Citation Nr: 21020760 Decision Date: 04/08/21 Archive Date: 04/08/21 DOCKET NO. 18-20 110 DATE: April 8, 2021 REMANDED Entitlement to an initial compensable disability rating for a right elbow disability prior to June 6, 2017, a disability rating in excess of 20 percent from June 6, 2017, to December 22, 2020, and a disability rating in excess of 30 percent from December 23, 2020 is remanded. Entitlement to a disability rating in excess of 30 percent for right ulnar neuropathy is remanded. Entitlement to a disability rating in excess of 20 percent for limitation of pronation of the right elbow is remanded. Entitlement to a compensable disability rating for limitation of extension of the right elbow is remanded. Entitlement to a compensable disability rating for a right elbow scar is remanded. REASONS FOR REMAND The Veteran served on active duty from May 1959 to April 1963. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2015 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO), which granted the Veteran service connection for a right elbow disability and assigned a noncompensable rating. A March 2018 rating decision assigned a disability rating of 20 percent from June 16, 2017. A January 2021 rating decision assigned a disability rating of 30 percent from December 23, 2020. The January 2021 rating decision also granted service connection for ulnar neuropathy, limitation of pronation, limitation of extension, and a scar, each related to the Veteran’s right elbow. In June 2019 and May 2020, the Board remanded the Veteran’s claims to the Agency of Original Jurisdiction (AOJ) for further action consistent with the Board’s remand directives. Specifically, the Board remanded to afford the Veteran a VA examination compliant with Sharp and to determine the etiology of the Veteran’s neurological symptoms. The claims are back before the Board for further appellate proceedings. Regrettably, the Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board’s prior remand instructions. See Stegall v. West, 11 Vet. App. 268, 271 (1998). In the May 2020 remand, the Board requested that a VA examiner provide an opinion as to the nature and severity of any related neurological condition as well as the specific nerves involved. The Veteran’s representative now argues that the Veteran is entitled to an extraschedular rating for his right elbow disability. See March 2021 appellate brief. Thus, it is imparative that the Board have a full account of the functional effects and impairments related to the Veteran’s right elbow disability. In January 2021, the Veteran was afforded a new VA examination. The examiner listed several medical entries wherein the Veteran received treatment for neurological conditions, to include the median nerve, ulnar nerve, and medial antebrachial cutaneous nerve. See January 2021 VA examination report. The examiner described the severity of the Veteran’s ulnar neuropathy, but did not discuss any other neurological conditions or provide an etiological opinion as to any neurological condition. Id. Moreover, the examiner noted that the Veteran complained of multiple parts of the Veteran’s hand had neurological symptoms, to include the entire hand, simultaneously, during certain periods. Private medical records indicate that the Veteran’s neurological conditions include the ulnar nerve, median nerve, a diagnosed carpal tunnel syndrome, and an interosseous syndrome. See April 2018 private medical records. There is inadequate, competent evidence of record that describes the nature severity of the neurolgical conditions of record and what nerves are involved. Thus, a new medical opinion is necessary. The claim for an increased rating for the Veteran’s right elbow, to include on an extraschedular basis, is inextricably intertwined with the outcome of the remanded issue. The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his right elbow disability that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. Thereafter, schedule the Veteran for examination(s) to determine the current nature and severity of his right elbow disability and related neurological conditions. The claims file should be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. After the record review and examination of the Veteran, the examiner should identify all neurological conditions present related to the Veteran’s right elbow, to include the ulnar nerve, median nerve, medial antebrachial cutaneous nerve, a diagnosed carpal tunnel syndrome, and an interosseous syndrome. For each identified condition, the examiner must indicate the specific nerve(s) involved and comment on the nature and severity of the neurological impairment. The examiner should conduct all indicated tests and studies, to include range of motion studies. The joint involved should be tested in both active and passive motion, in weight-bearing and non-weight-bearing. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including: frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran’s lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 3. After the above has been completed to the extent possible, readjudicate the claims. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Strickland 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.