Citation Nr: 21029243 Decision Date: 05/13/21 Archive Date: 05/13/21 DOCKET NO. 18-04 354 DATE: May 13, 2021 REMANDED Entitlement to an initial disability evaluation in excess of 30 percent for service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy associated with temporomandibular disorder with bruxism, status post fracture jaw with operative reduction and internal fixation, on or after February 7, 2017, is remanded. Entitlement to a total disability evaluation based on individual unemployability (TDIU) due to service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1993 to May 1996. This matter again comes before the Board of Veterans' Appeals (Board) on appeal from a June 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Board previously remanded this matter in February 2019, October 2019, June 2020, and December 2020. Unfortunately, another remand is warranted in this matter. The Board sincerely regrets the additional delay; however, further evidentiary development is necessary before the Veteran's issues of entitlement to an initial disability evaluation in excess of 30 percent for service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, and entitlement to a TDIU, can be adjudicated on the merits. 1. Right Greater Auricular Neuropathy, to Include Right Anterior Cutaneous Nerve of the Neck Neuropathy After issuance of the December 2020 remand, the VA arranged for the Veteran to be evaluated in January 2021 to determine the nature and severity of his service-connected neuropathy condition. The Board acknowledges receipt of the January 2021 examination report; however, the Board finds that there are internal inconsistencies in the report that renders it inadequate to ascertain the severity of the Veteran's disability. First, the Board notes that the January 2021 examiner stated that the Veteran exhibited no radicular pain or any other signs or symptoms due to cervical radiculopathy. Nevertheless, the examiner noted that the Veteran exhibited signs and symptoms of neuropathy including that he suffered numbness of the jaw. Additionally, the sensory examination was "normal," yet the examiner stated that the Veteran had no sensation in the left jaw or cheek. Furthermore, the examiner stated in the Disability Benefits Questionnaire that the Veteran did not report flare-ups. However, in a submitted "Medical Opinion" the examiner stated that the Veteran had in fact reported flare-ups. These internal inconsistencies unfortunately render the Board incapable of making an informed decision in this case and therefore the January 2021 examination report is inadequate. See Barr v. Nicholson, 21 Vet. App. 303 (2007). Consequently, the Board finds that a remand is necessary for an addendum opinion as to the severity of the Veteran's service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy throughout the period on appeal should be obtained. The Board also acknowledges that the January 2021 examiner concluded that the Veteran's neuropathic condition is affiliated with his cranial nerves. The VA did not provide the Veteran with a cranial nerve examination after the issuance of the December 2020 remand and after receiving the opinion of the January 2021 VA examiner. As such, the Board finds that, on remand, all relevant Disability Benefits Questionnaires, including for both cranial nerve and peripheral nerve conditions, should be obtained. Additionally, the Board notes that the most recent medical records of the Veteran are dated December 2020. On remand, prior to obtaining the addendum opinion as to the severity of the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, the Board requests that the Veteran's updated medical records be affiliated with the claims file. 2. TDIU Numerous VA examination reports indicate that the Veteran's service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy negatively impacts his ability to work. See May 2017 VA C&P Examination; September 2020 VA C&P Examination; January 2021 VA C&P Examination. As such, the Board finds that the issue of entitlement to a TDIU, including as due to the Veteran's service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, is reasonably raised by the record. See Rice v. Shinseki, 22 Vet. App. 447, 453 (2009); see also 38 C.F.R. §§ 3.340, 4.16. The issue of TDIU is part and parcel of the increased rating claim, and consequently is before the Board via the appeal of that issue. See Rice, 22 Vet. App. at 453. Because the issue of TDIU could be significantly impacted by the evaluation of severity of the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, the Board finds that these issues are inextricably intertwined. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). Although raised by the evidence, the claim for a TDIU has not been addressed by the RO. Accordingly, the Board finds that additional development is necessary before the Veteran's claim for entitlement to a TDIU can be adjudicated. The matters are REMANDED for the following action: 1. The RO should request the Veteran to identify any and all updated and/or outstanding VA and/or private medical records regarding the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy, including from December 2020 forward. Appropriate efforts must be made to obtain these records if he has adequately identified them and authorized their release (with respect to any private medical records). He should also be invited to submit these records himself. All actions to obtain the requested records should be documented in the claims file. If they cannot be located or no such records exist, the Veteran and his representative should be so notified in writing. 2. Then, forward the claims file to an appropriate clinician to determine the nature and severity of the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy for the period on appeal. If the clinician determines that a new examination (or telehealth interview, etc., if an in-person examination is not feasible) would be beneficial, one is to be obtained. The appropriate Disability Benefits Questionnaires, including for cranial nerves, cervical spine disability, and peripheral nerves, should be obtained. The clinician should opine on the severity of the Veteran's service-connected right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy from February 7, 2017, forward. Based on review of the claims file, the examiner should render an opinion addressing whether, at any point from February 7, 2017, forward, the record reflects any change(s) in the severity of the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy and, if so, the approximate date(s) of any such change(s). If an examination is performed, all indicated testing should be accomplished and all symptomatology associated with the Veteran's right greater auricular neuropathy, to include right anterior cutaneous nerve of the neck neuropathy should be identified. The clinician is asked to describe whether pain, weakness, fatigue, and/or incoordination significantly limits functional ability during flare-ups, as reported throughout the appellate period. If the examination does not take place during a flare-up, the clinician should have the Veteran describe and/or demonstrate functional ability during flare-ups. The clinician should describe the duration, frequency, and severity of any functional limitation during flare-ups. If there is no pain and/or no limitation of function, such facts must be noted in the report. The clinician should comment as to whether there is any medical reason to accept or reject the Veteran's description of functional loss during flare-ups. The clinician should also attempt to reconcile any and all internal inconsistencies in the January 2021 examination report. 3. The RO should send the Veteran a formal application for TDIU (VA Form 21-8940) and request him to complete and return the form. 4. When the completed VA Form 21-8940 has been submitted by the Veteran, or after a reasonable time has been provided for him to complete and return the form, and after conducting any additional development that may be warranted as determined by the RO, adjudicate the issue of entitlement to a TDIU. 5. If any of the above-sought benefits are denied, the RO should issue a Supplemental Statement of the Case (SSOC) to the Veteran and his representative. An appropriate period of time should be allowed for response before returning the appeal to the Board. DELYVONNE M. WHITEHEAD Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Seserman 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.