Citation Nr: 21007704 Decision Date: 02/10/21 Archive Date: 02/10/21 DOCKET NO. 14-21 148 DATE: February 10, 2021 REMANDED Entitlement to service connection for right upper extremity radiculopathy is remanded. Entitlement to an initial rating in excess of 10 percent for cervical strain with osteoarthritis is remanded. Entitlement to a total disability based on individual unemployability (TDIU) is remand. REASONS FOR REMAND The Veteran served on active duty from May 1979 to January 1981 and from January 2008 to January 2009. These matters come before the Board of Veterans’ Appeals (Board) on appeal from June 2016, February 2018, and March 2018 rating decisions from the Department of Veterans Affairs (VA) Regional Office (RO). In a November 2020 Board decision, these matters were remanded for the issuance of a Supplemental Statement of the Case (SSOC) from the Agency of Original Jurisdiction (AOJ) since pertinent records and examination reports were received after the issuance of the original SOC but before certification to the Board. See 38 C.F.R. §§ 19.37(b), 20.1304(c). Although, the SSOC was issued in November 2020, the Board regrets that another remand is necessary for the reasons detailed below. 1. Entitlement to service connection for right upper extremity radiculopathy is remanded. The Veteran contends that his right upper extremity radiculopathy was caused by his service-connected cervical strain with ostearthritis. See Form 9 received 12/26/2018 at page 2. In a January 2018 VA examination, the VA examiner found no objective evidence of radiculopathy on the examination for the Veteran’s cervical spine condition and opined that a nerve conduction study would need to be done to determine the nerves involved. See C&P Exam received 1/15/2018 at page 10. In a February 2018 addendum medical opinion, the February 2018 VA examiner opined that a diagnosis of cervical radiculopathy could not be made without resorting to mere speculation. See C&P Exam received 2/21/2018 at page 5. The February 2018 examiner opined that additional diagnostic testing is needed to confirm cervical radiculopathy and recommended that the Veteran receive an MRI and/or EMG study of his cervical spine. Id. In a March 2019, the Veteran was provided a VA examination for his peripheral nerve condition. The March 2019 examiner found mild symptoms of right upper radiculopathy. See C&P Exam received 5/14/2019 at pages 2-3. However, sensory examinations were normal, and his right upper radicular group was also determined to be normal. Id. at page 7. The March 2019 VA examiner did not provide the Veteran with an EMG study nor was a diagnostic examination other than x-rays found in the record. The Board finds that a new examination and medical opinion are warranted to reconcile the conflicting medical findings of mild symptoms of upper extremity radiculopathy but no indication of right upper radiculopathy on nerve testing. On remand, the Board will direct the RO to provide the Veteran with an MRI and/or EMG study to diagnosis any right upper radiculopathy per prior medical evidence.   2. Entitlement to an initial rating in excess of 10 percent for cervical strain with osteoarthritis is remanded. The Veteran argues that a new examination is warranted because the March 2019 VA examiner did not opine on the basis for concluding that there was no additional functional loss due to flare ups. See Third Party Correspondence received 12/17/2020 at page 2. A review of the March 2019 VA examination shows that the Veteran did perform repetitive-use testing, however there was no additional loss of function or range of motion after the repetitions. See C&P Exam received 5/14/2019 at page 4. That said, the Board agrees that clarification on the basis of concluding that there is no additional functional loss due to flare ups is needed in order to make an informed decision on this claim. Accordingly, the Board will remand for an addendum opinion from the examiner to opine on the basis of the finding of no additional ROM due to flare ups and to specifically apply the DeLuca factors. See DeLuca v. Brown, 8 Vet. App. 202 (1995). 3. Entitlement to a TDIU is remand. Since the Veteran’s the increased rating for cervical strain is being remanded, the Board finds that a remand for a TDIU is also warranted are inextricably intertwined because the increased rating issue may impact the Veteran’s combined evaluation for compensation. See Henderson v. West, 12 Vet. App. 11, 20 (1998) (holding that claims are inextricably intertwined when a decision on one issue would have a "significant impact" upon the other). These matters are REMANDED for the following actions: 1. Schedule the Veteran for a VA examination for his right upper extremity radiculopathy. The examiner must review the claims file. Provide the Veteran with an MRI and/or EMG study to diagnosis any right upper radiculopathy per prior medical evidence. See 2/21/2018 C&P Exam. If such diagnostic testing is not available or the examiner determines such is not necessary, please include a detailed explanation of why not. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. Please complete the functional impact section. The examiner is asked to provide a response to the following: (a) Is right upper extremity radiculopathy at least as likely as not related to service? (b) Is right upper extremity radiculopathy at least as likely as not (1) proximately due to OR (2) aggravated by his service-connected cervical strain? A comprehensive rationale for all opinions is to be provided. All pertinent evidence, including both lay and medical, should be considered. If an opinion cannot be given without resorting to speculation, the examiner should explain why and 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), the record (additional facts are required), or the examiner (does not have the knowledge or training). 2. Obtain an addendum opinion from an appropriate clinician regarding the Veteran’s claim for an increased rating for his service-connected cervical strain with osteoarthritis.   The examiner is asked to discuss, considering the Veteran’s lay statements: (1) Whether pain, weakness, fatigability or incoordination significantly limit functional ability with flare ups? If not, explain why not? (2) Whether there is additional loss due to flare ups? If no additional loss is found, explain why not? If the clinician determines an examination is necessary to answer the above questions, then schedule the Veteran for an appropriate examination. Paul Sorisio Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board S. Dixon, 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.