Citation Nr: 21008459 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 10-20 106 DATE: February 17, 2021 REMANDED Entitlement to an initial rating in excess of 10 percent for posttraumatic laceration of the flexor of the right thumb with cystic changes and degenerative joint disease of the first metacarpal and interphalangeal joint (right thumb disability) is remanded. Entitlement to a total disability rating due to individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1966 to August 1968. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an August 2009 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to a TDIU has been raised by the record and is part and parcel of the Veteran’s increased rating claim currently before the Board. Rice v. Shinseki, 22 Vet. App. 447 (2009). Unfortunately, the Board finds that further AOJ action on the claims on appeal is warranted, even though such will, regrettably, further delay an appellate decision on the matters on appeal. The Court of Appeals for Veterans Claims (Court) has held "that a remand by this Court or the Board confers on the veteran or other claimant, as a matter of law, a right to compliance with the remand orders." Stegall v. West, 11 Vet. App. 268, 271 (1998). As such, compliance with the terms of the remand is necessary prior to further appellate review, and if not, "the Board itself errs in failing to ensure compliance." Id. In the Board’s November 2018 remand, the Board instructed that the Veteran be afforded a VA examination to determine the current nature, extent and severity of the Veteran’s service-connected right thumb disability. The examiner was requested to describe all impairment attributable to the Veteran’s service-connected right thumb disability picture, including any neurological impairment, and consider September 2013 EMG studies. For any impairment identified, the examiner was to complete a corresponding Disability Benefits Questionnaire. On the November 2019 examination, the examiner discussed prior EMG and nerve conduction studies, which revealed mild carpal tunnel syndrome. The examiner noted that carpal tunnel syndrome is typically due to compression of the median as it passed through the carpal tunnel at the wrist. He indicated that, since the service-connected injury of the hand involved laceration and tendon damage to the base of the right thumb, the service-connected condition would be a factor in the development of carpal tunnel disease, which is an injury to the median nerve at the wrist. However, despite finding related neurological impairment of the right hand/wrist, the examiner did not complete a corresponding Disability Benefits Questionnaire of provide any findings sufficient to rate any neurological impairment related to the right thumb disability. The Board must accordingly remand the matter again for examination sufficient to evaluate all manifestations and impairment of the Veteran’s service-connected right thumb disability. See Stegall, 11 Vet. App. at 271. In regard to the claim for a TDIU, any findings related to the Veteran’s right thumb disability might be relevant to the determination of the impact of the disability on his employability. Further, any decision with respect to the claims for increased rating may affect the Veteran's claim for a TDIU. Hence, a remand of this matter is warranted, as well. The matters are REMANDED for the following action: 1. Assist the Veteran in associating with the claims folder outstanding treatment records, to specifically include updated VA treatment records. 2. Schedule the Veteran for a VA neurologic/peripheral nerves examination to ascertain the current severity and manifestations of any neurologic impairment stemming from the Veteran's service-connected right thumb disability. The claims file should be made available to the examiner for review in connection with the examination. The examiner should review and address the conclusions of the November 2019 examiner that the Veteran’s service-connected right thumb disability would be a factor in the development of carpal tunnel disease. All necessary tests should be conducted. The examiner should identify all nerves involved and indicated whether there is complete or incomplete paralysis of the nerve, and if incomplete, whether it is severe, moderately severe, moderate, or mild. The examiner should also comment on the impact of the Veteran's right thumb disability on his ability to work. The examiner must provide a complete rationale for all the findings and opinions. 3. The AOJ should undertake any additional development deemed warranted, including whether, if any separate/increased rating is assigned for the Veteran’s right thumb disability, additional referral to the Director of Compensation Service pursuant to 38 C.F.R. § 4.16(b) is warranted. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board G. E. Wilkerson, 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.