Citation Nr: 21040556 Decision Date: 07/06/21 Archive Date: 07/06/21 DOCKET NO. 10-45 430 DATE: July 6, 2021 REMANDED The claim of entitlement to a higher initial disability rating for disseminated coccidioidomycosis, with resection lesion of right shoulder and debridement of left chest and 10th rib (disseminated coccidiomycosis), rated as 50 percent prior to October 1, 2009, and 30 percent thereafter, is remanded. The claim of entitlement to a higher initial disability rating for right shoulder injury, rated as 10 percent prior to May 23, 2016, and 20 percent thereafter, is remanded. The claim of entitlement to a higher initial disability rating for irritable bowel syndrome, rated as 10 percent prior to February 25, 2014, and 30 percent thereafter, is remanded. The claim of entitlement to an initial compensable rating for right shoulder scars is remanded. The claim of entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. REASONS FOR REMAND The Veteran had honorable active duty service with the United States Army from March 2002 to July 2002, August 2004 to January 2006, and July 2006 to August 2007. In June 2017, this matter was remanded for additional development. A claim for TDIU has been reasonably raised by the record. The Board notes that in Rice v. Shinseki, 22 Vet. App. 447 (2009), the Court held that a claim for a TDIU due to a service-connected disability is part and parcel of an increased rating claim when such claim is raised by the record. 1. The claim of entitlement to a higher initial disability rating for disseminated coccidioidomycosis, rated as 50 percent prior to October 1, 2009, and 30 percent thereafter, is remanded. Please see discussion in paragraph 3. 2. The claim of entitlement to a higher initial disability rating for irritable bowel syndrome, rated as 10 percent prior to February 25, 2014, and 30 percent thereafter, is remanded. Please see discussion in paragraph 3. 3. The claim of entitlement to an initial compensable rating for right shoulder scars is remanded. The record indicates that there are outstanding private medical records relevant to the issues on appeal. January 2019 VA treatment records noted that the Veteran was seeing infectious disease experts, Dr. M. and/or Dr. R. at Texas Tech in Odessa, Texas to treat his coccidioidomycosis. The Board finds that a remand is required to obtain the outstanding private medical records. Additionally, the medical records show that the Veteran was prescribed itraconazole throughout the period on appeal to treat his coccidioidomycosis. An August 2016 VA treatment record indicated that the Veteran had not been taking itraconazole for the past year. At that time, there was no evidence of recurrence and the physician discussed getting a coccidiodes titre to determine the need for restarting the medication. A July 2018 VA treatment record noted the Veteran's reported history of taking itraconazole for two years. The physician stated that the Veteran had a threefold increase in coccidiodes antibody level. He reported joint pain involving the shoulders, hand, and knee, as well fleeting rashes and a persistent cough. Notably, July 2020 VA examiner noted that the Veteran treated his coccidioidomycosis with itraconazole, but indicated that suppressive therapy was not required. In light of the Veteran's ongoing use of itraconazole for his coccidioidomycosis, a remand is required to determine whether the Veteran's disorder requires suppressive therapy. 4. The claim of entitlement to a higher initial disability rating for right shoulder injury, rated as 10 percent prior to May 23, 2016, and 20 percent thereafter, is remanded. The Board finds that the July 2020 VA examination is inadequate for adjudication purposes. In Sharp v. Shulkin, 29 Vet. App. 26 (2017), the Court found that, in order for an examination of a joint to be adequate, the examiner must express an opinion on whether pain could significantly limit functional ability and the examiner's determination in that regard should, if feasible, be portrayed in terms of the degree of additional range of motion loss due to pain on use or during flare-ups. The July 2020 VA examiner stated that pain significantly limited functional ability with repeated use and during flare-ups. The examiner included the frequency, duration, severity, precipitating factors, and alleviating factors, however, he/she was unable to describe in terms of range of motion. The examiner did not provide an explanation as to why he/she could not provide range of motion estimates. Accordingly, a remand is required to obtain another VA examination. 5. The claim of entitlement to a total disability rating based upon individual unemployability (TDIU) is remanded. The record does not contain a VA Form 21-8940 or comparable information to determine the Veteran's employment and educational history. On remand, the Veteran should be provided a VA Form 21-8940 and the AOJ should undertake all appropriate development and then adjudicate the Veteran's TDIU claim. The matters are REMANDED for the following action: 1. The AOJ should undertake appropriate development to obtain any outstanding records pertinent to the Veteran's claims, to include private medical records from Dr. M. and/or Dr. R. at Texas Tech in Odessa, Texas. If any requested records are not available, the record should be annotated to reflect such and the Veteran notified in accordance with 38 C.F.R. § 3.159 (e). 2. Then, the AOJ must provide the Veteran with proper VCAA notice regarding the evidence and information necessary to substantiate his TDIU claim. He should also be requested to complete and return a VA Form 21-8940 (Veteran's Application for Increased Compensation Based on Unemployability). 3. Then, the Veteran should be afforded a VA examination by an examiner with sufficient expertise to determine the current severity of his service-connected coccidioidomycosis. The electronic records should be made available to and reviewed by the examiner. Any indicated studies should be performed. The AOJ should ensure that the examiner provides all information required for rating purposes. The examiner is specifically asked to state whether or not the Veteran's coccidioidomycosis requires suppressive therapy. In doing so, the examiner must consider and discuss the Veteran's ongoing use of itraconazole to treat the disorder. The examiner must also consider and discuss the Veteran's report of fleeting rashes, as well as joint pain associated with his coccidioidomycosis A complete rationale must be provided for all opinions offered. 4. Then, the Veteran should be afforded a VA examination by an examiner with sufficient expertise to determine the current severity of his service-connected right shoulder disorder. The electronic records should be made available to and reviewed by the examiner. Any indicated studies should be performed. The AOJ should ensure that the examiner provides all information required for rating purposes. The examiner should record the results of range of motion testing for pain on both active and passive motion, as well as on weight-bearing and nonweight-bearing and, if possible, with range of motion measurements of the opposite undamaged joint. The examiner is also requested to review the VA examination containing range of motion findings pertinent to the Veteran's right shoulder conducted during the course of the appeal. If the examiner is unable to do so, he or she should explain why. The examiner is specifically asked to set forth the extent of any functional loss due to weakened movement, excess fatigability, incoordination, pain on use, swelling, deformity, or atrophy of disuse. In addition, the examiner must determine the extent of any additional limitation of joint motion (in degrees) due to weakened movement, excess fatigability, incoordination, or pain during flare-ups and/or with repeated use. In doing so, the examiner must consider and discuss all procurable and assembled data such as the frequency, duration, characteristics, precipitating and alleviating factors, and the severity, and then provide an assessment of the functional loss during flares or on re, if possible in degrees of motion lost. This query should be accomplished regardless of whether the Veteran is experiencing a flare-up at the time of testing or not. If the VA examiner is unable to report the degree of additional range of motion loss during repeated use or a flare-up, the VA examiner must explain why it is not feasible to render such an opinion. In other words, the VA examiner should opine as to any resultant loss in range of motion that would occur during repeated use or flare-ups or explain why it is not feasible to render such an opinion. If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner (does not have the knowledge or training). (Continued on the next page) 5. Then, readjudicate the issues on appeal. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran and his representative should be furnished an appropriate supplemental statement of the case and be afforded the requisite opportunity to respond. Thereafter, the case should be returned to the Board for further appellate review. B. MULLINS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. McKinley, 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.