Citation Nr: 22017984 Decision Date: 03/27/22 Archive Date: 03/27/22 DOCKET NO. 20-23 898 DATE: March 27, 2022 REMANDED Entitlement to service connection for atrial fibrillation is remanded. Entitlement to an initial rating in excess of 30 percent for unspecified depressive disorder with insomnia is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left vagus cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right vagus cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left hypoglossal cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right hypoglossal cranial nerve is remanded. Entitlement to initial ratings in excess of 20 percent prior to January 4, 2018, and in excess of 10 percent from that date, for Parkinson's disease with left upper extremity weakness is remanded. Entitlement to initial ratings in excess of 30 percent prior to January 4, 2018, and in excess of 10 percent from that date, for right upper extremity weakness is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left glossopharyngeal cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right glossopharyngeal cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left facial cranial nerve is remanded. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right facial cranial nerve is remanded. Entitlement to a total disability rating based on individual unemployability is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1967 to March 1970. These matters come before the Board of Veterans' Appeals (Board) from July 2017, September 2017, March 2018, and July 2018 rating decisions. In September 2021, the Veteran testified before the undersigned Veterans Law Judge by virtual hearing; a transcript is of record. 1. Entitlement to service connection for atrial fibrillation is remanded. The Veteran contends that he has atrial fibrillation that is secondary to his service-connected Parkinson's disease. The Veteran specifically asserts that his Parkinson's disease has caused hypotension, and that hypotension is a cause of his atrial fibrillation. The record contains a Patient Education Note furnished to the Veteran with information about Parkinson's disease. This note lists hypotension as a symptom of Parkinson's disease. A June 2020 private treatment record noted that the Veteran was seen for atrial fibrillation. It noted that the Veteran also had hypotension that "he relates to his Parkinson's disease and medications." In argument received with his substantive appeal in April 2020, the Veteran requested that he be provided with a VA examination to determine whether he is entitled to service connection for atrial fibrillation as secondary to Parkinson's disease. The Board agrees that a VA examination is needed to properly evaluate the Veteran's claim. McLendon v. Nicholson, 20 Vet. App. 79 (2006). 2. Entitlement to an initial rating in excess of 30 percent for unspecified depressive disorder with insomnia is remanded. 3. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left vagus cranial nerve is remanded. 4. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right vagus cranial nerve is remanded. 5. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left hypoglossal cranial nerve is remanded. 6. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right hypoglossal cranial nerve is remanded. 7. Entitlement to initial ratings in excess of 20 percent prior to January 4, 2018, and in excess of 10 percent from that date, for Parkinson's disease with left upper extremity weakness is remanded. 8. Entitlement to initial ratings in excess of 30 percent prior to January 4, 2018, and in excess of 10 percent from that date, for right upper extremity weakness is remanded. 9. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left glossopharyngeal cranial nerve is remanded. 10. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right glossopharyngeal cranial nerve is remanded. 11. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, left facial cranial nerve is remanded. 12. Entitlement to an initial rating in excess of 10 percent for loss of automatic movements, right facial cranial nerve is remanded. The Veteran testified before the undersigned that his service-connected Parkinson's disease and associated disabilities, specifically unspecified depressive disorder, bilateral upper extremity weakness, and loss of automatic movements of the left and right vagus cranial nerve, the left and right hypoglossal cranial nerve, the left and right glossopharyngeal cranial nerve, and the left and right facial cranial nerve, have worsened since the most recent VA examinations for such, conducted in 2018 and 2020. Accordingly, on remand, the Veteran should be scheduled for new VA examinations to determine the current severity of these disabilities. 38 C.F.R. § 3.327 (a); see Snuffer v. Gober, 10 Vet. App. 400 (1997). 13. Entitlement to a total disability rating based on individual unemployability is remanded. The issue of entitlement to a TDIU has been raised as part and parcel of the increased rating claims on appeal. Rice v. Shinseki, 22 Vet. App. 447 (2009). As the increased rating claims are being remanded for further development, the Board will defer adjudication of the intertwined issue of entitlement to a TDIU. See Harris v. Derwinski, 1 Vet. App. 180 (1991). The Veteran submitted a VA Form 21-8940 in September 2021. On remand, a VA Form 21-4192 should be obtained from the employer identified by the Veteran. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination by an appropriate medical professional to determine the etiology of his atrial fibrillation. The examiner is to review the file and conduct all necessary tests and studies. The examiner is to provide an opinion as to whether it is at least as likely as not that the Veteran's atrial fibrillation is proximately caused by or aggravated by his service-connected Parkinson's disease. The Veteran asserts that his Parkinson's disease has caused hypotension, and that hypotension is a cause of his atrial fibrillation. Thus, in providing the nexus opinion, the examiner must specifically discuss the role of hypotension, to include whether any hypotension that may be related to atrial fibrillation is itself associated with the service-connected Parkinson's disease. A rationale for all opinions expressed must be provided. 2. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected unspecified depressive disorder with insomnia. The examiner should provide a full description of the disability. The examiner should also opine regarding the levels of occupational and social impairment caused by the psychiatric disability, and should describe the symptoms, to include the frequency and severity of symptoms, that results in those levels of impairment. 3. Schedule the Veteran for a VA examination to determine the current nature and severity of the Veteran's service-connected Parkinson's disease and associated disabilities, specifically bilateral upper extremity weakness; loss of automatic movements of the left and right vagus cranial nerve; loss of automatic movements of the left and right hypoglossal cranial nerve; loss of automatic movements of the left and right glossopharyngeal cranial nerve; and loss of automatic movements of the left and right facial cranial nerve. The examiner should provide a full description of the Veteran's disabilities and report all signs and symptoms necessary for evaluating these disabilities under appropriate rating criteria. 4. Attempt to obtain a completed VA Form 21-4192, Request for Employment Information, from the employer identified in the Veteran's VA Form 21-8940 received in September 2021 and conduct any necessary development to adjudicate entitlement to TDIU. D. JOHNSON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. G. Mazzucchelli, 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.