Citation Nr: 18149209
Decision Date: 11/09/18	Archive Date: 11/08/18

DOCKET NO. 18-22 169
DATE:	November 9, 2018
REMANDED
Entitlement to service connection for disability of the fingers as secondary to pulmonary fibrosis is remanded.
REASONS FOR REMAND
The Veteran served on active duty in the U.S. Navy from July 1958 to June 1960 and from May 1963 to May 1965.  He also served in the U.S. Naval Reserve.
This matter comes to the Board of Veterans’ Appeals (Board) on appeal from an October 2017 rating decision issued by a Department of Veterans Affairs (VA) Regional Office.
Entitlement to service connection for disability of the fingers as secondary to pulmonary fibrosis is remanded.
The Veteran seeks to establish service connection for disability of his fingers, claimed as clubbing, as secondary to service-connected pulmonary fibrosis.  In September 2017, a VA examiner concluded that the Veteran did not suffer from clubbing of the fingers, but rather had ankylosis of the distal interphalangeal joints (DIPs) with X-ray confirmation of osteoarthritis.  The examiner did not offer an explicit opinion as to whether the noted ankylosis and arthritis was caused or aggravated by pulmonary fibrosis.  Another examination is warranted.
Updated records of VA treatment should also be obtained.  See Bell v. Derwinski, 2 Vet. App. 611 (1992) (holding that VA is charged with constructive notice of medical evidence in its possession).
This matter is REMANDED for the following action:
1.  Obtain copies of records pertaining to any relevant VA treatment the Veteran has received since the time that such records were last procured, following the procedures set forth in 38 C.F.R. § 3.159.  The evidence obtained, if any, should be associated with the record.
2.  After the foregoing development has been completed to the extent possible, arrange to have the Veteran scheduled for a VA examination of his hands and fingers.  The examiner should review the record.  All indicated tests should be conducted and the results reported.
After examining the Veteran and reviewing the record, together with the results of any testing deemed necessary, the examiner should identify any disabilities affecting the Veteran’s hands, to include any clubbing, if present.  Then, with respect to each such disability, the examiner should offer an opinion as to whether it is at least as likely as not (i.e., whether it is 50 percent or more probable) that the disability has been caused or aggravated by the Veteran’s service-connected pulmonary fibrosis.
A complete medical rationale for all opinions expressed must be provided.
3.  After completing the above, and any other development as may be indicated by any response received as a consequence of the actions taken in the preceding paragraphs, the Veteran’s claim should be readjudicated based on the entirety of the evidence.  If the benefit sought remains denied, the Veteran and his representative should be issued a supplemental statement of the case.  An appropriate period of time should be allowed for response. 
 
DAVID A. BRENNINGMEYER
Acting Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	R. Brunot, Associate Counsel