Citation Nr: 18160107 Decision Date: 12/21/18 Archive Date: 12/21/18 DOCKET NO. 08-36 100 DATE: 1. Entitlement to service connection for carpal tunnel syndrome as due to residuals of a fracture of the fourth finger of the right hand. 2. Entitlement to a separate compensable evaluation since January 30, 2009, for neurologic residuals of a fracture of the fourth finger of the right hand. 3. Entitlement to an increased disability rating on an extraschedular basis for residuals of a fracture of the fourth finger of the right hand from January 30, 2009. December 21, 2018 REMANDED Entitlement to a separate compensable evaluation for neurologic residuals of a fracture of the fourth finger of the right hand from January 30, 2009, is remanded. Entitlement to an increased disability rating on an extraschedular basis for residuals of a fracture of the fourth finger of the right from January 30, 2009, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from September 1954 to April 1955 and in the United States Navy from July 1956 to April 1959. These matters come before the Board of Veterans’ Appeals (Board) on remand from the United States Court of Appeals for Veterans Claims (Court) regarding Board decisions rendered in October 2015 and July 2017. These matters were originally on appeal before the Board from a May 2006 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in New Orleans, Louisiana. This matter was last before the Board in July 2017, at which time, the Board denied entitlement to a separate disability rating for neurologic residuals of a fracture of the fourth finger of the right hand, and denied extraschedular consideration for residuals of a fracture of the fourth finger of the right hand. In authorizing a July 2018 Joint Motion for Remand, the Court vacated the Board’s July 2017 decision, finding that it did not address the possibility of aggravation of the Veteran’s non-service connected carpal tunnel syndrome by his service connected residuals of a fracture of the fourth finger of the right hand. The Court remanded the matter, directing the Board to address that question. Essentially, the Court is directing the Board to address a secondary service connection claim that has not been previously advanced nor perfected for appeal on the implied basis that it is inextricably intertwined with the increased rating claim that was perfected for appeal. Specifically, the issue of secondary service connection for carpal tunnel syndrome is deemed to be at issue as inextricably intertwined with the increased rating for residuals of a fracture of the fourth finger of the right hand. 1. Entitlement to service connection for carpal tunnel syndrome as due to residuals of a fracture of the fourth finger of the right hand, is remanded. The Veteran was afforded a VA peripheral nerves examination in October 2016, with an addendum opinion obtained in April 2017. It was noted that the Veteran underwent electromyogram testing in March 2017 which revealed bilateral carpal tunnel syndrome. The examiner noted that there is no residual nerve damage from the right ring finger fracture and that the Veteran has decreased right hand grip and muscle wasting between the thumb and index finger as a result of his chronic carpal tunnel syndrome. As neither opinion addresses aggravation of the neurologic condition of carpal tunnel syndrome by the Veteran’s service connected residuals of a fracture of the fourth finger of the right hand, the Board finds that a remand for an addendum VA opinion is required. 2. Entitlement to a separate compensable evaluation since January 30, 2009, for neurologic residuals of a fracture of the fourth finger of the right hand. Finally, because a decision on the remanded issue of entitlement to service connection for carpal tunnel syndrome as due to residuals of a fracture of the fourth finger of the right hand could significantly impact a decision on the issue of entitlement to a separate compensable evaluation since January 30, 2009, for neurologic residuals of a fracture of the fourth finger of the right hand, the issues are inextricably intertwined. As such, a remand is required. 3. Entitlement to an increased disability rating on an extraschedular basis for residuals of a fracture of the fourth finger of the right from January 30, 2009, forward is remanded. When either the Veteran or the evidence of record suggests that a schedular rating may be inadequate, the Board must specifically adjudicate the issue of whether referral for an extraschedular rating is warranted. 38 C.F.R. § 3.321 (b); see, Barringer v. Peake, 22 Vet. App. 242 (2008). Consideration of whether entitlement to service connection for carpal tunnel syndrome as due to residuals of a fracture of the fourth finger of the right hand is warranted is inextricably intertwined with consideration of entitlement to a separate compensable evaluation for neurologic residuals of a fracture of the fourth finger of the right hand, which is herein remanded. See, Harris v. Derwinski, 1 Vet. App. 180, 183 (1991). The matters are REMANDED for the following action: 1. Obtain the Veteran’s VA treatment records for the period from April 2015 to the Present. 2. After, and only after, completion of step one above, obtain an addendum opinion from the VA examiner who conducted the October 2016 and provided the January 2017 VA addendum opinion, if available. If the previous examiner is not available, obtain such opinion from a suitable substitute. If, and only if, the medical professional determines that additional examination of the Veteran is necessary to provide a reliable opinion, such examination must be scheduled. The examiner must opine as to whether it is as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s diagnosed carpal tunnel syndrome is aggravated by his service connected residuals of a fracture of the fourth finger of the right hand. All opinions provided must be thoroughly explained, and a complete and detailed rationale for any conclusions reached should be provided (a bare conclusory statement will be deemed inadequate). The examiner is reminded that the term “as likely as not” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against it. 3. Refer the Veteran’s claim for an increased rating for entitlement to an increased disability rating on an extraschedular basis for residuals of a fracture of the fourth finger of the right from January 30, 2009, forward, to VA’s Director of Compensation Service for extraschedular consideration. 4. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal, including the inextricably intertwined issue of entitlement to service connection for carpal tunnel syndrome as due to residuals of a fracture of the fourth finger of the right hand. Issue a rating decision for that service connection issue. If the benefits sought on appeal are not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case for the issues of entitlement to a separate compensable evaluation since January 30, 2009, for neurologic residuals of a fracture of the fourth finger of the right hand, and entitlement to an increased disability rating on an extraschedular basis for residuals of a fracture of the fourth finger of the right from January 30, 2009, forward and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. Michael Pappas Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD B. P. Keeley, Associate Counsel