Citation Nr: 18142138 Decision Date: 10/16/18 Archive Date: 10/12/18 DOCKET NO. 11-07 973 DATE: October 16, 2018 ORDER Entitlement to service connection for residuals of a fracture of the right small finger is denied. REMANDED Entitlement to an initial compensable evaluation for degenerative spurring of the right thumb metacarpal joint (thumb disorder) is remanded. FINDING OF FACT The Veteran does not have a current small finger disorder that manifested in service or that is otherwise related thereto. CONCLUSION OF LAW The Veteran’s current small finger disorder was not incurred in active service. 38 U.S.C. §§ 1110, 1154 (West 2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2018). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service from May 1985 to May 1989. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a July 2009 rating decision from the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a videoconference hearing before the undersigned Veterans Law Judge in September 2013. A transcript of that hearing has been associated with the claims file. The Board remanded the Veteran’s claims for further development in May 2014, August 2016, and July 2017. The case has since been returned to the Board for appellate review. The Board notes that the Veteran’s appeal had included the issues of entitlement to service connection for a skin disorder and a right forearm injury. However, during the pendency of the appeal, the Agency of Original Jurisdiction (AOJ) granted service connection for these disabilities in October 2014 and November 2016 rating decisions, respectively. The grant of service connection constitutes a full award of the benefits sought on appeal. See Grantham v. Brown, 114 F. 3d 1156, 1158 (Fed. Cir. 1997). Thus, the matters are no longer in appellate status. See Grantham, 114 F.3d at 1158 (holding that a separate notice of disagreement must be filed to initiate appellate review of “downstream” elements such as the disability rating or effective date assigned). Law and Analysis The Veteran and his representative have not raised any issues with the duty to notify or duty to assist with regard to the claim decided herein. See Scott v. McDonald, 789 F.3d 1375, 1381 (Fed. Cir. 2015) (holding that “the Board’s obligation to read filings in a liberal manner does not require the Board... to search the record and address procedural arguments when the veteran fails to raise them before the Board.”); Dickens v. McDonald, 814 F.3d 1359, 1361 (Fed. Cir. 2016) (applying Scott to a duty to assist argument). Service connection may be established for disability resulting from personal injury suffered or disease contracted in line of duty in the active military, naval, or air service. 38 U.S.C. §§ 1110, 1131. That an injury or disease occurred in service is not enough; there must be chronic disability resulting from that injury or disease. If there is no showing of a resulting chronic condition during service, then a showing of continuity of symptomatology after service is required to support a finding of chronicity. 38 C.F.R. § 3.303(b). Service connection may also be granted for any injury or disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease or injury was incurred in service. 38 C.F.R. § 3.303(d). In considering the evidence of record under the laws and regulations as set forth above, the Board concludes that the Veteran is not entitled to service connection for residuals of a right small finger fracture. The Veteran’s service treatment records show that his fingers were normal upon entry to service; however, he fractured his fifth right finger in August 1988. X-rays taken at that time showed a fracture without significant displacement, and the Veteran was placed in a short arm cast. X-rays taken in September 1988 found a healed fracture with good callus. The examiner noted some dorsal angulation was present. The cast was later removed in September 1988, and the examiner noted decreased range of motion at that time. However, at the Veteran’s separation examination in May 1989, his right wrist and fingers were normal with no deformity or limitation of motion. The Veteran was later afforded a VA examination in connection with his claim in June 2014. The examiner noted that x-rays showed deformity of the fifth metacarpal. The examiner also opined that the right small finger disorder was not related to service, as the service treatment records were silent as to any little finger disorder during service. However, as the Veteran’s service treatment records clearly show an injury to the right little finger, the Board finds that the June 2014 VA medical opinion has very limited probative value. The Veteran was later afforded a VA examination in November 2016 at which time he was diagnosed with a little finger sprain with PIP flexion at rest. The examiner noted that the Veteran held his little finger in mild flexion and stated that he was unable to fully extend it, but the examiner noted that the finger was easily extended fully at the PIP passively without apparent discomfort. The examiner opined that the Veteran’s current little finger disorder was not related to service, as the May 1989 separation examination indicated no deformity or limitation of motion. The examiner also noted that a July 2009 VA examination performed in connection with the Veteran’s thumb claim had found no deformity of the digits. The examiner further found no objective evidence that linked the current inability to actively extend the finger PIP with the in-service 1988 injury. Instead, the examiner noted that, over the years since the in-service fracture, the Veteran had performed daily, hand intensive work at his civilian job and that there were numerous occasions where an injury or sprain to the hand may have occurred, which would cause the current flexion issue. In that regard, the examiner noted that the Veteran had a history of trigger finger at the long and ring fingers, which was not due to service, but had been caused by his civilian employment. The Veteran was also afforded a VA examination in September 2017 during which the examiner noted that the Veteran had flexion of the right fifth finger PIP joint at rest, but found no objective evidence of pathology. Therefore, he declined to provide a diagnosis. Nevertheless, after an evaluation of the Veteran and review of the medical records, the examiner opined that a right little finger disorder was not related to service. In so doing, he noted that the Veteran’s service treatment records had documented a fracture of the proximal part of the right fifth metacarpus without significant displacement, but explained that a fracture that occurred 29 years earlier would not in and of itself constitute a chronic disabling process. The examiner noted that hand x-rays taken in July 2009 and March 2017 showed no objective evidence of any skeletal residual from the 1988 fracture. The examiner did observe that the June 2014 VA examiner had indicated that x-rays of the right hand showed a right little finger deformity, but the examiner was not able to review such x-rays. Therefore, he could not opine as to what deformity was found. The examiner further noted that the Veteran’s x-ray in 1988 had shown a fracture of the proximal metacarpus, yet indicated that the current disorder was affecting the PIP joint, which he explained were anatomically different and not interchangeable terms. With regard to the November 2016 VA examiner’s diagnosis of a little finger sprain, the examiner noted that a muscle strain of the little finger is a soft-tissue disorder which typically resolves in several weeks to months without substantial residuals or long-lasting sequelae. After reviewing the evidence, the Board finds that the September 2017 VA examiner’s opinion is the most probative evidence of record. The examiner provided a medical opinion that was supported by rationale, to include a detailed discussed regarding the location of the in-service injury and the current disorder. As such, the Board finds that the evidence of record shows that the Veteran’s right little finger disorder did not manifest in service and is not otherwise related thereto. The Board also acknowledges the Veteran’s statements that his current finger disorder is due to his in-service injury. The Veteran is competent to report observable symptoms. However, although lay persons are also competent to provide opinions on some medical issues, Kahana v. Shinseki, 24 Vet. App. 428, 435 (2011), as to the specific issue in this case, the diagnosis and etiology of his current finger disorder falls outside the realm of common knowledge of a lay person. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). Moreover, even assuming the Veteran’s lay assertions regarding etiology are competent, the Board finds the September 2017 VA medical provider’s statement is more probative in assessing whether the Veteran has a chronic little finger disorder that is related to service. The September 2017 VA examiner considered the Veteran’s reported medical history and complaints and performed a physical examination. The examiner noted that the Veteran’s separation examination in 1989 found no deformity or limitation of motion of the little finger. Additionally, several x-rays since that time have found no evidence of a residual issue from the in-service fracture. Finally, the September 2017 examiner explained that the Veteran’s current little finger disorder was affecting the PIP joint and that the in-service fractured was located at the metacarpal, which are two distinct and unrelated joints. Thus, the in-service fracture could not be causing the current finger issue. The September 2017 medical opinion was based on review of the claims file, including the Veteran’s lay statements and treatment records, as well as on a physical examination and the examiner’s own medical knowledge and training. There is no medical opinion of record relating the Veteran’s right little finger disorder to his military service. Based on the foregoing, the Board finds that a preponderance of the evidence is against the Veteran’s claim for service connection for residuals of a right little finger disorder. Because the preponderance of the evidence is against the Veteran’s claim, the benefit of the doubt provision does not apply. Accordingly, the Board concludes that service connection is not warranted. REASONS FOR REMAND The Board notes that the Veteran indicated in August 2017 that he had an upcoming trigger release surgery for his right thumb disorder. In September 2017, the Veteran was afforded a VA examination; however, this examination occurred prior to his thumb surgery. VA medical records show that the Veteran was continuing to work on his range of motion following the surgery. As such, the Veteran’s claim should be remanded for another VA examination. Accordingly, the case is REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request that the Veteran provide the names and addresses of any and all health care providers who have provided treatment for his right thumb disorder. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. Any outstanding VA medical records should also be obtained and associated with the claims file. 2. After the above development has been completed, the Veteran should be afforded a VA examination to ascertain the severity and manifestation of his service-connected right thumb disability. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he has first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should report all signs and symptoms necessary for rating the right thumb disability. In particular, he or she should provide the range of motion of the right and left thumbs in degrees and test the Veteran’s range of motion in active motion and passive motion. The examiner should also indicate the distance of the gap between the thumb pad and the fingers and state whether there is any form of ankylosis. The presence of objective evidence of pain, excess fatigability, incoordination, and weakness should also be noted, as should any additional disability, including any additional loss of motion, due to those factors. A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history [,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. After completing these actions, the AOJ should conduct any other development as may be indicated by a response received as a consequence of the actions taken in the preceding paragraphs. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. Rideout-Davidson, Counsel