Citation Nr: 18161042 Decision Date: 12/28/18 Archive Date: 12/28/18 DOCKET NO. 16-40 543 DATE: December 28, 2018 ORDER Entitlement to service connection for left hand degenerative arthritis is denied. REMANDED Entitlement to service connection for right ankle condition, to include as secondary to a right foot condition, is remanded. Entitlement to service connection for right foot condition is remanded. FINDING OF FACT The preponderance of the probative evidence of record is against finding that the currently diagnosed left hand degenerative arthritis is related to the Veteran's active duty. CONCLUSION OF LAW The criteria for service connection for left hand degenerative arthritis have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a), 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDINGS AND CONCLUSION The Veteran served on active duty in the United States Marine Corp from October 1984 to October 1988. This matter comes to the Board of Veterans’ Appeals (Board) from a January 2015 Rating Decision. 1. Entitlement to service connection for left hand degenerative arthritis The Veteran submitted a claim for service connection concerning his tingling in his left pinky finger/hand in October 2013. He argues that an injury to his left that occurred in April 1985, during service, is the cause of his currently diagnosed degenerative arthritis. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303 (a). Service connection requires competent evidence showing: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004); see also Caluza v. Brown, 7 Vet. App. 498 (1995). In rendering a decision on appeal, the Board must analyze the credibility and probative value of the evidence, account for the evidence which it finds to be persuasive or unpersuasive, and provide the reasons for its rejection of any material evidence favorable to the claimant. Gabrielson v. Brown, 7 Vet. App. 36, 39-40 (1994); Gilbert v. Derwinski, 1 Vet. App. 49, 57 (1990). The standard of proof to be applied in decisions on claims for veterans’ benefits is set forth in 38 U.S.C. § 5107. A veteran is entitled to the benefit of the doubt when there is an approximate balance of positive and negative evidence. See 38 C.F.R. § 3.102. When a veteran seeks benefits and the evidence is in relative equipoise, the veteran prevails. See Gilbert v. Derwinski, 1 Vet.App. 49 (1990). The preponderance of the evidence must be against the claim for benefits to be denied. See Alemany v. Brown, 9 Vet.App. 518 (1996). The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of degenerative arthritis in his left hand, the preponderance of the evidence weighs against finding that the Veteran’s arthritis was caused or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303 (a), (d). The service treatment records reveal the Veteran sought treatment for a cut on the little finger of his left hand in April 1985. Physical examination was conducted and the assessment was superficial laceration of the left little finger. There were no further complaints of, diagnosis of or treatment for problems with the left hand. No pertinent abnormalities were noted on the report of the separation examination which was conducted in October 1988. Clinical examination of the extremities was determined to be normal at that time. There are no post-service clinical records associated with the claims file and the Veteran has not identified any post-service treatment he has received for his left hand. The Veteran was afforded a VA examination in January 2015. In that examination, the examiner acknowledged an in-service injury to the Veteran’s left hand that occurred in April 1985. See April 1985 service treatment records (STRs). The examiner noted that the 1985 injury resulted in trauma to the fifth digit of the left hand. However, the x-rays that were taken during the 2015 examination did not demonstrate any significant degenerative or asymmetric changes in the hand near the area where the injury occurred. The examiner further wrote that limited range of motion in the left hand was not identified. Ultimately, the examiner opined that the left hand degenerative arthritis diagnosis is not at least likely as not caused by or aggravated by an injury in-service. The January 2015 VA examination report is the only medical evidence of record which addresses the etiology of the hand disorder. The Board finds that this examination report is adequate and the most probative evidence of record on this matter. The examiner reviewed and discussed the relevant evidence in the claims file, including the Veteran’s service treatment records, post-service medical records, and own reported history and complaints. He also relied on his own expertise, knowledge, and training. In addition, the examiner supported his opinion with a clear and thorough rationale based on clinical findings from the claims file. The only evidence which indicates that the Veteran does have a current left had disorder which is due to active duty is the Veteran's own allegations and opinions. As a lay person, the Board finds he is competent to report on symptomology he experiences through his senses. However, he is not competent to provide a diagnosis for his left hand disorder as this requires specialized testing and medical knowledge which the Veteran does not possess. The Board notes the Veteran's reports of symptomology he experienced was taken into account by the VA examiner who conducted the 2015 examination report. Greater probative value is placed on this examination report than the Veteran's own lay allegations. Based on the foregoing, the Board finds that the Veteran’s claimed left hand disorder is not causally or etiologically related to his military service. Accordingly, the claim for service connection for left hand arthritis must be denied. REASONS FOR REMAND 1. Entitlement to service connection for right foot and right ankle condition are remanded. The Veteran asserts that he has right foot pain due to an injury to his right foot during active duty service in 1985. Likewise, he asserts that he has right ankle pain also sustained due to an injury to his right ankle in service. In his notice of disagreement, the Veteran claims that his right ankle disorder is secondary to his right foot disorder. The Veteran was afforded a VA examination in January 2015. The examination report indicates the claimed condition to be examined was right foot pain. Physical examination was negative for any findings regarding the right foot and it was specifically noted that the Veteran did not report right foot pain at the time of the examination. Imaging studies were interpreted as revealing a lack of degenerative or traumatic arthritis. With regard to functional impact, the examiner noted that the Veteran was having more difficulty climbing stairs. The diagnosis provided was a box checked as “Other” with no further specification. With regard to the opinion as to etiology, the examiner wrote the diagnosis was not at least as likely as not caused by or aggravated by active duty. He noted that there was a documented injury in service affecting the right foot. The examiner then wrote that there was no assymetry in the findings on physical examination and imaging. No further explanation was provided. The Board finds this opinion inadequate for several reasons. No actual diagnosis is provided and there are no actual clinical findings regarding the right foot from which the Board might be able to discern what the diagnosis of “Other” may have been based on. The rationale is also confusing in that it references a lack of assymetry in the findings but, as noted above, there are no actual clinical findings. There is a single reference to the Veteran having increased difficulty climbing stairs for an unknown reason. The examination report is incomplete. Under question 12 for pain, the examiner indicated that there was no pain found on physical examination. The directions for this portion of the DBQ form direct that, if the answer to 12 is no but the Veteran reported pain in his medical history, a rationale was to be provided. The examiner did not respond to this request for a rationale. Based on the inadequacy of the examination report, the Board finds a new examination is required. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. All obtained records should be associated with the evidentiary record. 2. Schedule the Veteran for a VA examination with a suitably qualified health care professional who should determine the nature and etiology of any right foot and/or right ankle disability found on examination. The examiner must obtain a pertinent medical history from the Veteran regarding his right foot and ankle complaints. For any right foot or right ankle disorder found on examination, the examiner must provide an opinion as to whether it is at least as likely as not (a 50% or greater probability) that the right foot and/or right ankle disorder was etiologically linked to the Veteran's active duty. If a right foot and right ankle disorder are both found on examination, the examiner must provide an opinion as to whether it is at least as likely as not (a 50% or greater probability) that the right foot and right ankle disorder are etiologically linked to each other in any way. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. The opinion must include a notation that this record review took place. A complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. The Veteran is assumed competent to report on the symptoms he experiences through his senses. If the examiner has any reason to dispute the Veteran's reported history, the nature of the dispute should be noted and the findings supported by a rationale. G. A. WASIK Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Smith, Associate Counsel