Citation Nr: 18157016 Decision Date: 12/11/18 Archive Date: 12/11/18 DOCKET NO. 16-50 972 DATE: December 11, 2018 REMANDED Entitlement to service connection for a left hand condition (left ring finger) is remanded. REASONS FOR REMAND The Veteran had active service from April 1984 to April 2014. This case comes before the Board of Veterans’ Appeals (Board) on appeal from a May 2014 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Winston-Salem, North Carolina. Entitlement to service connection for a left hand condition (left ring finger) is remanded. A remand is needed to ensure there is a complete record upon which to decide the issue of entitlement to service connection for a left hand condition (left ring finger). 38 C.F.R. § 19.9(a). The Veteran’s lay evidence indicates complaints of pain and functional impairment of his left ring finger. The Veteran contends that his left hand condition (left ring finger) occurred during active service because his left ring finger was dislocated while participating in Marine Corps Martial Arts Program training in April 2010. This is substantiated in an April 2010 Service Treatment Record (STR). The April 2010 STR also noted that the Veteran was “unable to complete [sic] straighten digit with occasional discomfort felt with direct pressure.” In contrast, the Veteran’s 2013 Exit Examination states that he had a full range of motion of all fingers, x-rays of the hand were normal, and there was no pathology found upon which to render a diagnosis of a left hand condition. Also, a 2015 private medical treatment record stated that the Veteran did not have a left hand condition, there were no limitations on flexion and extension of all fingers, and the Veteran was able to make a fist. The Veteran underwent a VA examination in December 2013, where the examiner found that he did not have a left hand disability and therefore did not provide an etiology opinion. “[P]ain in the absence of a presently-diagnosed condition can cause functional impairment.” Saunders v. Wilkie, 886 F.3d 1356, 1368 (Fed. Cir. 2018). The Veteran stated in his September 2014 Notice of Disagreement that he did not have full range of motion. Additionally, the Veteran stated in his January 2015 Statement in Support of Claim that he could not straighten his finger at all and forcing it to do so is very painful. The Veteran’s credible report of pain plus functional impairment suggests a disability may be present and the VA examiner did not address his contentions. For this reason, a new examination and opinion are needed. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination with an appropriate clinician for his left hand condition (left ring finger). The entire claims file and a copy of this remand must be made available to the examiner for review, and the examiner must specifically acknowledge receipt and review of these materials in any reports generated. The examiner is advised that, even if there is no diagnosable pathology of the left hand condition (left ring finger), he or she must consider pain to constitute a disability if it causes functional impairment. The examiner must provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran has a left hand condition (left ring finger) that began during active service or is related to an incident of service. Although an independent review of the claim file is required, the Board calls the examiner’s attention to the following: a. A May 2004 STR (report of medical history) where the Veteran reported that his left ring finger is permanently bent. b. An April 2010 STR noting that the Veteran dislocated his PIP on his left ring finger during martial arts training. c. A November 2013 private medical record noting a normal x-ray of the left hand. d. A January 2015 medical record noting no left hand conditions. e. The Veteran’s September 2014 and January 2015 statements detailing the pain and functional impairment of his left ring finger. The examiner must provide all findings, along with a complete rationale for his or her opinions in the examination report. Note that the fact that a left hand condition (left ring finger) is not specifically mentioned in the Veteran’s service treatment records cannot serve as the sole basis for a negative finding. If the above requested opinion cannot be made without resort to speculation, the examiner must state this and provide a rationale for such conclusion. 2. Readjudicate the claim. If the decision is adverse to the Veteran, issue a Supplemental Statement of the Case and allow the applicable time for response. Then, return the case to the Board. D. Martz Ames Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD L. Willoughby, Law Clerk