Citation Nr: 21040075 Decision Date: 07/02/21 Archive Date: 07/02/21 DOCKET NO. 15-29 376 DATE: July 2, 2021 REMANDED Entitlement to a disability evaluation in excess of 20 percent for a right shoulder disability, excepting temporary total evaluation periods is remanded Entitlement to a compensable evaluation for scarring of the bilateral lower extremities is remanded. Entitlement to a TDIU is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1982 to February 2003. These matters come before the Board of Veterans' Appeals (Board) on appeal from rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge at a Board hearing in February 2017. The transcript is of record. These matters were most recently before the Board in September 2020, at which time they were remanded for development. They have been returned to the Board for appellate review. 1. Entitlement to a disability evaluation in excess of 20 percent for a right shoulder disability, excepting temporary total evaluation This matter must be remanded in order to obtain clarity as to the current nature and severity of the Veteran's right shoulder disability. The two most recent VA examinations of the Veteran's service-connected right shoulder disability are grossly at odds with respect to the degree of limitation shown, with no apparent explanation in the latter examination report, or elsewhere in the record, to reconcile the disparate findings. For instance, in November 2019, right shoulder flexion and abduction were limited to 80 degrees each, with pain on motion, and such a degree of tenderness as to preclude repeat testing. In contrast, in February 2021, range of motion in flexion and abduction had doubled, both measuring to 160 degrees, albeit with continued pain on motion. Moreover, the examiner indicated that no loss of range of motion would be expected during flareups or with repeated use over time, despite the November 2019 findings, and the disparity in testing was not addressed in the examination report. Treatment records do not shed sufficient light on the current nature and manifestations of the Veteran's condition to permit the Board to adjudicate this matter without additional clarity as to the current limitations associated with the Veteran's right shoulder disability, and as such, the Board finds that a new VA examination is necessary. On remand, the Veteran must be afforded a new examination of the right shoulder, and the examiner should address the manifest disparity with respect to earlier testing. 2. Entitlement to a compensable evaluation for scarring of the bilateral lower extremities The Veteran has several scars on his lower extremities associated with his history of bunionectomies on the bilateral feet. While treatment records do not explicitly reveal the nature or measurements of the scarring, the Veteran has been afforded several VA examinations exploring the nature and severity of the scars. In November 2019, the Veteran's scars were noted to be four in number, the largest measuring 5 cm by 0.5 cm, and the others 3 cm x 0.5 cm, 2cm x 0.5 cm, and 1 cm x 0.5 cm. The scars were neither painful nor unstable, and the examiner opined that the scarring alone conferred no functional limitations. A March 2021 VA examiner noted five scars, all of which he characterized as painful, with none unstable, and each measured at 1 x 0.5cm. The examiner explained that the scarring caused no functional limitation and no disfigurement. The Board notes that these examination results are not in accord. Moreover, the scarring has never been characterized, either in treatment records or in previous examination reports, including general medical examinations and the November 2019 VA scars examination, as being painful. However, the March 2021 VA examiner characterized all lower extremity scarring as painful, without explanation as to why that finding differed from those made previously, and without clarifying whether that finding was based on the Veteran's subjective reporting, or some other testing or criteria. On remand, a new VA examination must be conducted, and some clarity obtained as to the number and dimensions of the Veteran's lower extremity scarring, and whether any of the scars identified are painful or unstable. 3. Entitlement to a TDIU is remanded. Because the Veteran's claim for entitlement to a TDIU is inextricably intertwined with the above-enumerated claims for increase, it too must be remanded. The matters are REMANDED for the following action: 1. After obtaining the necessary authorization, obtain any outstanding VA and private treatment records relevant to the Veteran's claim. 2. Then, schedule the Veteran for a VA examination to assess the severity of the service-connected right shoulder disability. The record, including a copy of this remand, must be made available to the examiner, and the examination report should include discussion of the Veteran's documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the requesting examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. The examiner is asked to describe the current nature and severity of the Veteran's right shoulder disability. All pertinent symptomatology and findings should be reported in detail in accordance with VA rating criteria. Range of motion in active motion, passive motion, weight-bearing, and nonweight-bearing must be conducted. 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 rationale for all opinions expressed must be provided. The examiner is specifically directed to estimate the degree of functional loss expected during flareups or with repetitive use of the right shoulder over time, in terms of degrees of range of motion if possible. It is understood that assessments with respect to any condition not under direct observation may require a degree of speculation. 3. Schedule the Veteran for a VA examination to assess the nature and severity of the service-connected scarring of the bilateral lower extremities. The record, including a copy of this remand, must be made available to the examiner, and the examination report should include discussion of the Veteran's documented medical history and assertions. All indicated tests and studies should be accomplished (with all findings made available to the requesting examiner prior to the completion of his or her report), and all clinical findings should be reported in detail. In particular, the examiner is directed to note whether any scars of the bilateral lower extremities are painful or unstable. The examiner should clarify on the examination report whether findings with respect to painful or unstable scars are based on testing or other objective criteria. 4. Review the opinions and any examination reports to ensure that they are in complete compliance with the directives of this remand. If any opinion or report is deficient in any manner, the AOJ must implement corrective procedures. 5. Readjudicate the claims remaining on appeal, including the TDIU claim. GAYLE STROMMEN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Z. Sahraie, 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.