Citation Nr: 22013587 Decision Date: 03/10/22 Archive Date: 03/10/22 DOCKET NO. 13-21 426 DATE: March 10, 2022 REMANDED Entitlement to an initial rating in excess of 10 percent prior to September 15, 2021, and a rating in excess of 20 percent thereafter, for myofascial syndrome is remanded. Entitlement to a compensable rating prior to March 28, 2018, and a rating in excess of 30 percent thereafter, for left upper extremity (LUE) radiculopathy associated with myofascial syndrome is remanded. REASONS FOR REMAND The Veteran served honorably from July 1987 to September 1992. This matter comes to the Board of Veterans' Appeals (Board) on appeal from an April 2010 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). A personal hearing was conducted before the undersigned Veteran Law Judge in November 2017. A transcript is associated with the record. The issue of an increased rating for myofascial syndrome was most recently Remanded in August 2021. An October 2021 rating decision granted a rating of 20 percent for myofascial syndrome effective September 15, 202. That decision also assigned a separate compensable 30 percent rating for LUE radiculopathy, effective March 28, 2018. Entitlement to an initial rating in excess of 10 percent prior to September 15, 2021, and a rating in excess of 20 percent thereafter, for myofascial syndrome is remanded. On Remand in August 2021, the Board sought to clarify whether the Veteran experienced intervertebral disc syndrome (IVDS). Reference was made to earlier VA examinations that contained conflicting findings. The examiner was specifically asked to reconcile the findings of a March 2018 DBQ and March 2019 VA examination. The VA examiner determined that the Veteran did not have a diagnosis of IVDS but failed to reconcile the earlier findings. The Board finds that the September 2021 VA examination does not comply with the August 2021 remand instructions. A remand by the Board confers on the Veteran, as a matter of law, the right to compliance with the remand order. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Another remand is needed to address the conflicting evidence of record. Entitlement to a compensable rating prior to March 28, 2018, and a rating in excess of 30 percent thereafter, for LUE radiculopathy associated with myofascial syndrome is remanded. In light of the above determination, the Board finds it must also remand the Veteran's claim for increased rating for LUE radiculopathy. The issue is inextricably intertwined with the issue of entitlement to increased compensation for myofascial syndrome, as the evidence developed during the processing of the latter claim may impact the former's rating. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (holding issues are inextricably intertwined when a decision on one issue would have a significant impact on a veteran's claim for the second issue). The matters are REMANDED for the following action: Obtain an addendum opinion to determine the nature and severity of the Veteran's service-connected myofascial syndrome. The evidence of record including a copy of this REMAND, must be made available to, and reviewed by the examiner. The medical opinion should include a notation that the full REMAND instructions were reviewed by the VA examiner. 1. Determine whether the record supports the diagnosis of IVDS at any time during the appeal period. 2. If a diagnosis of IVDS is made, determine the date of onset and severity throughout the appeal period. 3. If the VA examiner determines that the Veteran did not have a diagnosis of IVDS during the appeal period, the VA examiner must reconcile this finding with the March 2018 DBQ and March 2019 VA examination that determined that the Veteran has IVDS. The clinical significance of December 2017 MRI showing multilevel cervical spondylosis with multilevel neural foraminal stenosis should also be discussed. Rationale must be provided for all requested opinions. The opinion should acknowledge, address, consider, and discuss all lay evidence in the record pertaining to the Veteran's cervical spine disability. If the VA examiner concludes that an opinion cannot be offered without resort to mere speculation, the VA examiner must address whether research in the medical literature might assist him/her in providing the medical opinion requested in this matter, and if so, such research in the medical literature must be conducted. The VA examiner must also indicate whether any use of the phrase "without resorting to mere speculation" reflects the limitations of knowledge in the medical community at large as opposed to the limits of his/her knowledge and expertise in particular. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Smith, 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.