Citation Nr: 21009521 Decision Date: 02/22/21 Archive Date: 02/22/21 DOCKET NO. 15-06 644A DATE: February 22, 2021 REMANDED Entitlement to a rating in excess of 40 percent for service-connected post-operative residuals of right wrist fracture (right wrist condition) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from June 1980 to July 1984 and from November 1990 to May 1991. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2014 rating decision issued by a Department of Veterans Affairs (VA) regional office. This matter was previously remanded by the Board in October 2018 and August 2019. In March 2018, the Veteran testified before the undersigned Veterans law Judge (VLJ). A transcript of the hearing has been associated with the claims file. See March 2018 Board Hearing Transcript. Entitlement to a rating in excess of 40 percent for service-connected right wrist condition is remanded. The Board regrets the delay associated with this remand, particularly as this matter has been the subject of two prior remands. However, based on a review of the evidence of record, the Board finds that another remand is necessary as the Agency of Original Jurisdiction (AOJ) has not substantially complied with the August 2019 remand directives. See Stegall v. West, 1 Vet. App. 368 (1998). Specifically, in August 2019, the Board instructed the AOJ to provide the Veteran with a VA examination to determine the current severity of his right wrist condition. As part of this examination, the examiner was instructed obtain an x-ray of the Veteran’s wrist. Additionally, the examiner was instructed to review and comment on the December 1999 four-point fusion surgery. Further, the examiner was instructed to determine whether ankylosis was present, and if not, discuss whether fusion was no longer present. The Veteran was afforded VA examinations in December 2019 and September 2020. However, neither examiner obtained an x-ray of the Veteran’s wrists prior to conducting the examination, nor did either examiner discuss the December 1999 four-point fusion surgery. Additionally, while both examiners determined that right wrist ankylosis was not present, neither discussed whether fusion was no longer present. See December 2019 VA Wrist Conditions Disability Benefits Questionnaire (DBQ); September 2020 Wrist Conditions DBQ. As the Board cannot find substantial compliance with the August 2019 remand directives, a remand is necessary to allow the AOJ to provide the Veteran with a new VA examination to determine the current nature and severity of his service-connected right wrist condition. Even if the Board could find substantial compliance with the August 2019 remand directives, a remand would nonetheless be necessary to allow the AOJ to afford the Veteran with an adequate examination regarding his service-connected right wrist condition. As discussed above, the Veteran was afforded VA examinations in December 2019 and September 2020. However, at the time of these examinations, the Veteran’s VA treatment records had not been associated with claims file since October 2018. See Durham VA Medical Center (VAMC) records, received October 2018 in CAPRI. Further, although an x-ray of the Veteran’s wrists was eventually obtained after these examinations, neither doctor had the benefit of the x-ray to respond to the requested questions submitted by the Board. As such, the Board finds both the December 2019 and September 2020 examinations to be inadequate for adjudication purposes as the respective examiners were unable to consider the Veteran’s prior medical history. See Stefl v. Nicholson, 21 Vet. App. 102, 124 (2007). Accordingly, the matter is REMANDED for the following action: 1. With the Veteran’s assistance as appropriate, obtain and associate with the electronic claims file any outstanding pertinent medical records, whether VA or private, including records relating to treatment at Durham VAMC from June 2020 to current. Pursuant to 38 C.F.R. § 3.159(e), any efforts to secure these records MUST be documented in the electronic claims file, and the Veteran must be informed if any of these records are unable to be secured. 2. The Board recognizes the potential practical difficulties in scheduling an examination in light of the COVID-19 epidemic and requests flexibility and understanding in affording the Veteran any warranted examination. 3. AFTER COMPLETING THE DEVELOPMENT ABOVE, AND ANY ADDITIONAL DEVELOPMENT WARRANTED BY THE RECORD, schedule the Veteran for an examination with an appropriate clinician, preferably one specializing in orthopedics, to determine the current nature and severity of the Veteran’s right wrist condition. The entire claims file must be provided to, and reviewed by, the examiner, and any indicated studies, tests, or evaluations, to include x-rays, should be performed. The examiner is asked to: (a.) Obtain the Veteran’s detailed lay history, including onset and progression of symptomatology. (b.) Test and document the range of motion (ROM) for the Veteran’s right wrist in active motion, passive motion, on weight-bearing and non-weight-bearing, on both an initial and after repetitive use basis. The examiner must also conduct the same testing on the left wrist. FOR EACH ROM, THE EXAMINER IS ASKED TO EXPLICITLY IDENTIFY THE DEGREE IN WHICH PAIN IS FIRST EVIDENCED BY THE VETERAN’S VISIBLE BEHAVIOR. (c.) Identify the nature and severity of all current manifestations of the Veteran’s service-connected right wrist condition. The extent of any weakened movement, excess fatigability, and incoordination should be described. Any additional impairment due to such should be assessed in terms of the degree of additional ROM loss. Additional limitation following repetitive use over time, if any, must also be noted. (d.) If the Veteran describes flare-ups, after documenting the frequency, severity, and duration thereof, express an opinion as to whether there would be additional functional impairment during such flare-ups. The examiner should assess such impairment in terms of the degree of additional ROM loss and provide an explanation as to how such was determined. (e.) Determine the presence, or absence, of ankylosis of the right wrist. In making this determination, the examiner MUST address: i. The December 1999 four-point fusion surgery; ii. The December 2000 VA examination report noting near ankylosis of the right wrist; and iii. The December 2013, May 2017, June 2018, January 2019, December 2019, and September 2020 VA examination reports findings of no ankylosis. (f.) If ankylosis IS present, indicate whether it is favorable in 20 to 30 degrees dorsiflexion; in any other position except favorable; or unfavorable in any degrees of palmar flexion, or with ulnar or radial deviation. (g.) If ankylosis is NOT found, indicate whether the fusion following the December 1999 surgery is no longer present, and determine is dorsiflexion is less than 15 degrees or palmer flexion is limited in line with forearm. • Any opinion expressed by the examiner must be accompanied by a complete rationale. If medical literature is relied upon in rendering a determination, the examiner should identify and specifically cite each reference material utilized. • If it is not feasible to perform a requested assessment to any degree of medical certainty without resort to speculation, a thorough explanation as to why the assessment cannot be performed should be provided. 4. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT ACTION IS INCOMPLETE, THE APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT OR OPINION DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC REPORTS OR OPINIONS REQUESTED, IT MUST BE RETURNED TO THE PROVIDING EXAMINER FOR CORRECTIVE ACTION. YVETTE R. WHITE Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. T. Martin III, 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.