Citation Nr: 1321794 Decision Date: 07/08/13 Archive Date: 07/18/13 DOCKET NO. 11-05 503A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Columbia, South Carolina THE ISSUE Entitlement to service connection for a right hand disability, secondary to service-connected degenerative joint disease of the left knee. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD R. Dodd, Associate Counsel INTRODUCTION The Veteran had active service from November 1942 to February 1946. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2010 RO decision that, in part, denied service connection for a right hand disability secondary to the service-connected left knee disability. A review of the Virtual VA paperless claims processing system revealed VA outpatient treatment records dated September 1990 to May 2012 and a VA examination dated April 2013. Please note this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). 38 U.S.C.A. § 7107(a)(2) (West 2002). 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 Although the Board regrets the additional delay, remand is necessary to ensure that there is a complete record upon which to decide the Veteran's claim. Remand is required to obtain a VA examination addendum in accordance with the March 2013 remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (holding that a remand confers on the claimant, as a matter of law, the right to compliance with the remand order). In March 2013, the Board remanded the issue of entitlement to service connection for a right hand disability, secondary to service-connected degenerative joint disease of the left knee. The Board requested that a VA examiner provide an opinion regarding whether the Veteran's right hand condition was related to his service-connected left knee condition. In particular, the Board requested that the examiner provide an opinion as to whether the Veteran's right hand condition had been aggravated by the service-connected left knee condition, as a prior VA examination in January 2011 had failed to do so. The opinion in the January 2011 VA examination diagnosed the Veteran with a right thumb trigger finger and dupuytrens contractures of the right hand resulting in flexion contractures of digits 3-5 and requiring recent surgical release on digits 4 and 5 and stated that these conditions were not caused by the Veteran's griping of a cane for his left knee, as these conditions were longstanding and dupuytrens contractures existed in the left (non-griping) hand as well. No issue of whether these conditions may have been aggravated by the Veteran's use of a cane was addressed. The AMC provided the Veteran with an addendum opinion to the January 2011 VA examination in April 2013. The addendum in the April 2013 VA examination showed that the claims file was reviewed and rendered the opinion that these conditions were not caused by the Veteran's griping of a cane for his left knee, as these conditions were longstanding and dupuytrens contractures existed in the left (non-griping) hand as well. This addendum opinion did not further address the issue of aggravation as requested in the March 2013 remand. Service connection may be granted where a disability is proximately due to or the result of a service-connected disease or injury. 38 C.F.R. § 3.310(a) (2012). Establishing service connection on a secondary basis requires evidence sufficient to show (1) that a current disability exists and (2) that the current disability was either (a) caused by or (b) aggravated by a service-connected disability. Allen v. Brown, 7 Vet. App. 439, 448 (1995) (en banc). Claims of secondary service connection also include instances in which there is an additional increment of disability of a nonservice-connected disability due to aggravation by an established service-connected disability. Where a medical examination does not contain sufficient detail to decide the claim on appeal, the Board must return the report as inadequate for evaluation purposes. Hayes v. Brown, 9 Vet. App. 67, 73 (1996); see also, Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007) (noting that once VA provides an examination to a Veteran, VA has a duty to ensure that the examination is adequate for evaluation purposes). Generally, a medical opinion should address the appropriate theories of entitlement. Stefl v. Nicholson, 21 Vet. App. 120, 123-24 (2007). Here, the Board finds that the VA examinations associated with the claims file are inadequate, as they do not fully address all the appropriate theories of entitlement. As it does not appear that the VA examiner has properly considered the issue of aggravation as requested by the 2013 remand instructions, an additional addendum opinion is necessary. Accordingly, the VA examiner must address the issue of whether the Veteran's right hand condition had been aggravated by the service-connected left knee condition in a new VA examination. Additionally, as this case must be remanded for the foregoing reasons, any recent treatment records, including VA records, should also be obtained. 38 U.S.C.A. § 5103A (West 2002); 38 C.F.R. § 3.159(c) (2012); Bell v. Derwinski, 2 Vet. App. 611, 613 (1992). Accordingly, the case is REMANDED for the following action: (Please note, this appeal has been advanced on the Board's docket pursuant to 38 C.F.R. § 20.900(c) (2012). Expedited handling is requested.) 1. The Veteran should be requested to provide the names, addresses and approximate dates of treatment of all medical care providers, VA and non-VA, who have treated her for the disability on appeal. After the Veteran has signed the appropriate releases, those records should be obtained and associated with the claims folder. Appropriate efforts must be made to obtain all available VA treatment records. All attempts to procure records should be documented in the file. If the AMC cannot obtain records identified by the Veteran, a notation to that effect should be inserted in the file. The Veteran is to be notified of unsuccessful efforts in this regard, in order to allow her the opportunity to obtain and submit those records for VA review. 2. After any additional evidence has been associated with the claims file, it should be returned to the VA examiner who evaluated the Veteran in April 2013, or if unavailable, the Veteran should be scheduled for another VA examination by a qualified physician. The examiner should note in the examination report that the claims file has been reviewed. All indicated tests and studies should be accomplished. The examiner should describe all findings in detail and provide a complete rationale for all opinions offered. Following a complete review of the claims folder and examination of the Veteran, the examiner should render an opinion as to whether it is at least as likely as not that any current right hand disability is proximately due to, the result of, or aggravated by the service-connected left knee disability. A fully articulated medical rationale for any opinion expressed should be set forth in the examination report. The examiner should discuss the particulars of this Veteran's medical history and the relevant medical science as applicable to this claim. If the examiner is unable to render an opinion without resorting to speculation, this should be noted and explained. In so doing, the examiner should identify the evidence required in order to render a non-speculative opinion, or indicate the inability to provide the opinion is based on the limits of medical knowledge. If the examiner is unable to render an opinion because of a lack of specified evidence, the AMC should attempt to obtain that evidence and return the claims file to the examiner for completion of the opinion. Note: The term "at least as likely as not" does not mean merely within the realm of medical possibility, but rather that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of causation as it is to find against it. Note: The term "aggravation" in the above context refers to a permanent worsening of the underlying condition, as contrasted to temporary or intermittent flare-ups of symptomatology which resolve with return to the baseline level of disability. 3. Review the examination report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AMC must implement corrective procedures. Stegall v. West, 11 Vet. App. 268, 271 (1998). 4. After completing the above action, and any other development as may be indicated by any response received as a consequence of the actions taken in the paragraphs above, the claim must be readjudicated. If the claim remains denied, a supplemental statement of the case must be provided to the Veteran and his representative. After the Veteran and his representative have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. The appellant has the right to submit additional evidence and argument on the matter or 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. 2012). _________________________________________________ WAYNE M. BRAEUER 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) (2012).