Citation Nr: 21075490 Decision Date: 01/19/22 Archive Date: 01/19/22 DOCKET NO. 13-21 161 DATE: January 19, 2022 REMANDED A rating higher than 10 percent for a right wrist disability is remanded. A total disability rating based on individual unemployability (TDIU) is remanded. Special monthly compensation (SMC) at the housebound rate is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1971 to October 1973. In August 2018, the Court of Appeals for Veterans Claims (Court) remanded his right wrist increased rating claim to the Board of Veterans' Appeals (Board) for readjudication. The Board then remanded to the agency of original jurisdiction (AOJ) in June 2019. As explained below, another remand to the AOJ is now warranted. Increased Rating for Right Wrist Disability The Veteran's right wrist disability is rated at 10 percent under 38 C.F.R. § 4.71a, Diagnostic Code 5215, based on limitation of motion. In December 2016, the Board denied an increased rating because the disability was not manifested by ankylosis, per Diagnostic Code 5214. However, the Court found that the Board failed to address whether he is entitled to a higher rating under 38 C.F.R. § 4.73, Diagnostic Codes 5307-5308, for muscle impairment. The Court noted that a March 2016 VA examination revealed the disability "had manifested in poor muscle strength on both flexion and extension of the wrist." Memorandum Decision at 3. As explained in the Board's prior remand, the 2016 examination report did not contain the information necessary to rate the disability under Diagnostic Codes 5307 or 5308. The Board remanded for a muscle injuries examination, and the Veteran received one from a VA contractor in March 2021. The Board finds the March 2021 examination inadequate to decide the claim because the examiner made internally inconsistent findings about the Veteran's muscle impairment. The examiner indicated that he has (or had) an injury to multiple muscle groups affecting the right arm, forearm and hand, i.e., Groups V-VIII. The examiner determined that, as a result, he "is unable to perform functions that require repetitive flexion of [the] right elbow and wrist." Additionally, muscle strength testing revealed less than normal strength (4/5) on right wrist flexion and extension, compared to normal strength (5/5) on the left side. However, at the same time, the 2021 examiner indicated that the Veteran did not have any of the cardinal signs or symptoms of a muscle disability, which include loss of power, weakness, lower threshold of fatigue, fatigue and/or pain, impairment of coordination, and uncertainty of movement. See 38 C.F.R. § 4.56(c). This appears to contradict the findings above, as well as the March 2016 examiner's finding that a reduction in strength on examination was "entirely due" to the service-connected disability. The 2021 examination report contains no explanation for these contradictory findings. Another remand to the AOJ is necessary to ensure compliance with the Board's previous instructions. Stegall v. West, 11 Vet. App. 268, 271 (1998); see also Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). On remand, the examiner must specifically address the cardinal signs and symptoms of a muscle disability present in the Veteran's case. TDIU & SMC In December 2021, the Veteran submitted evidence and argument in support of a TDIU and SMC based on the right wrist disability. These issues are now part of the appeal. Rice v. Shinseki, 22 Vet. App. 447, 453 (2009); Akles v. Derwinski, 1 Vet. App. 118, 121 (1991); 38 C.F.R. § 3.155(d)(2). Because they are "inextricably intertwined" with the right wrist increased rating claim, the Board will remand them as well. Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The Board by this remand makes no determination, expressed or implied, concerning the credibility of any statements on file. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected right wrist muscle injury. The examiner should provide a full description of the muscle disability and report all signs and symptoms necessary to evaluate the muscle disability under the appropriate diagnostic code(s). See 38 C.F.R. §§ 4.56, 4.73. In particular, the examiner must address the cardinal signs and symptoms of a muscle disability present in the Veteran's case. 38 C.F.R. § 4.56(c). 2. Review the examination report above to ensure substantial compliance with the Board's directives. Take any necessary corrective action. 3. Readjudicate the Veteran's right wrist claim, as well as the intertwined TDIU and SMC issues. Allow the Veteran and his attorney the opportunity to respond. Then return to the Board for further appellate review. KELLI A. KORDICH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D.Z. Wall, 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.