Citation Nr: 21006945 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 12-20 858 DATE: February 8, 2021 REMANDED Entitlement to a rating greater than 30 percent for Parkinson’s disease from November 2, 2009 to August 28, 2015, is remanded. Entitlement to a rating greater than 20 percent for Parkinson’s disease with loss of automatic movements (Right) is remanded. Entitlement to a rating greater than 20 percent for Parkinson’s disease with loss of automatic movements (Left) is remanded. Entitlement to a rating greater than 20 percent for tremors with muscle rigidity of the right upper extremity is remanded. Entitlement to a rating greater than 20 percent for left upper extremity peripheral neuropathy is remanded. Entitlement to a rating greater than 10 percent for tremors and bradykinesia with muscle rigidity and balance impairment of the left lower extremity is remanded. Entitlement to a rating greater than 10 percent for tremors and bradykinesia with muscle rigidity and balance impairment of the right lower extremity is remanded. Entitlement to a compensable rating for urinary problems from August 28, 2015, and greater than 20 percent from October 23, 2015, and greater than 40 percent from September 13, 2017 is remanded. Entitlement to a rating greater than 10 percent for speech changes is remanded. Entitlement to a rating greater than 10 percent for dysphagia is remanded. Entitlement to a rating greater than 10 percent for anosmia is remanded. Entitlement to a rating greater than 20 percent for stooped posture is remanded. Entitlement to a rating greater than 10 percent for constipation is remanded. Entitlement to a compensable rating for sexual dysfunction is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1967 to January 1969, to include service in the Republic of Vietnam. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a November 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO), which inter alia, granted service-connection for Parkinson’s disease and assigned a 30 percent disability rating, effective November 2, 2009. The Veteran timely appealed that decision. This appeal has been advanced on the Board’s docket pursuant to 38 U.S.C. § 7107(a)(2) and 38 C.F.R. § 20.900(c). In December 2012, the Veteran testified via videoconference hearing before the undersigned. A copy of the transcript has been associated with the Veteran’s claim file. In May 2015, and most recently in August 2017, the Board remanded this case to the agency of original jurisdiction (AOJ), for additional development. In September 2020, the RO found that the manifestations of the Veteran’s Parkinson’s disease had increased in severity, and thus warranted separate disability ratings under the appropriate body systems. The RO documented the worsening to have occurred on August 28, 2015 and separate ratings were assigned from that date. See September 2020 rating decision and September 2020 supplemental statement of the case (SSOC). Ratings for Parkinson’s disease, also known as “paralysis agitans” are assigned under 38 C.F.R. § 4.124a, Diagnostic Code (DC) 8004. Under this DC, a minimum 30 percent rating is for application when there are “ascertainable residuals” of the disability. However, VA is required to also consider whether any of the residuals may be otherwise rated under a separate DC. Potential residuals include, but are not limited to, loss of smell or taste (38 C.F.R. § 4.87a, DCs 6275, 6276), bladder or bowel dysfunction (38 C.F.R. §§ 4.114, DC 7332 & 4.115 DC 7542), disorders to the cranial nerves or nerves in the extremities (38C.F.R. § 4.124a) or cognitive impairment (38 C.F.R. § 4.130, DC 9326). If there are identifiable residuals that can be rated under a separate DC, and the combined disability rating resulting from these residuals exceeds 30 percent, then these separate ratings will be assigned in place of the minimum rating assigned under DC 8004. As noted above, the RO determined that separate DC ratings should be assigned for the ascertainable residuals of the Veteran’s Parkinson’s disease. Pursuant to the August 2017 Board remand, the Veteran underwent a VA contract examination in September 2017. The examiner noted the Veteran’s Parkinson’s disease and indicated the Veteran’s motor manifestations, mental manifestations, sleep disturbances, chewing/swallowing difficulty, and constipation due to his disability were mild in nature; the Veteran was found to have complete loss of smell and severe sexual dysfunction. The Board notes that in its most recent remand, it directed the examiner “to opine as to whether the Veteran has any lingual and ocular residuals of his Parkinson’s disease, and if so, indicate the severity of all identified such disorders.” Upon examination, the examiner opined that the Veteran has lingual residual from his Parkinson’s disease, but he did not indicate the severity of the lingual residuals as directed. Notably, the Veteran indicated through his representative that his Parkinson’s disease had worsened in severity since his last VA examination over three years ago. See January 2021 Appellate Brief. VA Treatment records dated in August 2019 reflect that the Veteran had more frequent falls over the previous three weeks and stated “that he would like a visit with [his physician] to address his worsening Parkinson’s [disease] symptoms.” In light of the above, the medical evidence before the Board is inadequate to determine the functional effects and severity of the symptomatology due to the Veteran’s Parkinson’s disease. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Moreover, in light of the evidence of possible worsening since the Veteran’s last VA examination over three years ago, remand is warranted for additional examination. See Caluza v. Brown, 7 Vet. App. 498, 505-506 (1995) (“where the record does not adequately reveal the current state of the claimant’s disability and the claim is well grounded, the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination”). The matters are REMANDED for the following action: 1. Associate any outstanding records to include VA treatment records regarding treatment and evaluation for Parkinson’s disease. All reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records. 2. Schedule the Veteran for appropriate VA examination(s) to ascertain the current nature and severity of his service-connected Parkinson’s disease and associated symptomatology to include various motor manifestations, mental manifestations, cognitive impairment or dementia, sleep disturbance, difficulty chewing/swallowing, incontinence, constipation, and sexual dysfunction. The entire record must be reviewed in conjunction with the examination and all indicated tests and studies must be conducted. The examiner should opine as to whether the Veteran has any lingual and ocular residuals of his Parkinson’s disease, and if so, indicate the severity of all identified such disorders. All pertinent symptomatology and findings should be reported in detail. The examiner should indicate the appropriate severity (as delineated in the schedular criteria for each identified disability). All examination findings must be set forth in detail and a complete rationale should be provided for any opinions expressed. K. Parakkal Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Kovacs, 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.