Citation Nr: 21011793 Decision Date: 03/02/21 Archive Date: 03/02/21 DOCKET NO. 18-02 392 DATE: March 2, 2021 REMANDED Entitlement to a rating in excess of 20 percent for residuals of left radial and median nerve disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1975 to July 1978. In December 2019, the Veteran presented testimony before the undersigned Veterans Law Judge of the Board. The content of that testimony has been considered and is reflected in the remand discussion below. By way of background, the Board notes that the Veteran was awarded a 20 percent rating for traumatic injury to the left radial and median nerves, effective from October 26, 1981, in an April 2014 rating decision. In so finding, the RO determined there was clear and unmistakable error (CUE) in an October 1982 rating decision that awarded only 10 percent for residuals of left wrist laceration with injury of radial nerve and painful subcutaneous nodule. The Board notes that this April 2014 rating decision in essence recharacterized the Veteran’s service-connected nerve disability, which was previously characterized as residuals of a left wrist laceration with injury to the radial nerve and painful subcutaneous nodule, rated at 10 percent from October 28, 1981, pursuant to Diagnostic Codes 7899-7804, 8514. The Veteran was then awarded a separate 10 percent rating for the left median nerve, effective from January 31, 2000. The Veteran now seeks a rating in excess of 20 percent for his service-connected nerve disabilities. He also argues that he is entitled to separate ratings for the radial and median nerve disabilities or, alternatively, a higher rating for the entire lower radicular group pursuant to Diagnostic Code 8512. In the prior January 2020 Board remand, it was noted the Veteran was last examined to assess the severity of his nerve disability in September 2011. As such, the Veteran was reexamined by VA in a March 2020 VA Peripheral Nerves Conditions Disability Benefits Questionnaire (DBQ). At that time, the VA examiner noted only involvement of the radial and median nerves. However, the accompanying March 2020 VA medical opinion then proceeded to differentiate the symptoms attributable to the radial and ulnar nerves, without mention of the median nerves. Parenthetically, the Board acknowledges that the prior remand erroneously noted ulnar involvement in the directives. Regardless, if there was no ulnar involvement, that should have been noted and an opinion regarding the symptoms attributable to the diagnosed radial and median nerves provided. Therefore, the Board finds that the clarification is necessary as to whether the Veteran does, in fact, have ulnar nerve involvement in addition to the radial and median nerve involvement. The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the VA examiner who conducted the March 2020 VA examination and provided the accompanying medical opinion. The examiner is instructed to review all pertinent records associated with the claims file. Then, the examiner should provide comment on the following: (a.) Identify the nerves impacted by the Veteran’s service-connected disability. (b.) For each identified nerve, the examiner is asked to determine whether the manifestations of each affected nerve are separate and distinct disabilities, or do they overlap to the extent that differentiation is not possible. If the examiner determines that the requested directives cannot be answered without reexamination of the Veteran, the RO is requested to schedule an examination, but that is left to the examiner’s and the RO’s discretion. It should be noted that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” (38 C.F.R. § 4.1), copies of all pertinent records in the Veteran’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 2. THE AOJ MUST REVIEW THE CLAIMS FILE AND ENSURE THAT THE FOREGOING DEVELOPMENT ACTION HAS BEEN COMPLETED IN FULL. IF ANY DEVELOPMENT IS INCOMPLETE, APPROPRIATE CORRECTIVE ACTION MUST BE IMPLEMENTED. IF ANY REPORT DOES NOT INCLUDE ADEQUATE RESPONSES TO THE SPECIFIC 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 T. Berry, 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.