Citation Nr: 18106918 Decision Date: 06/01/18 Archive Date: 05/31/18 DOCKET NO. 14-35 476A DATE: June 1, 2018 ORDER The Board having determined that new and material evidence has not been presented, reopening of the claim of entitlement to service connection for prostate cancer is denied. Entitlement to a compensable rating for a right index finger disability is denied. REMANDED Entitlement to service connection for an acquired psychiatric disorder, to include posttraumatic stress disorder (PTSD), a sleep disorder, and anxiety, is remanded. FINDINGS OF FACT 1. In an unappealed October 2008 rating decision, the Veteran was denied entitlement to service connection for prostate cancer. 2. The evidence associated with the claims file subsequent to the October 2008 rating decision is cumulative or redundant of the evidence previously of record, or does not relate to an unestablished fact necessary to substantiate the claim. 3. The Veteran’s right index finger disability is manifested by pain and stiffness, with no evidence of a gap between the fingertip and proximal transverse crease of the palm, with the finger flexed to the extent possible; extension is limited by no more than 30 degrees. CONCLUSIONS OF LAW 1. New and material evidence has not been received to reopen a claim of entitlement to service connection for prostate cancer. 38 U.S.C. § 5108 (2012); 38 C.F.R. § 3.156 (2017). 2. The criteria for a compensable rating for a right index finger disability have not been met. 38 U.S.C. §§ 1155, 5107 (2012); 38 C.F.R. §§ 4.17, 4.71a, Diagnostic Code 5229 (2017). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from October 1972 to October 1975 and from October 1979 to October 1996, to include service in Southwest Asia. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a March 2011 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in San Juan, Puerto Rico. 1. Claim to Reopen – Prostate Cancer In an October 2008 rating decision, the Veteran was denied entitlement to service connection for prostate cancer based on a finding that the disability was not related to active service and was not present to a compensable degree within one year of the Veteran’s separation from active service. The Veteran did not appeal that decision. The pertinent evidence of record at the time of the October 2008 rating decision included the following: the Veteran’s service treatment records (STR); a general medical VA examination from January 1997; a prostate VA examination from December 1996 diagnosing chronic prostatitis; and post-service treatment records showing a diagnosis of, and treatment for prostate cancer. The pertinent evidence that has been received since the October 2008 rating decision includes additional post-service treatment records indicating the Veteran had a history of prostate cancer, and the Veteran’s report that his prostate cancer was due to in-service radiation exposure. The Board finds that the evidence received since the October 2008 rating decision is cumulative and redundant of the evidence previously of record, and that it does not relate to the reason the claim was originally denied. In this regard, the Veteran has not submitted any evidence indicating that his prostate cancer was manifest to a compensable degree within one year of his separation from active service, or that it is otherwise etiologically related to his active service. The Board acknowledges the Veteran’s claim that his prostate cancer is the result of radiation exposure during active service. However, the Veteran has not submitted specifics regarding any such exposure and the Veteran’s service records, to include any reports of exposure to radiation, were of record and considered at the time of the October 2008 denial. Therefore, the Veteran’s mere assertion that his prostate cancer is related to in-service radiation exposure does not rise to the level of new and material, as it does not raise a reasonable possibility of substantiating his claim. Accordingly, the Board must conclude that new and material evidence to reopen the claim for service connection for prostate cancer has not been received and reopening of the claim of entitlement to service connection for prostate cancer is not warranted. As the Veteran has not fulfilled his threshold burden of submitting new and material evidence to reopen this finally disallowed claim, the benefit-of-the-doubt doctrine is not applicable. See Annoni v. Brown, 5 Vet. App. 463, 467 (1993). 2. Increased Rating for a Right Index Finger Disability The Veteran asserts that he should have a compensable rating for his right index finger as his symptoms are worse than those contemplated by the currently assigned noncompensable rating. In June 2010, the Veteran was afforded a VA examination for his right index finger disability. At that time, he reported that had difficulty closing his right hand, with decreased hand strength and decreased hand dexterity. He reported limited motion, locking, stiffness, and deformity in the right index finger. He denied a history of flare-ups. Upon physical examination, there was no evidence of pain. The examiner found abnormal range of motion, where extension was limited by 28 degrees. No gap between the index finger and proximal transverse crease of the hand on maximal flexion of finger was found. There was no additional functional loss or loss of motion after repetitive-use testing. A deformity of the right index finger was shown at the DIP joint, manifested as a mallet finger. No decreased strength for pushing, pulling, or twisting was found. No decreased dexterity for twisting, probing, writing, touching, or expression was found. The examiner found there were no significant effects of the Veteran’s right index finger disability on his usual occupation or activities of daily living. In February 2017, the Veteran was afforded another VA examination for his right index finger disability. At that time, he reported that he had incomplete extension of his right index fingertip, with pain when grasping objects or upon reaching into his pants pockets with his right hand, and aggravation of pain with cold weather exposure. The Veteran was noted to be right hand dominant. He reported flare-ups and functional loss as due to the right index finger disability. Upon physical examination, there was evidence of pain. The examiner found abnormal range of motion measured as follows: maximum extension to 0 degrees for the metacarpophalangeal joint (MCP), 0 degrees for the proximal interphalangeal joint (PIP), and 10 degrees for distal interphalangeal joint (DIP); maximum flexion to 90 degrees of the MCP, 100 degrees for PIP, and 80 degrees for DIP. No gap between the index finger and proximal transverse crease of the hand on maximal flexion of finger was found. There was no gap between the pad of the thumb and the fingers. There was evidence of localized tenderness on palpation of the joint or associated soft tissue, at the DIP. There was no additional functional loss or loss of motion after repetitive-use testing. No additional factors contributing to disability were found. Muscle strength testing was shown to be normal, and no muscle atrophy was found. The Veteran did not have ankylosis in the right hand. No other pertinent physical findings, complications, conditions, signs, or symptoms related to the Veteran’s right index finger disability were found. The Veteran did not use any assistive devices. The examiner found that there was no functional impact on the Veteran’s current employment status shown. There was evidence of pain on passive range of motion; there was evidence of pain when the joint was used in non-weight bearing; and the opposing joint in the left hand was found to be undamaged. The Board finds that the Veteran is not entitled to a compensable rating for his right index finger disability. In this regard, there is no indication from the record that the Veteran has a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, or that his right index finger extension is limited by no more than 30 degrees. The Board has considered the Veteran’s reports of right index finger pain, which was noted to be worse during flare-ups and on repeated use. However, there is no indication from the record that his increased pain results in a gap of one inch or more between the fingertip and the proximal transverse crease of the palm, or that his right index finger extension is limited by no more than 30 degrees. Further, the Veteran’s reported symptoms were contemplated by the examiners in the determination of the functional impact of the disability. Therefore, entitlement to a compensable rating for a right index finger disability is not warranted. 38 C.F.R. § 4.71a, Diagnostic Code 5229 (2017). Consideration has been given to assigning staged ratings. However, at no time during the period in question has the disability warranted a higher schedular rating than that assigned. Hart v. Mansfield, 21 Vet. App. 505 (2007). Neither the Veteran nor his representative has raised any other issues, nor have any other issues been reasonably raised by the record, to include an extraschedular rating for a right index finger disability. See Doucette v. Shulkin, 28 Vet. App. 366, 368 (2017). REMANDED ISSUE Entitlement to service connection for an acquired psychiatric disorder, to include PTSD, a sleep disorder, and anxiety. The Board finds that additional development is required before the Veteran’s remaining claim on appeal is decided. A review of the record shows that VA medical opinions were obtained in conjunction with the Veteran’s claim in January 2011, February 2017, and May 2017. However, a review of those medical opinions shows that they are inadequate for adjudication purposes. In this regard, the VA examiners failed to properly address the nature and etiology of the Veteran’s claim and did not adequately consider the Veteran’s lay statements regarding the onset and continuity of his psychiatric symptoms. Thus, the Board finds that the Veteran should be afforded another VA examination to determine the nature and etiology of any currently acquired psychiatric disorder. Additionally, current treatment records should be identified and obtained before a decision is made in this case. The matter is REMANDED for the following action: 1. Identify and obtain any pertinent, outstanding VA and private treatment records and associate them with the claims file. 2. Conduct the appropriate development to verify the Veteran’s reported PTSD stressor(s). All attempts to verify the Veteran’s reported PTSD stressor(s) must be documented in the claims file. Then, schedule the Veteran for a VA examination with a psychologist or psychiatrist to determine the nature and etiology of any currently present psychiatric disability. The claims file must be made available to, and reviewed by the examiner. All indicated tests and studies must be performed. Based on the examination results and review of the record, the examiner should first identify all psychiatric disabilities present during the pendency of the claim, and proximate thereto. Then, the examiner should provide an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any currently present psychiatric disability had its onset during active service, or is otherwise etiologically related to such service. In forming the opinion, the examiner must consider the Veteran’s statements regarding the onset and continuity of his psychiatric symptoms. The rationale for all opinions expressed must be provided. 3. Confirm that the VA examination report and any opinions provided comport with this remand, and undertake any other development found to be warranted. 4. Then, readjudicate the remaining issue on appeal. If the decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD Mariah N. Sim, Associate Counsel