Citation Nr: 18152375
Decision Date: 11/21/18	Archive Date: 11/21/18

DOCKET NO. 12-17 054
DATE:	November 21, 2018
REMANDED ISSUE
Entitlement to a disability rating in excess of 10 percent for a service connected left palm skin condition, to include a chronic lesion or scar.
The Veteran served on active duty in the United States Army from February 1975 to January 1978.
In July 2017 the Board of Veterans’ Appeals (Board) denied the Veteran’s claim for a disability rating in excess of 10 percent for his service connected left palm skin condition, to include a chronic lesion or scar.  The Veteran appealed his claim to the United States Court of Appeals for Veterans Claims (Court).  Pursuant to the July 2018 Joint Motion for Remand (JMR), the Court vacated the Board’s July 2017 decision that denied the above listed claim, and remanded the matter to the Board for further proceedings consistent with the JMR.
In particular, the JMR stipulated that the Board must obtain an addendum medical opinion or new examination that provides sufficient rationale and clarifies which finger or fingers, if any, are affected by the Veteran’s service-connected scar.  The JMR also indicated that the Board must ensure that an examiner consider medical evidence the Veteran submitted to the Board in support of his claim.  Finally, the JMR also indicated that the Board must address the Veteran’s contention that he has “broken” skin on his left palm, and that because of this, the scar should be considered “unstable” and “painful,” warranting a higher rating under Diagnostic Code 7804.
In September 2018 correspondence, the Veteran specifically requested that the Board remand his appeal for agency of original jurisdiction (AOJ) review of all additional evidence.  
The matter is REMANDED for the following action:
1. Obtain any outstanding VA treatment records.
2. Schedule the Veteran for a VA hand and fingers examination.  The claims file should be made available to, and reviewed by the VA examiner.  The examiner should take a history from the Veteran as to the progression of his service-connected left palm lesion/scar.  
Upon review of the record, interview and examination of the Veteran, the examiner should respond to each of the following questions:
a)	Does the Veteran have additional disability of the fingers of the left hand—to include left index trigger finger and neuroma, hypersensitivity, tenosynovitis, ganglion cyst, and/or left little finger pain—that are manifestations of the scar/lesion of his left palm?  If there are separate and distinct disabilities of any finger that are unrelated to the lesion, these disabilities should be clearly differentiated, with an explanation as to how the conclusion was reached.  
In providing a response to the above, the examiner must consider the online medical articles submitted by the Veteran, as well as all prior records of medical treatment. 
b)	Assess the severity of all disabling effects and manifestations of the Veteran’s service-connected left palm lesion/scar, to include the severity of any associated manifestations of the fingers identified in answering question (a) above.  In particular, the examiner should specifically discuss whether the Veteran’s description of “broken” skin of the left palm scar is, from a medical perspective, the same or similar to having an “unstable” scar as referenced in the diagnostic criteria.  
Any opinion expressed should be accompanied by a complete medical explanation.  
3. Readjudicate the issue on appeal.  If any benefit sought remains denied, issue the Veteran and his representative a Supplemental Statement of the Case.
 
V. Chiappetta
Veterans Law Judge
Board of Veterans’ Appeals
ATTORNEY FOR THE BOARD	B. Mask, Associate Counsel