Citation Nr: 18161257 Decision Date: 12/31/18 Archive Date: 12/31/18 DOCKET NO. 10-28 065 DATE: December 31, 2018 REMANDED Service connection for a right hand disability is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from July 1978 to July 1982. This case originally came before the Board of Veterans’ Appeals (Board) on appeal from a November 2008 rating decision by a Regional Office (RO) of the Department of Veterans Affairs (VA). In March 2015, the Board remanded the case for evidentiary development. The Board issued a decision in November 2016 which, in pertinent part, denied the Veteran’s claim for service connection for a right hand disability. The Veteran appealed the Board’s November 2016 decision to the United States Court of Appeals for Veterans Claims (Court). In September 2018, pursuant to an August 2018 Joint Motion for Partial Remand, the Court vacated and remanded that part of the Board’s November 2016 decision which denied service connection for a right hand disability for compliance with the instructions in the Joint Motion. 1. Service connection for a right hand disability is remanded. In its November 2016 decision, the Board denied the Veteran’s claim for service connection for a right hand disability on the basis that “pain itself is not a disability.” As noted in the Joint Motion, subsequent to the Board’s decision, the United States Court of Appeals for the Federal Circuit held that pain resulting in functional impairment qualifies as a disability for VA purposes regardless of whether a medical diagnosis has been assigned. If pain results in functional impairment affecting earning capacity, a disability may be established. Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). The Veteran reports recurrent symptoms of the right hand since service, specifically pain and limitations due to pain. The service treatment records include a December 1981 orthopedic clinic service record that shows that after treatment of the fracture, the Veteran’s right hand had good rotation, good movement, no deformity, and neurologically the hand was within normal limits. The x-ray study showed well-healed fracture. The June 1982 separation examination shows normal upper extremity. An August 2008 VA x-ray of the right hand showed “Possible osteochondroma is present from the thumb metacarpal.” Otherwise the x-ray was unremarkable. A June 2009 VA occupational therapy note stated that the x-ray study showed bone prominence on the right hand that “may be consistent with old avulsion injury with subsequent spur, or congenital.” A May 2010 medical opinion from the Veteran’s VA physician noted that the Veteran has had an x-ray of the right hand “which shows no significant abnormalities and bone scan which showed no uptake to the area.” It is also noted that he has tenderness of the right hand but no gross abnormalities. In July 2010, the Veteran’s treating VA provider stated that the Veteran was being treated for right hand pain. After reviewing the Veteran’s chart, the provider was of the opinion that there was a direct relationship between the Veteran’s “current medical condition” and the fracture he sustained in 1981. However, the VA provider did not specify any right hand diagnosis or disability. The Board finds that the Veteran should be afforded another VA examination to determine whether he has a disability of his right hand as a result of an in-service injury. Further, the Board notes that Saunders requires that the examiner determine whether pain in the right hand results in functional impairment such that it may qualify as a disability in the event an underlying diagnosis is not provided. The matter is REMANDED for the following action: (Continued on the next page)   Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any diagnosed disorder or functional limitation of the right hand. The examiner must opine whether it is at least as likely as not that the Veteran has a diagnosed disorder of the right hand or, if there is no diagnosed disorder, if he has functional limitations of his right hand stemming from pain. If there is either a diagnosed disorder of the right hand or functional limitations due to pain of the right hand, the examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including right fourth metacarpal fracture in 1981. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD M. G. Mazzucchelli, Counsel