Citation Nr: 20002541 Decision Date: 01/10/20 Archive Date: 01/10/20 DOCKET NO. 17-61 862 DATE: January 10, 2020 REMANDED Entitlement to service connection for left hand arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from January 1977 to October 1980. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an October 2016 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). Entitlement to service connection for left hand arthritis is remanded. The Veteran states that his left hand arthritis is due to an injury incurred during service. He said that a mortar shell crushed his left hand, requiring stitches. Service treatment records do not contain records of any injuries incurred during service. Although the Veteran stated multiple times that he was treated at the hospital in Fort Lewis in September 1980, such records have not been obtained. See October 1980 Separation Exam; January 2016, August 2016, and June 2018 Statements in Support of Claim. On remand, an effort should be made to obtain any related in-service hospital records regarding treatment for his left hand, as hospital records are housed separately from service treatment records. The Veteran’s post service treatment records include a current diagnosis of osteoarthritis of the basal and metacarpophalangeal joints of the left hand. See November 2015 medical records from University of Rochester Medicine Noyes Health Medical Center (UR Noyes). McClendon v. Nicholson, 20 Vet. App. 79 (2006). The doctor diagnosing the arthritis also notes in the November 2015 medical records that the arthritis in the Veteran’s basal joint may have been caused by prior trauma, but he does not provide any details. This indicates that the Veteran’s left hand arthritis may have been related to his service. However, the Board cannot make a fully-informed decision on this issue because no VA examiner has opined whether the Veteran’s left hand arthritis was caused by or occurred during service, or manifested to a compensable degree within a year of service. The Board notes that although the Veteran contends his left hand arthritis is due to his self-reported in-service injury, he also received post service treatment for a fracture in his left ring finger and a ganglion cyst in his left hand. See May 2000, June 2000, May 2014, November 2015, and January 2016 medical records. The examiner must address the impact of such injuries on the etiology of the Veteran’s left hand arthritis. Despite evidence of a potentially intervening injury, the VA still has a duty to provide an examination based on a current diagnosis of left hand arthritis, an indication that his left hand arthritis resulted from the claimed left hand injury in service, and insufficient competent medical evidence to decide the claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McClendon v. Nicholson, 20 Vet. App. 79 (2006). Therefore, the Board must remand to obtain a VA examination and medical opinion to determine the nature and etiology of the Veteran’s left hand arthritis. The matter is REMANDED for the following action: 1. Obtain copies of all outstanding hospitalization records from the Madigan Army Medical Center at Fort Lewis, to specifically include records from September 1980, as well as any current VA treatment records. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of his left hand arthritis. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The entire file should be made available to the examiner. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should provide opinions that respond to the following: (a.) Identify all disabilities to which the Veteran’s left hand arthritis is medically attributable. (b.) As to each disability diagnosed, is it at least as likely as not (a 50 percent or greater probability) that this disability: i. Had its onset in service, ii. Manifested to a compensable degree within a year of service, or iii. Is otherwise related to an in-service injury, event, or disease? In rendering this opinion, the examiner should consider and address as necessary the following: i. The Veteran’s 1980 separation exam wherein the Veteran reports his hospital visit and finger stitches. ii. All medical records pertaining to the Veteran’s ganglion cyst in his left hand. iii. Medical records from May 2000 and June 2000 relating to the Veteran’s left ring finger fracture. If the Veteran’s left hand arthritis is attributable SOLELY to an intervening hand injury, the examiner should explain why NONE of the current hand disabilities would be attributable to an injury sustained in service. The examiner is requested to provide a clear rationale and explain in detail the underlying reasoning for any opinions expressed. A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, he or she should expressly indicate this and provide a supporting rationale as to why an opinion cannot be made without resorting to speculation. TANYA SMITH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Papacalos, Law Clerk The Board’s decision in this case is binding only with respect to the instant matter decided. This decision is not precedential, and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.