Citation Nr: 21030665 Decision Date: 05/19/21 Archive Date: 05/19/21 DOCKET NO. 11-10 036 DATE: May 19, 2021 REMANDED Service connection for a left rib condition. A total disability rating based on individual unemployability (TDIU) prior to January 8, 2021. REASONS FOR REMAND The Veteran served on active duty from July 1972 to July 1974. The case is on appeal from an August 2010 and January 2012 rating decisions. In April 2014, the Veteran testified at a Board hearing. Most recently, in a September 2020 decision, the Board granted service connection for a left hand condition and a right hand condition. The Board also remanded the claims remaining on appeal for additional development. 1. Service connection for a left rib condition. The Veteran is seeking service connection for a left rib condition. He contends that he has a left rib disability related to a fall from a ladder during service. The claim was remanded most recently by the Board in September 2020 for an examination or opinion to determine if the Veteran has a current left rib disability, and if so, the etiology of such condition. The Board directed the examiner to address whether the Veteran has a current left rib condition, to include whether there exists pain alone that rises to the level of functional impairment. See Saunders v. Wilkie, 886 F.3d 1356, at 1367-68 (Fed. Cir. 2018) (indicating that the term "disability" refers to the functional impairment of earning capacity, rather than the underlying cause of the impairment, and pain alone may be a functional impairment). An opinion was obtained in October 2020. The VA examiner noted that there was no documentation in the Veteran's service treatment records (STRs) of functional impairment during service or after service aside from a fall reported in 2008. The Board finds this opinion is not entirely adequate to decide the claim. In this regard, the examiner did not consider statements from the Veteran at the time of an October 2016 VA examination in which in reported experiencing pain with deep breaths, coughing, and twisting. As such, the Board finds a new VA examination is warranted to evaluate the Veteran's left rib pain to determine if he has a current disability, and if so, whether it is related to his reports of the in-service fall. In reaching these conclusions, the examiner should also consider the Veteran's post-service work history which includes work as a professional boxer and an October 2008 left side rib fracture the Veteran sustained after a fall. 2. A TDIU prior to January 8, 2021. The Veteran contends that his service-connected conditions prevent him from obtaining and maintaining substantially gainful employment. The Board notes that in a June 2014 decision it assumed jurisdiction of the claim for entitlement to TDIU as part and parcel of the Veteran's left shoulder increased rating claim. See Rice v. Shinseki, 22 Vet. App. 447 (2009). The Board also notes that, while the case was in remand status, in a December 2020 rating decision, the RO granted a TDIU effective from January 8, 2021. Thus, the TDIU issue is on appeal for the period prior to January 8, 2021 even though the issue was not included in the most recent January 2021 supplemental statement of the case (SSOC). Prior to January 8, 2021, the Veteran's service-connected conditions included residuals of a head injury, arthritis of the left shoulder, and arthritis of several fingers. In this case, the Board finds that a "combined effects" opinion regarding employability is warranted that considers all of the Veteran's service-connected disabilities. See Geib v. Shinseki, 733 F.3d 1350 (Fed. Cir. 2013); Floore v. Shinseki, 26 Vet. App. 376 (2013). Additionally, the evidence indicates that records from the Social Security Administration (SSA) exist, but complete SSA records do not appear to be currently associated with the claims file. As SSA records could be relevant to the Veteran's claim concerning the instant appeal. Thus, complete SSA records should be requested on remand. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159(c). The matters are REMANDED for the following action: 1. Request all documents pertaining to the application of disability benefits from SSA, including the records relied upon in determining whether benefits were warranted. 2. Schedule the Veteran for an examination (or telehealth interview, records review, etc. if an in-person examination is not feasible) to determine the nature and etiology of the Veteran's left rib condition. The entire claims file must be reviewed by the examiner. The examiner is to conduct all indicated tests. First, the examiner should determine whether the Veteran has any current left rib condition, which may include pain alone that rises to the level of functional impairment. If a diagnosis or functional impairment is not shown, it should be explained why this is so. If a diagnosis or functional impairment is shown, the examiner should provide an opinion as to whether it is at least as likely as not that the Veteran's left rib condition has its onset or is otherwise related to service. The examiner should take into consideration the Veteran's post-service employment history which includes work as a professional boxer and a history of long-term physical labor, and an October 2008 left side rib fracture the Veteran sustained after a fall. The examiner should provide rationale for all opinions expressed, including by citing to the record. 3. Thereafter, forward the Veteran's claims file to an appropriate examiner to obtain an opinion commenting on the effects of the combination of the Veteran's service-connected disabilities on his ability to secure or follow gainful employment prior to January 8, 2021. In proffering this "combined effects" opinion, the examiner should review the claims file and take into consideration the Veteran's level of education, special training, and previous work experience, but not age or any impairment caused by nonservice-connected disabilities. There should be one opinion as to the combined effects and not multiple opinions addressing each individual disability. The examiner should provide a rationale for all opinions expressed, including by citing to the record. RYAN T. KESSEL Veterans Law Judge Board of Veterans' Appeals Attorney for the Board E. Gray, 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.