Citation Nr: 21010655 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 16-05 727 DATE: February 25, 2021 ORDER Service connection for a neck disability, to include as secondary to service-connected right hand injury residuals (right hand disability) is denied. Service connection for right rotator cuff tear (right shoulder disability), to include as secondary to a service-connected right hand disability, is denied. Service connection for left rotator cuff pain (left shoulder disability), to include as secondary to a service-connected right hand disability, is denied. An increased rating, in excess of 30 percent, for right hand injury residuals (right hand disability) is denied. For the period prior to March 24, 2020, an increased rating, in excess of 10 percent, for the right hand nerve is denied. For the period beginning March 24, 2020, an increased rating, in excess of 30 percent, for the right hand nerve is denied. REMANDED The claim of an entitlement to a total disability rating based on an individual unemployability (TDIU) is remanded. FINDINGS OF FACT 1. The probative evidence has not shown that the Veteran’s neck disability is caused by or aggravated by his service-connected right hand disability. 2. The probative evidence has not shown that the Veteran’s right shoulder disability is caused by or aggravated by his service-connected right hand disability. 3. The probative evidence has not shown that the Veteran’s left shoulder disability is caused by or aggravated by his service-connected right hand disability. 4. The Veteran’s service-connected right hand disability is not approximated by unfavorable ankylosis of two digits of the right hand nor is it comparable to one requiring amputation. 5. For the period prior to March 24, 2020, the Veteran’s right hand nerve damage has been manifested by no more than mild, incomplete paralysis of the median nerve. 6. For the period beginning March 24, 2020, the Veteran’s right hand nerve damage has been manifested by no more than moderate, incomplete paralysis of the median nerve. CONCLUSIONS OF LAW 1. The criteria for service connection for a cervical spine disability, to include as secondary to service-connected right hand injury residuals have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310. 2. The criteria for service connection for a right shoulder disability, to include as secondary to service-connected right hand injury residuals have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310. 3. The criteria for service connection for a left shoulder disability, to include as secondary to service-connected right hand injury residuals have not been met. 38 U.S.C. § 1131; 38 C.F.R. § 3.310. 4. The criteria for an increased rating, in excess of 30 percent, for right hand injury residuals (right hand disability) have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 3.102, 4.1, 4.3, 4.40, 4.45, 4.59, 4.7, 4.71a, Diagnostic Code (DC) 5223. 5. For the period prior to March 24, 20202, the criteria for an increased rating, in excess of 10 percent, for right hand nerve damage, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8515. 6. For the period beginning March 24, 2020, the criteria for an increased rating, in excess of 30 percent, for right hand nerve damage, have not been met. 38 U.S.C. § 1155; 38 C.F.R. §§ 4.1, 4.3, 4.7, 4.124a, DC 8515. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from April 1958 to April 1961. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Louisville, Kentucky. In January 2018, the Board denied the service connection claims for a cervical spine disability and a shoulder disability, as well as and the increased rating claim for residuals of a right hand injury; and awarded a separate, 10 percent rating for nerve damage of the right hand. Thereafter, the Veteran appealed the January 2018 Board decision to the United States Court of Appeal for Veterans Claims (CAVC). In November 2018, CAVC vacated and remanded the Board’s decision on all the claims, for additional development. In June 2019, the Board remanded the claims for additional development, consistent with the CAVC Order. In an October 2020 rating decision, the RO increased the disability rating for right hand nerve damage to 30 percent, effective March 24, 2020. However, since this increase is not representative of a total grant of the benefits sought on appeal, the claim for increase remains before the Board. AB v. Brown, 6 Vet. App. 35 (1993). Service Connection Service connection may be granted for a disability resulting from a disease or injury incurred in, or aggravated during service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. That determination requires a finding of a current disability that is related to an injury or disease in service. Service connection may be granted for a disability diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disability is due to disease or injury that was incurred or aggravated in service. 38 C.F.R. § 3.303(d). Generally, to establish service connection, there must be competent, credible evidence of (1) a current disability, (2) in-service incurrence or aggravation of an injury or disease, and (3) a nexus, or link, between the current disability and the in-service disease or injury. See, e.g., Davidson v. Shinseki, 581 F.3d 1313(Fed. Cir. 2009); Pond v. West, 12 Vet. App. 341 (1999). Alternatively, a disability which is proximately due to or the result of a service-connected disease or injury shall be service connected. When service connection is thus established for a secondary condition, the secondary condition shall be considered a part of the original condition. 38 C.F.R. § 3.310(a). Thus, secondary service connection may also be established for a nonservice-connected disability which is aggravated by a service-connected disability. In such an instance, the Veteran may be compensated for the degree of disability over and above the degree of disability existing prior to the aggravation. 38 C.F.R. § 3.310(b); see Allen v. Brown, 7 Vet. App. 439, 448 (1995). The Veteran asserts that his bilateral shoulder and cervical spine disabilities are secondary to his service-connected right hand disability. See e.g. December 2017 Appellate Brief. First, the Board notes that since the January 2018 Board decision, which was appealed to CAVC, focused solely on secondary service connection, the Board will focus on secondary service connection in this decision, and thus, will not address the issue of direct service connection. As indicated above, the Veteran has been service-connected for residuals of injury to the right hand, to include loss of use, pain, poor circulation, and muscle weakness of the right arm. Further, the medical evidence reflects that the Veteran has current diagnoses of right shoulder rotator cuff tear; left shoulder pain; and chronic neck pain. See e.g. February 2016 Progress Note; see also February 2017 Non-VA Note; see too, December 2017 Primary Care Note. However, the evidence of record does not support a finding that there may be a correlation between the Veteran’s bilateral shoulder and neck disabilities and his service-connected right hand disability. Specifically, none of the medical records have indicated or suggested that the Veteran’s bilateral shoulder and/or neck disabilities are related to the right hand disability; and the Veteran has not presented or identified any medical evidence, such as, for example, a private treatment record or opinion, to support the claim of secondary service connection. The Board acknowledges that the RO has not obtained a medical opinion to determine whether the Veteran’s bilateral shoulder and neck disabilities are secondary to the right shoulder disability. However, the Veteran’s statements alone are insufficient to warrant a medical examination, as this would, contrary to the intent of Congress, result in medical examinations being “routinely and virtually automatically” provided to all veterans claiming service connection. See, e.g., Waters v. Shinseki, 601 F.3d 1274 (Fed. Cir. 2010) Therefore, VA is under no duty to obtain a medical opinion. At the same time, for clarification purposes, the Board finds that while the Veteran has a current disability of the cervical spine, the VA examiner’s focus, in an October 2020 addendum opinion, was not on the Veteran’s cervical spine condition, when he found that there was no neurological impairment affecting the hand. Rather, this October 2020 addendum opinion was only limited to addressing the question of whether there is an impairment of the C6-8 (cervical spine) nerve root. Thus, as the preponderance of the evidence is against the claims, the service connection claims for a right shoulder disability, left shoulder disability, and neck disability are denied. Increased Ratings Disability ratings are determined by application of the criteria set forth in VA’s Schedule for Rating Disabilities, which is based on average impairment of earning capacity. 38 U.S.C. § 1155; 38 C.F.R. Part 4. When a question arises as to which of two ratings applies under a particular diagnostic code, the higher rating is assigned if the disability more closely approximates the criteria for the higher rating. Otherwise, the lower rating applies. 38 C.F.R. § 4.7. After careful consideration of the evidence, any reasonable doubt remaining is resolved in favor of the Veteran. 38 C.F.R. § 4.3. The Veteran’s entire history is to be considered when making disability evaluations. 38 C.F.R. § 4.1; Schafrath v. Derwinski, 1 Vet. App. 589 (1995). Where entitlement to compensation already has been established and an increase in the disability rating is at issue, it is the present level of disability that is of primary concern. Francisco v. Brown, 7 Vet. App. 55 (1994). Nevertheless, the Board acknowledges that a claimant may experience multiple distinct degrees of disability that might result in different levels of compensation from the time the increased rating claim was filed until a final decision is made. Hart v. Mansfield, 21 Vet. App. 505 (2007). 1. Right Hand Disability The Veteran asserts entitlement to an increased rating for his service-connected right hand disability. In evaluating disabilities of the musculoskeletal system, consideration must be given to functional loss, including due to weakness and pain, affecting the normal working movements of the body in terms of excursion, strength, speed, coordination, and endurance. 38 C.F.R. § 4.40. With respect to disabilities of the joints, it must be considered whether there is less movement or more movement than normal, weakened movement, excess fatigability, incoordination, and pain on movement, as well as swelling, deformity, or atrophy of disuse. 38 C.F.R. § 4.45. These provisions thus require a determination of whether a higher rating may be assigned based on functional loss of the affected joint on repeated use as a result of the above factors, including during flare-ups of symptoms, beyond any limitation reflected on one-time measurements of range of motion. DeLuca v. Brown, 8 Vet. App. 202, 206 – 07 (1995). However, a higher rating based on functional loss may not exceed the highest rating available under the applicable diagnostic code(s) pertaining to range of motion. See Johnston v. Brown, 10 Vet. App. 80, 85 (1997). In determining if a higher rating is warranted on this basis, pain itself does not constitute functional loss. Similarly, painful motion alone does not constitute limited motion for the purposes of rating under diagnostic codes pertaining to limitation of motion. However, pain may result in functional loss if it limits the ability to perform normal movements with normal excursion, strength, speed, coordination, or endurance, as provided in §§ 4.40 and 4.45. Functional loss due to pain is to be rated at the same level as functional loss caused by some other factor that actually limited motion. Mitchell v. Shinseki, 25 Vet. App. 32 (2011). The intent of the Rating Schedule is to recognize actually painful, unstable or misaligned joints, due to healed injury, as entitled to at least the minimum compensable rating for the joint. 38 C.F.R. § 4.59. As such, painful motion should be considered to determine whether a higher rating is warranted on such basis, whether or not arthritis is present. See Burton v. Shinseki, 25 Vet. App. 1 (2011). The Veteran has been assigned a 30 percent disability rating for residuals of right hand injury, under DC 5223. 38 C.F.R. § 4.71a, DC 5223. As is the case here, when two or more digits of the same hand are affected by any combination of amputation, ankylosis, or limitation of motion that is not otherwise specified in the rating schedule, the evaluation level assigned will be that which best represents the overall disability (i.e. amputation, unfavorable ankylosis, favorable ankylosis, or limitation of motion), assigning the higher level of evaluation when the level of disability is equally balanced between one level and the next higher level. 38 C.F.R. § 4.71a, DCs 5216 – 5230, Note (2). Pertinent to this claim, DC 5223, the rating criteria for favorable ankylosis of two digits of one hand, assigns the maximum rating of 30 percent for favorable ankylosis of the thumb and any other finger, for the dominant/major hand; and DC 5219, the rating criteria for unfavorable ankylosis of the thumb and any finger, assigns the maximum rating of 40 percent for unfavorable ankylosis of the thumb and any finger, for the dominant/major hand. Id. With unfavorable ankylosis, consideration is also given to whether evaluation as amputation is warranted. See Note to 38 C.F.R. § 4.71a, DC 5219. The Board notes that, per the stipulations of the JMPR, which indicated, in pertinent part, that in May 2004, Dr. B prepared a letter indicating that he treated the Veteran’s right index finger, the RO sought additional medical records from this provider. However, the medical records that were associated with the claims file mostly pertained to the Veteran’s treatment for total knee arthroplasty. Thus, as Dr. B’s office has not provided any additional treatment records for the Veteran’s right index finger, the Board has evaluated this increased rating claim on the basis of evidence, including and not limited to, available medical treatment records. The medical evidence reflects that the Veteran’s right hand is his major extremity. See e.g. March 2020 VA Examination Report for Hand and Finger Conditions. Thus, consideration of increased ratings shall be based on the rating criteria for the major extremity, right hand, under DCs 5219 and 5223. A February 2013 VA examination reflects that the Veteran’s residual injury to the right hand includes loss of use, pain, poor circulation, and muscle weakness of the right arm. At this VA examination, the Veteran reported having severe pain in the index finger and milder pain in the thumb. He also reported that he had limited motion to the index finger; that it is hard to grasp items and perform activities, such as brushing teeth or holding on to a coffee cup. He also complained of decreased strength, and that he has a loss of sensation to his thumb pad. He also reported having flare-ups, and described the impact, as weather changes and prolonged activity making the pain worse. On initial range of motion testing, there was evidence of limitation of motion or painful motion in the thumb, index, and little fingers. However, no gap was noted between the thumb pad and fingers. Additionally, on testing for finger flexion, the VA examination report notes that there is a gap between fingertips and the proximal transverse crease of the palm or evidence of painful motion, in attempting to touch the palm with the fingertips. On repetitive-use testing with 3 repetitions, which the Veteran was able to perform, there was no evidence of additional limitation of motion for any of the right fingers, post-test. On testing, there was evidence of additional limitation in range of motion following repetitive-use testing, due to contributing factors, such as less movement than normal in the thumb, index finger, and little finger; weakened movement in the thumb and index finger; excess fatigability in the thumb and index finger; pain on movement in the thumb, index finger and little finger; swelling in the index finger; and deformity in the thumb, index finger, and little finger. However, there was no evidence of ankylosis of the thumb and/or fingers. At the August 2015 VA examination, the Veteran reported having flare-ups, and he described the impact as weather changes and overuse increasing symptoms, causing swelling and pain. He further reported having functional loss or functional impairment of the right hand, which he described as difficulty with all fine motor tasks and grasping, handling loads and tools. On initial range of motion testing, limitation in range of motion contributed to functional loss, and specifically, limited fine motor function; and pain was noted with use of the hand. On testing with observed repetitive use, which the Veteran was able to perform, no additional functional loss or range of motion was noted after three repetitions. Additionally, the VA examination notes that pain, weakness, fatigability or incoordination significantly limits functional ability with repeated use over time, and factors causing this functional loss, include pain, fatigue, weakness, and lack of endurance. Further, the VA examination report also reflects that pain, weakness, fatigability or incoordination significantly limit functional ability with flare-ups, with factors causing functional loss, including pain, fatigue, weakness, and lack of endurance. However, there was no evidence of ankylosis of any thumb or finger joints. A March 2020 VA examination for hand and finger conditions reflects that the Veteran reported having flare-ups, of the right hand. He explained that they occur daily; are severe at times; they last from 1 – 5 minutes, several times a day; they are precipitated by picking up items, putting on clothes, opening doors, and driving; and they are alleviated by massaging the finger and thumb, using over-the-counter pain creams and prescription pain medication, as well as hot wax dip, twice a day. He also reported having functional loss or functional impairment of the right hand, which he described as having difficulty with grasping items, dropping items, and having difficulty with grasping the steering wheel, while driving. On initial testing for range of motion, a gap was noted between the finger and proximal transverse crease of the hand on maximal finger flexion; and pain was noted on examination. On repetitive use testing with at least three repetitions, which the Veteran was able to perform, no additional functional loss or range of motion was noted after three repetitions. The VA examination report additionally notes that pain, weakness, fatigability, or incoordination significantly limit functional ability with repeated use over a period of time, and the factors that cause functional loss, include pain, weakness, lack of endurance, and incoordination. The VA examination report also notes that additional factors contributing to the right hand disability, include less movement than normal; weakened movement due to muscle or peripheral nerve injury; swelling; and deformity. Pertinently, the VA examination report notes that the Veteran has ankylosis that results in limitation of motion of other digits or interference with the overall function of the hand. Describing the functional impact of ankylosis of the right hand, the VA examiner noted that the Veteran cannot use the index finger in his grip, due to very limited movement. After a review of all probative evidence, the Board finds that a rating, in excess of 30 percent, is not warranted for the right hand disability. Although the medical evidence reflects ankylosis of the right hand, unfavorable ankylosis of two digits of the right hand, and/or amputation are not shown, to warrant an increased, 40 percent disability rating for the major, right hand disability. Additionally, in determining whether a rating, in excess of 30 percent, is applicable under the DeLuca criteria, the Board finds that the current 30 percent disability rating has already contemplated and compensated the Veteran for painful motion and limited function of the thumb, index, middle, little fingers, and the right hand as a whole, including following repetitive use, as well as his flare-ups and weakened hand grip strength, based on the DeLuca criteria. Therefore, based on the foregoing reasons and bases, an increased rating, in excess of 30 percent, for the service-connected right hand disability must be denied. 2. Right Hand Nerve The Veteran has been assigned a 10 percent rating, for the period prior to March 24, 2020, and 30 percent rating, for the period beginning March 24, 2020, for right hand nerve damage, due to his service-connected right hand disability, under DC 8515. 38 C.F.R. § 4.124a, DC 8515. DC 8515, the diagnostic code for paralysis of the median nerve, provides that moderate incomplete paralysis of the median nerve warrants a 30 percent rating for the major extremity; and severe incomplete paralysis of the median nerve warrants a 50 percent rating for the major extremity. A 70 percent rating is warranted for complete paralysis of the major extremity. Id. In applying the schedular rating criteria to peripheral nerve disabilities, the term “incomplete paralysis” indicates a degree of lost or impaired function substantially less than the type pictured for complete paralysis given with each nerve, whether due to varied level of the nerve lesion or to partial regeneration. 38 C.F.R. § 4.124a. When the involvement is wholly sensory, the rating should be for the mild, or at most, the moderate degree. In rating peripheral nerve injuries and their residuals, attention should be given to the site and character of the injury, the relative impairment and motor function, trophic changes, or sensory disturbances. 38 C.F.R. § 4.120. Under 38 C.F.R. § 4.124a, disability from neurological disorders is rated from 10 to 100 percent in proportion to the impairment of motor, sensory, or mental function. With partial loss of use of one or more extremities from neurological lesions, rating is to be by comparison with mild, moderate, severe, or complete paralysis of the peripheral nerves. Words such as “moderate” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the extent that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, it is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6. The medical evidence reflects that the Veteran’s right hand is his major extremity. See e.g. March 2020 VA Examination Report for Peripheral Nerve Conditions. Thus, consideration of increased ratings shall be based on the rating criteria for major extremity, right hand nerve, under DC 8515. A. Prior to March 24, 2020 As noted above, the Veteran has been assigned a 10 percent disability rating for the service-connected right hand nerve damage, for the period prior to March 24, 2020. The Veteran was afforded a VA examination for peripheral nerve conditions in February 2013. This VA examination report reflects that the symptoms attributable to the Veteran’s right hand nerve condition, include mild constant pain; and mild numbness. Additionally, the Veteran reported having a loss of sensation, with numbness-like feeling to his thumb pad of his right hand. On testing for muscle strength, right hand wrist flexion and wrist extension were normal; and the right hand grip and pinch (thumb to index finger) were reflective of active movement against some resistance. On sensory examination, sensation testing for light touch was decreased for “hand/fingers (C6 – 8)” (cervical spine). On overall assessment, the VA examiner determined that the right hand nerve damage was reflective of mild, incomplete paralysis of the median nerve. In this regard, the Board finds that the probative evidence reflects that a rating in excess of 10 percent is not warranted. The Veteran’s symptoms of right hand nerve damage include mild constant pain and mild numbness. Although he reported having loss of sensation to the thumb pad of his right hand, the right hand grip and thumb to index finger pinch were rated at a 4/5, which denotes “active movement against some resistance”, as opposed to a rating of 0/5, which denotes “no muscle movement”, and whereas a rating of 5/5 denotes “normal strength.” Therefore, the muscle strength for the right hand grip and thumb to index finger pinch are mild in severity, as it is slightly less than normal strength. In this regard, the medical evidence suggests that, overall, the symptoms of the Veteran’s right hand nerve damage have been consistently mild in severity, and overall, as determined by the VA examiner, approximates mild, incomplete paralysis of the median nerve. Thus, as the medical evidence has not shown that the severity of the Veteran’s right hand nerve damage is approximated by moderate, incomplete paralysis, to warrant an increased, 30 percent disability rating, an increased rating is not warranted for this period of the appeal. The Board has considered whether any additional, different nerve root damage is involved, as the February 2013 VA examination reflects that on sensory examination, sensation testing for light touch was decreased for hand/fingers/cervical spine. In an October 2020 addendum opinion, a VA examiner clarified that after careful review and consideration of the available evidence, including and not limited to, this February 2013 examination, there is no evidence to support a cervical radiculopathy for this currently diagnosed disability. The VA examiner explained that the issue with the disability benefits questionnaire (DBQ) and its reference for the noted sensory changes at the hand/fingers and noted C6-C8 etiology, is that it does not take into account a peripheral source of insult to a nerve. He further explained that while the origin of the Veteran’s injury is distal, located at the hand/wrist, it excludes the source being at the level of the nerve root cervical spine. He explained that, for example, a median nerve neuropathy (carpal tunnel syndrome) would also reflect as C6-C8 radiculopathy, as there is no confusion, but in this case, this “is a simple error of interpreting the data on the DBQ”, and that therefore, it is his opinion that the nerve root at C6 – C8 is not diagnosed or present, given the understood anatomy. Therefore, based on this clarification, which provides an adequate rationale, the Board finds that no additional, different nerve roots, especially the cervical spine neve root, are involved for this period of the appeal. Therefore, based on the above-mentioned reasons and bases, an increased rating, in excess of 10 percent, for right hand nerve damage, must be denied for the period prior to March 24, 2020. B. Beginning March 24, 2020 As noted above, the Veteran has been assigned a 30 percent disability rating for the service-connected right hand nerve damage, for the period beginning March 24, 2020. The Veteran was afforded a VA examination for peripheral nerve conditions in March 2020. This VA examination report reflects that the symptoms attributable to the Veteran’s right hand nerve damage, include severe intermittent pain; moderate paresthesias and/or dysesthesias; and mild numbness. On testing for muscle strength, right hand wrist flexion, wrist extension, and grip, which have deteriorated since the last VA examination, were reflective of active movement against gravity (which is denoted by a 3/5 rating); and thumb to index finger pinch, which has improved since the last VA examination, was normal. On sensory examination, hand and fingers (cervical) spine was reflective of decreased sensation testing for light touch. On overall assessment, the VA examiner determined that the Veteran’s right hand nerve damage is productive of a moderate, incomplete paralysis of the median nerve. In this regard, the Board finds that an increased rating, in excess of 30 percent, is not warranted for the right hand disability, for this period of the appeal. In addition to the VA examiner’s determination that the Veteran’s right hand nerve is characteristic of moderate, incomplete paralysis of the median nerve, the symptoms of the Veteran’s right hand nerve damage have been no worse than moderate, with the exception of severe, intermittent pain. For example, there was no evidence of lack of muscle movement (rated at 0/5), or palpable or visible muscle contraction, but not joint movement (rated at 1/5), for right hand flexion of the wrist, extension of the wrist, grip, or thumb to index finger pinch. Thus, as the medical evidence has not shown that the severity of the Veteran’s right hand nerve damage is approximated by severe, incomplete paralysis of the median nerve, to warrant an even higher, increased 50 percent disability rating, an increased rating is not warranted for this period of the appeal. In the assessment of this claim, the Board has considered whether any additional, different nerve root damage is involved, as the March 2020 VA examination report notes that on sensory examination, sensation testing for light touch was decreased. As noted above, in an October 2020 addendum opinion, a VA examiner clarified that after careful review and consideration of the available evidence, including and not limited to, this March 2020 VA examination, there is no evidence to support a cervical radiculopathy for this currently diagnosed disability. The VA examiner further explained that the issue with the disability benefits questionnaire (DBQ) and its reference for the noted sensory changes at the hand/fingers and noted C6-C8 etiology, does not take into account a peripheral source of insult to a nerve. He further explained that while the origin of the Veteran’s injury is distal, located at the hand/wrist, it excludes the source being at the level of the nerve root cervical spine. He further clarified that, for example, a median nerve neuropathy (carpal tunnel syndrome) would also reflect as C6-C8 radiculopathy, as there is no confusion, but this “is a simple error of interpreting the data on the DBQ”, and that thus, it is his opinion that the nerve root at C6 – C8 is not diagnosed or present, given the understood anatomy. Therefore, based on this clarification, which provides a clear, adequate rationale, the Board finds that no additional, different nerve roots, especially the cervical spine neve root, are involved for this period of the appeal. In summary, and based on the foregoing reasons, an increased rating, in excess of 30 percent for service-connected right hand nerve damage, must be denied. REASON FOR REMAND The Board regrets further delay, but finds that additional development is necessary before a decision may be rendered on the remaining issue on appeal. The Board cannot make a fully informed decision on the TDIU claim as the evidence of record is incomplete. The evidence suggests that the Veteran may be in receipt, or is expecting to receive disability retirement benefits. See e.g. January 2020 and August 2020 Applications for Increased Compensation Based on Unemployability; see also September 2020 Executed Request for Employment Information in Connection with Claim for Disability Benefits. However, there is no indication that the RO has undertaken any efforts to obtain the Veteran’s records from Social Security Administration (SSA). Therefore, a remand is required for the RO to obtain these outstanding SSA records and associate them with the claims file. The matters are REMANDED for the following action: 1. Undertake all requisite steps, obtain the Veteran’s complete records from SSA, and associate them with the claims file. (Continued on the next page)   2. All attempts to obtain these records, including the mandatory response to this request, must be documented in the claims file. 3. After all the above-mentioned developments have been undertaken, readjudicate the TDIU claim. M. Tenner Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board V-N. Pratt 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.