Citation Nr: 21029587 Decision Date: 05/14/21 Archive Date: 05/14/21 DOCKET NO. 07-24 202 DATE: May 14, 2021 REMANDED Entitlement to an evaluation in excess of 10 percent for residuals of a right wrist fracture with degenerative changes and loss of motion is remanded. REASONS FOR REMAND The Veteran served on active duty from January 1975 to July 1976. This matter is before the Board of Veterans' Appeals (Board) on appeal of an August 2006 rating decision of a Regional Office (RO) of the Department of Veterans Affairs (VA). The Veteran testified before the undersigned during a May 2009 hearing. Most recently, the Board remanded this matter in February 2021 for further development. The case has been returned to the Board at this time for further appellate review. The Board notes that the Veteran has been granted entitlement to a total disability rating based on individual unemployability (TDIU) effective January 7, 2006. Although a TDIU claim would ordinarily be raised by the record as part and parcel of the February 2006 increased rating claim for residuals of a right wrist fracture with degenerative changes and loss of motion, pursuant to Rice v. Shinseki, 22 Vet. App. 447 (2009), the Board will not address entitlement to TDIU in this decision as entitlement to TDIU has already been granted for the entire time period encompassed by the 2006 Rice TDIU claim raised in the instant appeal. The Board also notes that, because the Veteran has been granted entitlement to TDIU for the entire time period covered by the instant appeal, he previously showed interest in withdrawing the claim on appeal but did not submit the required paperwork. Should the Veteran wish to withdraw the claim on appeal, he, or his authorized representative, may do so in writing. A written withdrawal must include the name of the veteran, the applicable VA file number, and a statement that the appeal is withdrawn. Entitlement to an evaluation in excess of 10 percent for residuals of a right wrist fracture with degenerative changes and loss of motion is remanded. The October 2020 VA wrist conditions examination reflects a new diagnosis of rheumatoid arthritis (RA) in both of the Veteran's wrists. However, it is unclear from the VA examination whether the Veteran's RA symptoms can be separated from the symptoms of his service-connected residuals of a right wrist fracture with degenerative changes and loss of motion. See generally Mittleider v. West, 11 Vet. App. 181, 182 (1998) (where effects of service-connected disabilities and non-service-connected disabilities cannot be distinguished, they will all be attributed to the service-connected disabilities). If the symptoms from RA are distinct from the currently service-connected residuals, then it must be determined if the symptoms stemming from RA are either caused or aggravated by the Veteran's service-connected residuals of a right wrist fracture. In this regard, the October 2020 VA examiner provided an opinion regarding secondary service connection for the Veteran's RA, however, the VA examiner did not properly address aggravation. See El-Amin v. Shinseki, 26 Vet. App. 136 (2013) (findings of "not due to," "not caused by" and "not related to" are insufficient to address the question of aggravation under 38 C.F.R. § 3.310 (b)). This matter is REMANDED for the following action: Obtain an opinion with a qualified clinician who has not previously opined about the Veteran's claim to determine the nature and etiology of the Veteran's rheumatoid arthritis of the bilateral wrists. If the selected clinician determines that an examination is necessary to respond to this request, such examination should be scheduled. Following review of the claims file, and examination of the Veteran if deemed necessary, the examiner should first opine as to whether the symptoms of the Veteran's rheumatoid arthritis can be clearly delineated from the symptoms of his service-connected residuals of a right wrist fracture with degenerative changes and loss of motion. If the symptoms from the rheumatoid arthritis cannot be clearly delineated from the symptoms of the service-connected residuals of a right wrist fracture with degenerative changes and loss of motion, this must be expressly stated. If they can be clearly delineated, the examiner must describe the symptoms attributable to each diagnosis. If the examiner finds that the symptoms of the Veteran's rheumatoid arthritis can be clearly delineated from the symptoms of his service-connected residuals of a right wrist fracture with degenerative changes and loss of motion, the examiner should opine whether it is at least as likely as not (50 percent or greater probability) that the Veteran's rheumatoid arthritis is (a) caused by; or (b) aggravated (i.e., worsened beyond the normal progression of the disease) by the Veteran's service-connected residuals of a right wrist fracture with Please note, causation and aggravation are separate concepts and must be addressed independently. The examiner is advised that the Veteran is competent to report his symptoms capable of lay observation, and such reports must be specifically acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, he or she must provide a reason for doing so. All findings must be reported in detail and all opinions must be accompanied by a clear rationale. If any of the above issues cannot be resolved without resorting to speculation, then a detailed medical explanation as to why this is so must be provided. M. HYLAND Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Elias, 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.