Citation Nr: 1012060 Decision Date: 03/31/10 Archive Date: 04/07/10 DOCKET NO. 06-26 896 ) DATE ) ) On appeal from the Department of Veterans Affairs (VA) Regional Office (RO) in Anchorage, Alaska THE ISSUES 1. Entitlement to service connection for a bilateral hand disability. 2. Entitlement to service connection for a bilateral wrist disability. REPRESENTATION Appellant represented by: Veterans of Foreign Wars of the United States WITNESS AT HEARING ON APPEAL Appellant ATTORNEY FOR THE BOARD D. Schechner, Associate Counsel INTRODUCTION The Veteran served on active duty from July 1997 to January 2005. This matter comes before the Board of Veterans' Appeals (Board) on appeal from an August 2005 rating decision of the Department of Veterans Affairs Regional Office in Anchorage, Alaska. The Veteran testified before the undersigned in a videoconference Board hearing in December 2007. A transcript of the hearing is included in the record. The Board previously issued a decision on these claims in January 2008. In an August 2009 memorandum decision, the Court vacated and remanded the claims to the Board. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND At the time of the Board's January 2008 decision, the Veteran had no confirmed diagnosis of any disability of his hands or wrists. An April 2005 VA examination found the hands and wrists to be normal upon physical examination. VA treatment records noted the Veteran's complaints of chronic pain and intermittent aches in his hands and wrists. In September 2007, the Veteran was recommended to continue using wrist splints at night, reduce caffeine, and treat pain with Aleve. However, no diagnosis of any disability was given regarding the Veteran's hands or wrists. In the Court's decision, it was noted that a November 2007 electrodiagnostic consultation with Dr. "H." suggested the "possibility" of Raynaud's phenomena. The Board noted this treatment record in its January 2008 decision, particularly the conclusion that the electrodiagnostic study was normal. Dr. H. noted that the Veteran's complaints of hand stiffness and swelling aggravated by cold were "suggestive" of Raynaud's, though the Veteran did not give a history of color change to suggest the same. Dr. H. also suggested vasomotor instability based upon the appearance of the Veteran's hands and feet. Dr. H. opined that "screening studies for a vasculitis might be of help". At the time of the Board's January 2008 decision, there was no additional medical evidence to support Dr. H.'s suggestions of the "possibility" of Raynaud's disease, vasomotor instability, or vasculitis. However, VA treatment records in March 2008 note the Veteran's self-reported history of Raynaud's disease. An April 2008 VA treatment record includes a diagnosis of Raynaud's, as well as xerosis and primary irritant contact dermatitis. Additionally, private treatment records of occupational therapy at Providence Alaska Medical Center in January and February 2009 note continuing symptoms of swelling, edema, and redness and blotchiness up to one inch proximal of the wrist. Symptoms were noted to increase with exposure to cold as well as with use of vibratory hand tools. The Board finds that the April 2008 diagnosis of Raynaud's disease requires a VA examination to determine the cause and etiology of the Veteran's hand and wrist symptoms. While the evidence of record at the time of the Board's previous decision did not indicate a diagnosis of any specific disability regarding the Veteran's hands and wrists, there is now sufficient medical evidence to require a new examination. With regard to some indication in the Court decision that an examination in the summer may not provide a basis to adjudicate this case (page four of the August 2009 decision), the Board is unsure how to proceed. As it is now spring, the Board believes it can not delay the adjudication of this case until winter for a VA examination. Accordingly, the case is REMANDED for the following action: 1. The RO should obtain any and all VA treatment records for the Veteran from April 2008 to the present not already included in the claims file. 2. The RO should attempt to obtain any private treatment records for the Veteran not already included in the claims file, if any. 3. The Veteran should be afforded a VA examination by a rheumatologist, wherein the medical examiner has the opportunity to review the entire claims file. The examiner should offer a medical opinion regarding the exact nature and etiology of the Veteran's current hand and wrist disabilities (if possible). The examiner is asked to offer a medical opinion as to the proper diagnosis for the Veteran's hand symptoms and wrist symptoms (if any). If the symptoms for both the hands and the wrists stem from the same source, the examiner should so state. Simply stated, the Board is attempting to determine the exact nature and cause of the Veteran's current problems with his hands and wrists upon exposure to cold weather and/or use of vibratory power tools (if any). The examiner should explain the reasoning behind any opinions offered, including a finding of "normal". A review of the Court's August 2009 decision in this case may be of assistance to the examiner in understanding the difficulty the Board faces in adjudicating this case. If a disability to the hands or wrists is found, the examiner is asked to indicate if it is at least as likely as not that it is related to the Veteran's service from July 1997 to January 2005. 4. The RO should then readjudicate the claim. If the benefits sought on appeal are not granted to the Veteran's satisfaction, the Veteran must be provided with an SSOC, which addresses all of the evidence received since the August 2007 SSOC was issued. An appropriate period of time should then be allowed for a response, before the record is returned to the Board for further review The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ JOHN J. CROWLEY, Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (2009).