is remanded. The issues of entitlement to a higher initial rating for shell fragment wound to the right upper extremity and entitlement to a higher initial rating for through and through shell fragment wound to the right shoulder were remanded for a contemporaneous evaluation in July 2019; however, with regard to these issues, the Board finds the November 2019 examinations to be inadequate. The 2019 examiner reported that the Veteran did not have or ever have injury to the muscle group of the forearm or hand and did not indicate impairment of Muscle Group VIII. Instead, the examiner indicated that all of the Veteran's symptoms of the right upper extremity were related to his Group I muscle injury. The examiner, however, did not discuss the reports of October 2006 examination of wasting of the thenar muscle of the right hand or the Veteran's reports of reduced grip strength during his August 2012 hearing. The Board notes that the 2019 peripheral nerves exam indicated muscle strength for grip of the right hand as 4/5. The Board finds that a new VA examination should be afforded to determine the current severity and impairment of the Veteran's right upper extremity due to his service-connected injuries to the right shoulder and right upper extremity to include any current impairment of the Group VIII muscle group. The matters are REMANDED for the following action: 1. Undertake appropriate efforts to schedule the Veteran for a VA examination(s) with an appropriate clinician(s) to determine the current degree of severity of his service-connected shell fragment wound to the right upper extremity and through and through shell fragment wound to the right shoulder. Any attempts to schedule such an examination should documented in the claims file. The claims file must be made available to the examiner for review. Any indicated diagnostic tests and studies must be accomplished. All pertinent symptomatology and findings should be reported in detail. The examiner should specifically discuss whether the Veteran has impairment of the Group VIII muscle group. If not, the examiner is asked to discuss the reports of the October 2006 examiner of wasting of the thenar muscle of the right hand and the Veteran's reports of reduced grip strength during his August 2012 hearing. K. Parakkal Veterans Law Judge Board of Veterans' Appeals Attorney for the Board P.M. Johnson, 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.