Citation Nr: 21010660 Decision Date: 02/25/21 Archive Date: 02/25/21 DOCKET NO. 14-33 224 DATE: February 25, 2021 REMANDED Entitlement to an increased rating in excess of 20 percent for right ankle residuals on an extraschedular basis is remanded. Entitlement to a total disability based on individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran served honorably with the United States Navy from March 1971 to February 1975. This matter was previously adjudicated by the Board of Veterans’ Appeals (Board) in a July 2019 Decision. Entitlement to an increased rating in excess of 20 percent for right ankle residuals on an extraschedular basis is remanded. Although the Board regrets the additional delay, further development is required prior to the adjudication of the Veteran’s claim. In particular, remand is required to obtain retrospective opinions, clarification on the Veteran’s ankylosis diagnosis, and extraschedular consideration. See Stegall v. West, 11 Vet. App. 268, 270-71 (1998) (requiring substantial compliance with remand directives). First, in the prior Board remand, the Board noted that there was conflicting evidence in the record regarding whether the Veteran suffered from ankylosis of the ankle. Compare September 2014 Medical Treatment Record with May 2013 VA Examination and April 2019 VA Examination. Consequently, the Board directed the examiner to determine if the Veteran had ankylosis at any point during the appeal, and to address the conflicting records. See July 2019 Board Decision. Despite this directive, the examiner concluded the Veteran did not have ankylosis at the time of the examination but failed to consider whether the Veteran had it at any time during the appeal period, and the examiner failed to reconcile the conflicting medical opinions as to that matter. See January 2020 VA examination. In addition, the Board directed the RO to refer the Veteran’s claim to the Director of Compensation Service, for consideration of assignment of an extraschedular evaluation under 38 C.F.R. § 3.321(b). See July 2019 Board Decision. However, a review of the record shows the RO did not refer the claim for increased rating for an ankle disability for extraschedular consideration. For the foregoing reasons, remand is required to obtain a medical opinion that complies with the prior remand instructions and refer the claim for increased rating for an ankle disability for extraschedular consideration. See Stegall, supra; see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (affirming that a medical opinion is adequate if it provides sufficient detail so that the Board can perform a fully informed evaluation of the claim).  Entitlement to a TDIU is remanded. If the claimant or the record reasonably raises the question of whether the Veteran is unemployable due to a disability for which an increased rating is sought, then part and parcel to that claim, is whether TDIU is warranted. Rice v. Shinseki, 22 Vet. App. 447 (2009). Here, the Board finds that evidence of record has raised the issue of a TDIU based on the Veteran’s ankle disability. In the January 2020 VA examination, the Veteran asserted that he needed to quit his last job because he was experiencing too much pain and swelling in his ankle and had to stand for too long. See January 2020 VA Examination at 4. The examiner noted that the Veteran’s condition would impact his ability to perform occupational tasks of walking, standing, or going up and down stairs for a prolonged amount of time. See id. at 14. Finally, in his informal hearing presentation, his representative questioned how the Veteran would be able to maintain a gainful occupation given his symptomatology. As a claim for a TDIU rating has been reasonably raised by the record, remand is warranted for proper notice and development. The matter is REMANDED for the following action: 1. Obtain a medical opinion for the Veteran’s diagnosis of ankylosis. The examiner must clarify whether ankylosis of the right ankle was present at any point during the period on appeal, and if so, whether the ankylosis is favorable or unfavorable. If the examiner finds that the Veteran did not suffer from ankylosis during the period on appeal, THE EXAMINER MUST RECONCILE THAT FINDING WITH THE SEPTEMBER 2014 PRIVATE TREATMENT RECORD. See September 2014 Medical Treatment Record. (Continued on the next page)   2. Request that the Veteran complete a VA Form 21-8940 (Veteran’s Application for Increased Compensation Based on Unemployability), and issue the Veteran notice consistent with his claim of entitlement to a TDIU. 3. Refer the issues of entitlement to an increased rating for an ankle disability to the Chief Benefits Director or the Director, Compensation and Pension Service, for consideration pursuant to 38 C.F.R. § 3.321(b) and 38 C.F.R. § 4.16(b). The review and determination should discuss and reconcile the relevant medical evidence of record. A. S. CARACCIOLO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Emily A. Kotroco 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.