Citation Nr: 21013422 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 14-03 204 DATE: March 9, 2021 REMANDED Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from August 2, 2011, for Parkinson’s disease with left lower extremity shuffling gait, tremors, stiffness, and bradykinesia is remanded. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from March 4, 2011, for right lower extremity shuffling gait, tremors, stiffness, and bradykinesia is remanded. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from August 2, 2011, for left upper extremity tremors, stiffness, and bradykinesia is remanded. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 30 percent from January 10, 2012, for right upper extremity tremors, stiffness, bradykinesia, and micrographia is remanded. Entitlement to an initial compensable disability rating for left side facies, seventh (facial) cranial nerve is remanded. Entitlement to an initial compensable disability rating for right side facies, seventh (facial) cranial nerve is remanded. Entitlement to an initial compensable disability rating for left side stooped posture is remanded. Entitlement to an initial compensable disability rating for right side stooped posture is remanded. Entitlement to an initial compensable disability rating for swallowing impairment, fifth (trigeminal) cranial nerve is remanded. Entitlement to an initial compensable disability rating for loss of sense of smell is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1963 to December 1963, from August 1965 to August 1967, and from June 1970 to June 1972. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a December 2011 rating decision. In January 2017, the Veteran testified before the undersigned Veterans Law Judge (VLJ) at a video-conference hearing. A transcript of that hearing is of record. The Veteran’s claim for an initial disability rating in excess of 30 percent for Parkinson’s disease was remanded by the Board in November 2017 for further development. While in remand status, an October 2020 rating decision assigned separate disability ratings described above for the Veteran’s right lower extremity shuffling gait, tremors, stiffness, and bradykinesia, left upper extremity tremors, stiffness, and bradykinesia, right upper extremity tremors, stiffness, bradykinesia, and micrographia, left side facies, seventh (facial) cranial nerve, right side facies, seventh (facial) cranial nerve, left side stooped posture, right side stooped posture, swallowing impairment, fifth (trigeminal) cranial nerve, and loss of sense of smell as relating to his Parkinson’s disease. For the reasons discussed below, the Board finds that an additional remand is necessary. The Board notes that the Board remanded the issue of entitlement to an initial disability rating in excess of 60 percent for coronary artery disease, status post myocardial infarction in November 2017. The October 2020 rating decision also assigned a 100 percent disability rating for the Veteran’s coronary artery disease, status post AICD implantation, effective February 13, 2011. As the October 2020 rating decision represents a full grant of the benefits sought concerning coronary artery disease, this issue is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). 1. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from August 2, 2011, for Parkinson’s disease with left lower extremity shuffling gait, tremors, stiffness, and bradykinesia is remanded. 2. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from March 4, 2011, for right lower extremity shuffling gait, tremors, stiffness, and bradykinesia is remanded. 3. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 40 percent from August 2, 2011, for left upper extremity tremors, stiffness, and bradykinesia is remanded. 4. Entitlement to an initial disability rating in excess of 20 percent disabling, and in excess of 30 percent from January 10, 2012, for right upper extremity tremors, stiffness, bradykinesia, and micrographia is remanded. 5. Entitlement to an initial compensable disability rating for left side facies, seventh (facial) cranial nerve is remanded. 6. Entitlement to an initial compensable disability rating for right side facies, seventh (facial) cranial nerve is remanded. 7. Entitlement to an initial compensable disability rating for left side stooped posture is remanded. 8. Entitlement to an initial compensable disability rating for right side stooped posture is remanded. 9. Entitlement to an initial compensable disability rating for swallowing impairment, fifth (trigeminal) cranial nerve is remanded. 10. Entitlement to an initial compensable disability rating for loss of sense of smell is remanded. The Board finds that a new VA examination is warranted to assess the current nature and severity of the Veteran’s service-connected disabilities relating to his Parkinson’s disease. See 38 C.F.R. § 3.327(a) (providing that reexaminations will be requested whenever VA needs to determine the current severity of a disability). The Veteran was last afforded a Parkinson’s Disease Disability Benefits Questionnaire in March 2019. The examination report states that the Veteran has mild stooped posture, mild balance impairment, moderate loss of automatic movements, and moderate speech changes. Concerning tremors, the Veteran has mild right upper tremors, moderate left upper tremors, and the lower extremities are not affected. The Veteran does not have muscle rigidity or stiffness or mental manifestations due to Parkinson’s disease. He has partial loss of sense of smell, mild difficulty chewing/swallowing, but no urinary problems, constipation, or sexual dysfunction. Since that time, the evidence demonstrates that the Veteran’s disabilities relating to his Parkinson’s disease have worsened. Of note, the Veteran fell and broke his left ankle in December 2019. A January 2020 VA Nursing Admission Evaluation Note states that the Veteran’s gait is unsteady, that he fractured his left ankle, and that he has decreased range of motion related to Parkinson’s disease. After his injury, the Veteran’s speech was noted to be slurred and slow. He underwent speech therapy and his speech was often described as low volume, rate, and clarity, with difficulty understanding at times. A January 2020 VA treatment record states that the Veteran has had dysphagia challenges for some time, but they appear to be worse with his weakened state. The Veteran also received treatment for his oropharyngeal dysphagia and was placed on a mechanical diet and thin liquids due to his difficulties swallowing. He endorsed intentionally falling and crawling to move around his home after sustaining his left ankle fracture. While receiving long-term care at VA, he primarily utilized a wheelchair for mobility. The Veteran’s VA treatment records indicate that his tremors increased, particularly on his left side. His VA treatment records also noted increased rigidity on his left side. Considering that the Veteran’s last examination occurred approximately two years ago and the evidence that his disability picture has changed, the Board finds that the current evidence of record does not adequately reveal the present state of the Veteran’s service-connected disabilities relating to his Parkinson’s disease. See Schafrath v. Derwinski, 1 Vet. App. 589, 595 (1991) (where the record does not adequately reveal the current state of the claimant’s disability, a VA examination must be conducted); see also Caffrey v. Brown, 6 Vet. App. 377, 381 (1994) (wherein the Court determined the Board should have ordered a contemporaneous examination of the Veteran because a 23-month old exam was too remote in time to adequately support the decision in an appeal for an increased rating); Palczewski v. Nicholson, 21 Vet. App. 174, 181-82 (2007), citing Caluza v. Brown, 7 Vet. App. 498, 505-06 (1998) (“Where the record does not adequately reveal the current state of the claimant’s disability…the fulfillment of the statutory duty to assist requires a thorough and contemporaneous medical examination.”); see also Snuffer v. Gober, 10 Vet. App. 400, 403 (1997); VAOPGCPREC 11-95 (1995). The Veteran’s VA treatment records indicate that he was treated at Southwest General Hospital in San Antonio, Texas, immediately after breaking his left ankle in December 2019. His claims folder does not contain these private treatment records. A remand is required to allow VA to obtain authorization and request these records. The matter is REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from October 2020 to the present. 2. Ask the Veteran to complete a VA Form 21-4142 for Southwest General Hospital in San Antonio, Texas. Make two requests for the authorized records from Southwest General Hospital, unless it is clear after the first request that a second request would be futile. 3. After the above development is completed, schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected disabilities relating to his Parkinson’s disease, including Parkinson’s disease with left lower extremity shuffling gait, tremors, stiffness, and bradykinesia, right lower extremity shuffling gait, tremors, stiffness, and bradykinesia, left upper extremity tremors, stiffness, and bradykinesia, right upper extremity tremors, stiffness, bradykinesia, and micrographia, left side facies, seventh (facial) cranial nerve, right side facies, seventh (facial) cranial nerve, left side stooped posture, right side stooped posture, swallowing impairment, fifth (trigeminal) cranial nerve, and loss of sense of smell. The examiner must review the Veteran’s claims folder. The examiner should provide a full description of the disabilities and report all signs and symptoms necessary for evaluating the Veteran’s disabilities under the appropriate rating criteria. P.M. DILORENZO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Sean Mussey, 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.