Citation Nr: 18131203
Decision Date: 08/31/18	Archive Date: 08/31/18

DOCKET NO. 16-01 098
DATE:	August 31, 2018
REMANDED
Entitlement to a rating in excess of 10 percent for meralgia paresthetica is remanded.
REASONS FOR REMAND
The Veteran served on active duty from June 1982 to September 1986, from May to September 1990 and from February 1994 to March 2010.
This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2015 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Oakland, California.  
Entitlement to a rating in excess of 10 percent for meralgia paresthetica is remanded.
The Veteran contends that he is entitled to a rating in excess of 10 percent for his meralgia paresthetica because he believes his symptoms are moderate in severity.  In that regard, he states that he experiences periods of time where his pain is severe and hinders his ability to walk by causing him to limp and at other times he has experienced milder symptoms.  He contends that in general, his symptoms are what he deems to be moderate.  See December 2015 VA Form 9. 
The Veteran was last afforded a VA examination in May 2015 where the examiner noted the Veteran’s diagnosis of meralgia paresthetica.  The Veteran reported that he has a constant level of discomfort and aches in the right thigh on the anterior surface.  He also reported that sometimes his pain is so great that he has to sit down.  The examiner noted that the Veteran had mild to moderate pain of the right upper extremity (The Board notes that the examiner checked the boxes for right upper extremity rather than right LOWER extremity).  Specifically, the examiner stated that the Veteran had mild constant pain; and moderate intermittent pain, paresthesias and numbness.  The Veteran’s muscle and sensory exams were normal.  The examiner stated that the Veteran had mild incomplete paralysis of the external cutaneous nerve of the thigh.
In a May 2015 correspondence, the Veteran stated that his meralgia paresthetica causes symptoms of daily pain; burning sensation; and a sensation of pins and needles in his right thigh.  He stated that he has tried several prescription medications, to no avail.  He also indicated that he told the May 2015 examiner that his disability was moderate in severity and was surprised that she recorded mild incomplete paralysis.  He stated that the examiner barely examined him and he thought of the examination as more of an interview than an exam.  See December 2015 VA Form 9.  
The Veteran’s meralgia paresthetica is rated under Diagnostic Code 8526, 38 C.F.R. § 4.124a. Under Diagnostic Code 8526, complete paralysis of the femoral nerve include paralysis of the quadriceps extensor muscles, and is to be rated at 40 percent. Severe incomplete paralysis is to be rated 30 percent; moderate incomplete paralysis is to be rated 20 percent; mild incomplete paralysis is to be rated 10 percent.
Words such as “severe,” “moderate,” and “mild” are not defined in the Rating Schedule. Rather than applying a mechanical formula, VA must evaluate all evidence, to the end that decisions will be equitable and just. 38 C.F.R. § 4.6. Although the use of similar terminology by medical professionals should be considered, is not dispositive of an issue. Instead, all evidence must be evaluated in arriving at a decision regarding a request for an increased disability rating. 38 U.S.C. § 7104; 38 C.F.R. §§ 4.2, 4.6.
Here, the Board finds that a remand is necessary to obtain another examination which provides requisite testing and an assessment of the current severity of the Veteran’s meralgia paresthetica.  In that regard, the Veteran’s Notice of Disagreement and VA Form 9 raised questions about the adequacy of the Veteran’s May 2015 VA examination.  The Veteran contended that little testing was conducted and he feels that the current severity of his disability was not captured.  Therefore, the Board finds that a remand is necessary to obtain an examination.  The examiner is to provide necessary testing and include the Veteran’s lay statements regarding the severity of his disability.  
Also, in a May 2015 correspondence, the Veteran stated that his last visit to Dr. J. Smith in 2013 (which is not of record) may shed some light on the current severity of his meralgia paresthetica.  The Veteran filed a claim for an increased rating in February 2015.  Evidence dating from February 2014 to the present is relevant to the current increased rating claim.  See 38 C.F.R. § 3.400(o)(2). Although evidence from the 2013 visit is not relevant to the current period on appeal, the Board finds that a remand is necessary to obtain any outstanding private treatment visit records during the period on appeal.
The matter is REMANDED for the following action:
1. Contact the Veteran and request that he provide or authorize the release of any private treatment records from Dr. J. Smith, as well as any other private records, not already of record, that are relevant to his claim. See May 2015 correspondence.  
If, after making reasonable efforts to obtain non-VA records the Agency of Original Jurisdiction (AOJ) is unable to secure same, the AOJ must notify the Veteran and (a) identify the specific records the AOJ is unable to obtain; (b) briefly explain the efforts that the AOJ made to obtain those records; (c) describe any further action to be taken by the AOJ with respect to the claim; and (d) inform the Veteran that he is ultimately responsible for providing the evidence. The Veteran must then be given an opportunity to respond.
2. Then, schedule a VA examination to ascertain the severity of the Veteran’s meralgia paresthetica. The claims file must be reviewed by the examiner in conjunction with the examination. 
a) The examiner should identify any affected nerves of the right lower extremity and should indicate whether there is incomplete or complete paralysis of the nerve;
b) If there is incomplete paralysis, the VA examiner should state whether it is mild, moderate or severe.
The examiner is requested to conduct requisite testing and include the Veteran’s lay statements regarding his symptoms.
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3. Ensure the development outlined above has been accomplished, and then readjudicate the claim on appeal. If the benefit sought remains denied, issue a supplemental statement of the case and provide the Veteran and his representative the requisite period of time to respond. The case should then be returned to the Board for further appellate review, if otherwise in order.
 
MICHAEL A. PAPPAS
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	L. Baskerville, Counsel

For A Complete Guide To VA Disability Claims and to find out more about your potential VA disability case and how to obtain favorable VA Rating Decision! Visit: VA-Claims.org

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