Citation Nr: 18159587 Decision Date: 12/20/18 Archive Date: 12/19/18 DOCKET NO. 08-07 879 DATE: December 20, 2018 REMANDED The claim of entitlement to service connection for arthritis of the right wrist, hand, and fingers, to include as secondary to the service-connected right elbow strain and ulnar nerve transposition, is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1947 to June 1950, September 1950 to August 1954, and October 1954 to October 1957. This case is before the Board of Veterans’ Appeals (Board) on appeal from a January 2009 rating decision of a Department of Veterans Affairs (VA) regional office. As to the claim on appeal, the disability for which service connection is sought now includes the right hand. This distinction has been added to the previously discussed right wrist and fingers as its inclusion best represents the contentions and medical findings on appeal. Arthritis of the Right Wrist, Hand, and Fingers In this case, service connection has been granted for the conditions the Veteran claims have caused disabilities in the right wrist and fingers – right elbow strain and right ulnar nerve transposition. At a January 2009 VA examination, the examiner noted it was obvious that the Veteran had significant joint disease of the right wrist and right hand with deformity of distal interphalangeal joints of both hands “though this [was] unrelated to his trauma that he sustained to his right elbow during military service.” No rationale was provided. In a January 2013 remand, the Board, in pertinent part, remanded the current claim for additional VA examination addressing causation. The requested VA examination was conducted in May 2013. Osteoarthritic changes were seen in the right hand, wrist, and first carpometacarpal joint. As to direct service connection, the examiner stated that she could not give an opinion without resort to speculation. Moreover, as to secondary causation, no opinion was provided. Clearly, more clinical information is necessary to address these questions. Moreover, as to secondary aggravation, it was the examiner’s opinion that the Veteran’s current right hand/wrist/finger osteoarthritis were less likely than not “permanently aggravated” by his service-connected right elbow condition. That opinion is also inadequate as the examiner relied on the wrong legal standard in the opinion. The proper standard for secondary service connection is simply any aggravation. See Allen v. Brown, 7 Vet. App. 439, 448 (1995) (in the context of secondary service connection, aggravation means “any increase in disability,” and is distinguished from the more specific definition of aggravation of a pre-existing disease during service as defined in 38 U.S.C. § 1153). Therefore, the Board finds that a remand is necessary to obtain additional medical opinions which properly address the medical questions raised. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment notes and associate them with the claims file. Moreover, invite the Veteran to identify any additional medical providers who treated him for right wrist/hand/finger conditions. After receiving this information and any necessary releases, contact the named medical providers and obtain copies of related medical records which are not already in the claims file. 2. Following completion of the above, schedule the Veteran for an appropriate examination to determine the nature and etiology of all right wrist, hand, and finger conditions found. The Veteran should be requested to provide a detailed history as to his right wrist, hand, and finger condition(s). The VA examiner should specifically address the following: (a) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right wrist, hand, and finger condition(s) is(are) of service onset or otherwise related thereto. (b) Whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s right wrist, hand, and finger condition(s) was(were) aggravated (increased in severity beyond normal progression) by the service-connected right elbow strain and residuals of ulnar nerve transposition. (c) If aggravation is found, the examiner should also state, to the extent possible, the baseline level of disability prior to aggravation. This may be ascertained by the medical evidence of record and also by the Veteran’s statements as he should be asked to provide a detailed history of his condition. (d) The Veteran’s report as to the nature, severity, and frequency of his observable symptoms over time (CONTINUED ON NEXT PAGE) should be considered by the examiner in forming his/her opinions. BARBARA B. COPELAND Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD T. Hal Smith