Citation Nr: 21010242 Decision Date: 02/24/21 Archive Date: 02/24/21 DOCKET NO. 12-20 938 DATE: February 24, 2021 REMANDED Entitlement to a disability rating in excess of 20 percent for McArdle’s disease with scar is remanded. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from June 2002 to October 2006. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a January 2010 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded this case in May 2018 for further development. 1. Entitlement to a disability rating in excess of 20 percent for McArdle’s disease with scar is remanded. 2. Entitlement to a total disability rating based upon individual unemployability due to service-connected disabilities (TDIU) is remanded. The evidence shows that the Veteran’s service-connected McArdle’s disease with scar results in muscle weakness and pain. Additionally, a November 2016 VA examination for muscle injuries showed that McArdle’s disease affected every muscle group in his shoulder girdle and arm, forearm and arm, foot and leg, pelvic girdle and thigh, and torso and neck resulting in pain, weakness, and fatigue. However, the November 2016 VA examiner did not specify the severity of the muscle injuries. As such, the Board does not have enough information to appropriately rate the current severity of the Veteran’s McArdle’s disease. Further, the record, specifically a December 2018 VA examination for fibromyalgia, indicates that the Veteran’s McArdle’s has worsened since the November 2016 VA examination for muscle injuries. Therefore, a more contemporaneous medical examination is warranted. Green v. Derwinski, 1 Vet. App. 121 (1991) (VA has a duty to provide the Veteran with a thorough and contemporaneous medical examination, one which takes into account the records of prior medical treatment, so that the rating of the disability will be a fully informed one); Caffrey v. Brown, 6 Vet. App. 377 (1994) (an examination too remote for rating purposes cannot be considered “contemporaneous”). Additionally, the Board notes that the Veteran asserted and VA treatment records indicate that his chronic kidney disease is a complication of his McArdle’s disease. Thus, a new VA examination is warranted. The Board finds that the claim of entitlement to TDIU is inextricably intertwined with the remanded claim for increased rating for McArdle’s disease. The appropriate remedy for an inextricably intertwined issue is to remand it pending resolution of the inextricably intertwined issues. Harris v. Derwinski, 1 Vet. App. 180 (1991). The matters are REMANDED for the following action: Schedule a VA examination to determine the current nature and severity of the Veteran’s McArdle’s disease with an appropriate specialist (i.e., metabolic disorder or neurology). Provide the claims file, including a copy of this REMAND, to the examiner for review. The examiner should provide current findings regarding all symptoms associated with McArdle’s disease. Specifically, the examiner must evaluate the severity of the muscle injury (i.e., slight, moderate, moderately severe, or severe). The examiner should indicate if multiple muscle groups are involved, and if so, the severity of each. The examiner is also advised that VA treatment records indicate that the Veteran’s chronic kidney disease is a complication of his McArdle’s disease. A complete rationale for any opinions must be provided. LESLEY A. REIN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board E. Ko, 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.