Citation Nr: 22017428 Decision Date: 03/25/22 Archive Date: 03/25/22 DOCKET NO. 12-33 625A DATE: March 25, 2022 REMANDED Entitlement to a rating in excess of 30 percent for status-post gunshot wound involving the right ulnar nerve distribution and muscular groups (MGs) VII and VIII is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1970 to August 1974 and in the United States Army from July 2002 to March 2004. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an October 2009 rating decision issued by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2013, the Veteran testified at a Board hearing before the undersigned Veterans Law Judge. A transcript of that hearing is associated with the claims file. In August 2021, the Board last remanded this matter to the RO for further development. Entitlement to a rating in excess of 30 percent for status-post gunshot wound involving the right ulnar nerve distribution and MGs VII and VIII Although the Board sincerely regrets the additional delay, a remand is warranted because the October 2021 VA retrospective opinion is inadequate to decide the Veteran's claim. In this regard, the October 2021 VA clinician opined that the Veteran's overall residuals involving the right ulnar nerve distribution and MGs VII and VIII since June 2008 are moderate. The VA clinician explained that there is no functional impairment, and no cardinal signs and symptoms of muscle disability, including any loss of power, weakness, lowered threshold of fatigue, fatigue pain, impairment of coordination, and uncertainty of movement. The clinician also noted that the evidence of record shows that the Veteran maintains full range of motion throughout all peripheral extremities and joints, that he is neurologically intact with a strength of 5/5 throughout both upper and lower extremities, and that on examination of the right shoulder more than a decade after his gunshot wound, he maintained a full range of motion of the shoulder with no detectable neurological weakness in the right hand. The October 2021 VA clinician's statements, however, contradict the other evidence of record, including the recent September 2021 muscle injuries and peripheral nerves examinations indicating the Veteran had consistent weakness, lowered threshold fatigue, fatigue and/or pain, and impairment of coordination attributable to MGs VII and VIII. Moreover, the September 2021 muscle injuries examination reflects 4/5 muscle strength in the right wrist flexion and extension and that the Veteran experienced difficulties with lifting, gripping, carrying, pushing, and pulling moderate objects while the June 2021 VA examiner noted that the Veteran would be limited in most occupation settings due to limitation in reaching, carrying, pushing, pulling and lifting, as well as gripping turning knobs, opening doors, writing and typing from the neuropathy of muscle groups VII and VIII. The October 2021 VA clinician did not provide any explanation for his findings in light of this other evidence of record. The Board notes that a medical opinion based on an inaccurate factual premise has no probative value. See Reonal v. Brown, 5 Vet. App. 458, 461 (1993). Accordingly, a remand is warranted for an addendum retrospective opinion that contains complete and factually accurate rationale based upon review of the evidence of record. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). The matters are REMANDED for the following action: 1. Obtain and associate with the claims file any outstanding VA treatment records. The last VA treatment of record is dated September 2021. 2. Then, obtain a retrospective opinion from an appropriate medical professional, other than the October 2021 VA provider, concerning the severity of MGs VII and VIII, to include any other MGs found to be associated with the right ulnar nerve distribution since June 2008 (one year prior to the date of the claim for increase). A copy of the Veteran's claims file, to include this Remand, must be made available to and be thoroughly reviewed by the VA clinician. The VA clinician is asked to respond to the following: The VA clinician must provide an assessment from June 2008 to present as to whether the Veteran's overall residuals for his status-post gunshot wound involving the right ulnar nerve distribution and MGs VII and VII are best characterized as moderate, moderately severe, or severe. The clinician should provide a rationale for the assigned degree of severity. In providing the above opinion, the VA clinician should consider the other evidence of record including the September 2021 muscle injuries VA examination; June 2021 muscle injuries and peripheral nerves VA examinations; August 2019 muscle injuries and peripheral nerves VA examinations; October 2013 Board hearing testimony (testifying that he experiences numbness in his arm and fingers and that he is limited in how much weight he can lift as his arm is weak); October 2009 VA peripheral nerves examination; and September 2009 VA muscles examination. A complete rationale must be provided for all opinions expressed. If any opinion cannot be provided without resorting to mere speculation, provide a complete explanation stating why, to include explaining whether the inability to provide a more definitive opinion is the result of a need for additional information or that you have exhausted the limits of current medical knowledge in providing answers to the questions. MARJORIE A. AUER Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Amanda Purcell, 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.