Citation Nr: 21007590 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 16-35 611A DATE: February 10, 2021 REMANDED Entitlement to a rating higher than 20 percent as of May 1, 2014, for service-connected residuals, fracture of the left navicular/scaphoid bones, status post carpectomy with radial styloidectomy and traumatic arthritis (left wrist fracture) is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1975 to October 1979. In August 2020, the Department Veterans Affairs (VA) Board of Veterans’ Appeals (Board) denied entitlement to a rating higher than 10 percent from January 1, 2011, to January 23, 2014, for service-connected left wrist fracture, and denied entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities; the Board remanded the remaining issue of entitlement to a rating higher than 20 percent as of May 1, 2014, for service-connected left wrist fracture to the VA Regional Office (RO) for additional development. The claims file has been returned to the Board for adjudication. Entitlement to a rating higher than 20 percent as of May 1, 2014, for service-connected left wrist fracture is remanded. The Board discussed, in its August 2020 remand, that in the February 2020 Disability Benefits Questionnaire (DBQ), the VA examiner indicated that the Veteran had extremely unfavorable ankylosis of the left wrist. However, the October 2015 DBQ reflects a finding of favorable ankylosis in 20 degrees to 30 degrees dorsiflexion. The VA treatment records do not show findings of unfavorable ankylosis. Accordingly, the Board determined that the RO should request that the February 2020 VA examiner clarify and explain the finding of “extremely unfavorable” ankylosis, and that if the examiner confirmed that finding, that he or she should reconcile it with the October 2015 DBQ and the Veteran’s January 2014 private total fusion surgery. The Board directed the RO that if the February 2020 VA examiner was not available, the opinion could be provided by a different medical professional. In an August 2020 addendum opinion, a VA examiner different than the February 2020 VA examiner reported that the Veteran was not seen due to COVID. The examiner reported that without seeing the Veteran’s wrist it is uncertain what angle the wrist is fused in. She discussed that the January 2014 surgery had no known complications and these fusions are typically fused in a favorable position as it is not painful; she noted that this was not an ankylosis due to trauma, rather a well-planned surgery to undergo a fusion for pain relief purposes, and such would most often result in a favorable result of the fusion with range of motion to zero degrees in all directions from the fused wrist. Unfortunately, the Board may not adjudicate the Veteran’s claim without clarification as to the level of ankylosis in the Veteran’s left wrist. The examiner, in August 2020, specifically reported that she was uncertain what angle the Veteran’s wrist is fused in without being able to see it. On remand, the RO should afford the Veteran an adequate VA examination to resolve the issue of the severity of his service-connected left wrist fracture. The matter is REMANDED for the following action: 1. Obtain the Veteran’s updated VA treatment records. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected left wrist fracture. (a) The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria. (b) In so doing, the examiner must test the Veteran’s active motion, passive motion, and pain with weight-bearing and without weight-bearing. 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). (c) In so doing, the examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups. If it is not possible to provide a specific measurement based on direct observation, the examiner should provide an estimate, if at all possible, of the additional impairment due to flare-ups based on the other evidence of record and the Veteran’s statements. 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). (d) The examiner must specifically determine if the Veteran’s service-connected left wrist fracture is manifested by: (1) favorable ankylosis in 20 to 30 degrees dorsiflexion; (2) ankylosis in any other position, except favorable; (3) unfavorable ankylosis, in any degree of palmar flexion, or with ulnar or radial deviation; or (4) extremely unfavorable ankylosis; and discuss whether the level of ankylosis shown present has been in effect since his January 2014 private total wrist fusion surgery. (e) The examiner must specifically discuss and reconcile their findings as to the level of ankylosis found present with: (1) the October 2015 DBQ finding of favorable ankylosis in 20 degrees to 30 degrees dorsiflexion; (2) the February 2020 DBQ finding of extremely unfavorable ankylosis; (3) and the fact that the Veteran underwent total wrist fusion surgery in January 2014. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.