Citation Nr: 18147239 Decision Date: 11/02/18 Archive Date: 11/02/18 DOCKET NO. 11-11 713 DATE: November 2, 2018 REMANDED Entitlement to service connection for left hand ulnar nerve paralysis is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1970 to October 1970. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a June 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Board previously denied this claim in February 2017. The Veteran appealed the Board’s decision to the United States Court of Appeals for Veterans Claims (the Court). A Joint Motion for Partial Remand (JMPR) was filed and on April 2018, the Court vacated the February 2017 decision and returned the case to the Board for action consistent with the JMPR. Finally, the Veteran reports that due to his attorney’s withdrawal, he is now representing himself. See October 2018 Status Letter. However, there is no withdrawal of record; DAV remains the Veteran representative. Entitlement to service connection for left hand ulnar nerve paralysis is remanded. The Veteran asserts aggravation of his pre-existing left hand ulnar nerve paralysis in service. Notably, the Veteran reports pain during service, aggravation due to military exercises, and some loss of functionality. See e.g. March 2010 VA 21-4138; October 2018 Status Letter. At entrance, the Veteran was noted to have a left hand laceration with loss of motion in the 4th and 5th finger. Nonetheless, the Veteran’s July 1970 entrance examination noted normal upper extremities and a score of “2” on the PULHES profile for the upper extremities. At separation, the Veteran’s score on the PULHES profile was “3” and examination noted neurologic abnormality with ulnar clawing of the left hand with decreased sensation and weakness. Further, September 1970 service treatment records indicate ulnar nerve paralysis. If a preexisting disability is noted upon entry into service, a Veteran cannot bring a claim for service connection for that particular disability, but the Veteran may bring a claim for service-connected aggravation of that disability. U.S.C. § 1153 (2012); Wagner v. Principi, 370 F.3d 1089 (Fed. Cir. 2004); Jensen v. Brown, 19 F.3d 1413 (Fed. Cir. 1994). A preexisting injury or disease will be considered to have been aggravated during service when there is an increase in disability during service, unless there is a specific finding that the increase in disability is due to the natural progression of the disease. 38 U.S.C. § 1153 (2012); 38 C.F.R. § 3.306 (a) (2017). Clear and unmistakable (obvious or manifest) evidence is required to rebut the presumption of aggravation where the pre-service disability underwent an increase in severity during service. 38 C.F.R. § 3.306 (b) (2017). As noted in the parties’ JMPR, the difference in the PULHES profile at entrance and separation suggests an increase in severity of the Veteran’s pre-existing condition. As such, a remand is necessary to obtain an addendum opinion. The matter is REMANDED for the following action: Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s pre-existing left hand ulnar nerve paralysis was at least as likely as not aggravated (i.e. a permanent increase in severity) during service from July 1970 to October 1970? If so, it the evidence clear and unmistakable (undebatable or obvious) that such increase in severity was due to the natural progress of the Veteran’s condition? 1. A complete rationale for the requested opinions should be provided. In providing the opinion, please consider and discuss the relevant evidence of record, especially the service treatment records. The examiner should also address the Veteran’s entrance examination which shows a PULHES score of “2” for upper extremities and no neurologic abnormality compared to the separation examination which shows PULHES score of “3” and neurologic abnormality. If the examiner feels that the requested opinions cannot be rendered without resorting to speculation, he or she must explain why this is so. D. JOHNSON Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD K. Vuong, Associate Counsel