Citation Nr: 18117131 Decision Date: 07/10/18 Archive Date: 07/09/18 DOCKET NO. 15-20 325 DATE: July 10, 2018 REMAND Entitlement to service connection for a right thumb disability is remanded. Entitlement to service connection for a left elbow disability is remanded. Entitlement to service connection for a left wrist disability is remanded. Entitlement to service connection for left cubital tunnel syndrome is remanded. Entitlement to a temporary total evaluation based on surgical treatment requiring convalescence for left cubital tunnel syndrome and left carpal tunnel syndrome is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a right thumb disability is remanded. The Veteran contends his current right thumb disability is secondary to the service-connected disabilities of right Dupuytren’s contractures, also claimed as tendonitis, and scar of the right finger distal palm crease. The Veteran contends he has been treated for trigger finger, two surgeries on his right Dupuytren’s contracture, and been diagnosed with right cubital tunnel syndrome, and now a right thumb condition, and that all of these disabilities started from one injury. See June 2015 VA Form 9; April 2014 informal claim. The Veteran was afforded a VA hand and fingers examination in January 2015, and the VA examiner diagnosed right thumb tenosynovitis. The VA examiner opined the Veteran’s right thumb condition is less likely as not caused by or a result of his service-connected Dupuytren’s contractures because tenosynovitis of the thumb is a totally separate condition with different pathologies, though both share a common risk factor of heavy use of the hands. However, the January 2015 VA examiner did not address whether the Veteran’s right thumb disability is aggravated by his service-connected right Dupuytren’s contractures. Further, the VA examiner did not address whether the Veteran’s right thumb disability was caused or aggravated by his service-connected scar of the right finger distal palm crease. Finally, the VA examiner did not address the Veteran’s contention that his current right thumb disability is related to the same injury as his right Dupuytren’s contractures. On remand, the Agency of Original Jurisdiction (AOJ) should obtain an addendum opinion to address the nature and etiology of the Veteran’s right thumb disability. 2. Entitlement to service connection for a left elbow disability is remanded. 3. Entitlement to service connection for a left wrist disability is remanded. 4. Entitlement to service connection for left cubital tunnel syndrome is remanded. In the March 2015 rating decision, the AOJ, in pertinent part, denied the Veteran’s claims of entitlement to service connection for a right thumb disability, a left elbow condition, a left wrist condition, and left cubital tunnel syndrome, as well as entitlement to a temporary total evaluation based on surgical treatment requiring convalescence. In the March 2015 notice of disagreement, the Veteran only indicated disagreement with the denials of service connection for a right thumb disability and for a temporary total evaluation. However, in the June 2015 VA Form 9, the Veteran indicated he is seeking entitlement to service connection for left cubital tunnel, a left elbow condition, and a left wrist condition, as well as entitlement to a temporary total evaluation based on surgical treatment on the left hand/arm requiring convalescence. The Board acknowledges that for all appeals filed on or after March 24, 2015, claimants must now submit a specific VA Form 21-0958, Notice of Disagreement, in order to begin processing of a notice of disagreement. However, 38 C.F.R. § 20.201(a) states that the specific Notice of Disagreement form is required to initiate an appeal for every case in which the AOJ provides the form to the Veteran in connection with its decision. Here, the Board finds the March 2015 notice letter does not indicate the AOJ provided the Veteran with a copy of VA Form 21-0958 in connection with the March 2015 rating decision. Accordingly, the Board finds the Veteran’s written statement on the June 2015 VA Form 9 indicating disagreement with the denials of service connection for a left elbow condition, left wrist condition, and left cubital tunnel syndrome constitutes a timely notice of disagreement with those decisions. See 38 C.F.R. §§ 20.201(b), 20.302. As a statement of the case has not yet been issued regarding the claims of service connection for a left elbow disability, left wrist disability, or left cubital tunnel syndrome, a remand is required for the AOJ to issue a statement of the case. 38 C.F.R. § 20.200; Manlincon v. West, 12 Vet. App. 238, 240-41 (1999). 5. Entitlement to a temporary total evaluation based on surgical treatment requiring convalescence for left cubital tunnel syndrome and left carpal tunnel syndrome is remanded. Finally, because a decision on the remanded issues of service connection for a left elbow disability, left wrist disability, and left cubital tunnel syndrome could significantly impact a decision on the issue of entitlement to a temporary total evaluation based on surgical treatment requiring convalescence, the issues are inextricably intertwined. See January 2015 VA plastic surgery note (in January 2015 the Veteran underwent a left cubital tunnel release with subfascial transposition, as well as left carpal tunnel release). Accordingly, a remand of the claim for entitlement to a temporary total evaluation based on surgical treatment requiring convalescence is required. The matters are REMANDED for the following action: 1. Obtain the Veteran’s relevant VA treatment records for the period from February 2015 to the present. 2. Obtain an addendum opinion from an appropriate clinician to determine the nature and etiology of the Veteran’s current right thumb disability. It is up to the discretion of the clinician as to whether a new examination is necessary to provide an adequate opinion. After a review of the evidentiary record, and examination of the Veteran if deemed necessary by the clinician, the clinician is asked to respond to the following inquiries: a) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current right thumb disability is related to his active duty service? The clinician should address the Veteran’s contention that his right thumb disability is related to the same injury as that which led to his service-connected right Dupuytren’s contractures. b) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current right thumb disability is aggravated by his service-connected right Dupuytren’s contractures? Aggravation indicates a worsening of the underlying condition as compared to an increase in symptoms. If aggravation is found, the clinician should attempt to identify the baseline level of the disability that existed before aggravation by the service-connected disability occurred. c) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current right thumb disability is caused by his service-connected scar of the right finger distal palm crease? The clinician should address the reports by the January 2015 VA scars examiner that this scar is painful and affects the Veteran’s ability to use his hands extensively at work. d) Is it at least as likely as not (i.e. probability of 50 percent or greater) that the Veteran’s current right thumb disability is aggravated by his service-connected scar of the right finger distal palm crease? 3. Send the Veteran and his representative a statement of the case that addresses the issues of service connection for a left elbow disability, left wrist disability, and left cubital tunnel syndrome. If the Veteran perfects an appeal by submitting a timely VA Form 9, the issues should be returned to the Board for further appellate consideration. (Continued on the next page)   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 a temporary total evaluation based on surgical treatment requiring convalescence for left cubital tunnel syndrome and left carpal tunnel syndrome. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a supplemental statement of the case and provide an opportunity to respond. If necessary, return the case to the Board for further appellate review. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Delhauer, Associate Counsel