Citation Nr: 18160461
Decision Date: 12/26/18	Archive Date: 12/26/18

DOCKET NO. 14-12 135
DATE:	December 26, 2018
REMANDED
Entitlement to an initial disability rating in excess of 10 percent for an umbilical hernia is remanded.
Entitlement to an initial compensable disability rating for an infraumbilical scar is remanded.
Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
REASONS FOR REMAND
The Veteran served on active duty from August 2002 to August 2006.  The Veteran has raised the issue of entitlement to a TDIU as part of his claim for an increased rating for his umbilical hernia.  Rice v. Shinseki, 22 Vet. App. 447 (2009).  Thus, the issues before the Board are as noted above.
In November 2016, the Veteran and his mother testified at a Travel Board hearing before the undersigned Veterans Law Judge.  A transcript is included in the record. The Board last remanded his claim in May 2017.  For the reasons that follow, another remand is needed before the Board can adjudicate the claims.
1. Entitlement to an initial disability rating in excess of 10 percent for an umbilical hernia is remanded. 
2. Entitlement to an initial compensable disability rating for an infraumbilical scar is remanded.
At his November 2016 Board hearing, the Veteran provided sworn testimony that he has experienced worsening symptoms of his service-connected disability since his last examination.  Namely, the Veteran stated that he has experienced sharp pains in his abdomen that he experiences daily, and he needs to constrict his abdomen area with a wrap for these pains to stop.
The Board remanded his claim in April 2017 to afford him a new VA examination to assess the severity of his disability.  However, the July 2017 VA examination report provides seemingly inconsistent findings with respect to the Veteran’s reports of pain due to his umbilical hernia.  In one instance, the examiner noted that no hernia was detected, although moderate tenderness was noted to the umbilical and infraumbilical area.  However, later in the examination report, it was noted that there was localized sharp to shooting pain to the umbilical/periumbilical area.  The examiner also made a finding that the Veteran’s hernia disability impacted his ability to work.  However, rather than making an independent assessment on the functional impairment resulting from this disability, the examiner appears to have simply recounted the Veteran’s reports of being unable to lift heavy objects and being released from his last job due to pain.  A remand is needed for a new VA examination which more thoroughly discusses any functional impairment the Veteran suffers because of his disability.
3. Entitlement to a total disability rating based on individual unemployability (TDIU) is remanded.
The Veteran reported at his July 2017 VA examination that he was unable to lift heavy objects, and he was released from his last position due to pain during welding duties.  He was last employed six months prior to the examination.  As such, he has reasonably raised the issue of entitlement to a TDIU.  On remand, he should be asked to complete a VA Form 21-8940 and provide related employment details. 
Since the claims file is being returned it should be updated to include any outstanding VA treatment records.  See 38 C.F.R. § 3.159 (c)(2); see also Bell v. Derwinski, 2 Vet. App. 611 (1992).
The matters are REMANDED for the following action:
1. Obtain and associate with the claims file any outstanding VA treatment records regarding the Veteran dated from May 2017 to the present.
2. Provide the Veteran a VA Form 21-8940, Veteran’s Application for Increased Compensation Based on Unemployability, to obtain relevant employment information.
3. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of his service-connected umbilical hernia and associated scar.  The examiner should provide a full description of the disability and report all signs and symptoms necessary for evaluating the Veteran’s disability under the rating criteria.  The examiner must attempt to elicit information regarding the severity, frequency, and duration of any flare-ups, and the degree of functional loss during flare-ups.  To the extent possible, the examiner should identify any symptoms and functional impairments due to umbilical hernia and associated scar alone and discuss the effect of the Veteran’s umbilical hernia and associated scar on any occupational functioning and activities of daily living.  If it is not possible to provide a specific measurement, or an opinion regarding flare-ups, symptoms, or functional impairment without speculation, the examiner must state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner does not have the knowledge or training.
 
M. E. Larkin
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	Jack S. Komperda, Counsel

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