Citation Nr: 20007068 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 17-53 306 DATE: January 28, 2020 ORDER Entitlement to service connection for a left pinky finger disorder, diagnosed as swan neck deformity of the left small finger, is granted. FINDING OF FACT The Veteran’s left pinky finger disorder, diagnosed as swan neck deformity of the left small finger, is related to his active service. CONCLUSION OF LAW The requirements to establish entitlement to service connection for a left pinky finger disorder, diagnosed as swan neck deformity of the left small finger, have been met. 38 U.S.C. §§ 1110, 1154, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active duty service in the United States Navy from August 1959 to July 1969. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a December 2016 rating decision. In November 2019, the Veteran testified at a Board videoconference hearing before the undersigned Veterans Law Judge. A transcript from that proceeding is associated with the claims file. 1. Entitlement to service connection for a left pinky finger disorder. Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131; 38 C.F.R. § 3.303(a). To establish a right to compensation for a present disability, a Veteran must show: (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-the so-called "nexus" requirement. Holton v. Shinseki, 557 F.3d 1362, 1366 (Fed. Cir. 2009) (quoting Shedden v. Principi, 38 F.3d 1163, 1167 (Fed. Cir. 2004)). The absence of any one element will result in denial of service connection. Service connection may also be granted for any disease initially diagnosed after service when all of the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). In addition, for Veterans who have served 90 days or more of active service during a war period or after December 31, 1946, certain chronic disabilities, including arthritis, are presumed to have been incurred in service if they manifested to a compensable degree within one year of separation from service. 38 U.S.C. §§ 1101, 1112, 1113, 1131, 1137; 38 C.F.R. §§ 3.307, 3.309. For the showing of a chronic disease in service, there is required a combination of manifestations sufficient to identify the disease entity and sufficient observation to establish chronicity at the time. If chronicity in service is not established, a showing of continuity of symptoms after discharge is required to support the claim. 38 C.F.R. §§ 3.303(b), 3.309; Walker v. Shinseki, 708 F.3d 1331 (Fed. Cir. 2013). The Veteran contends that he has a left pinky finger disorder that is related to an injury he sustained at the end of 1962 while he was on active duty in Japan. The Veteran reported that he injured his left pinky finger while playing basketball at the commissary. See November 2019 Board Hearing Transcript. The Veteran injured his ankle when he landed on the foot of another player shooting a basket, and he was carried to sick bay. It was at that time that the Veteran realized his left pinky finger was out of joint and painful. The Veteran recalled that the left pinky finger later went back into place. He was then taken to an Army Hospital at Camp Zama, Japan, and the providers placed his left pinky finger in a splint. The Veteran was hospitalized for two to three weeks, primarily as a result of his ankle injury. The Veteran and his representative testified that after the injury, the Veteran’s left pinky finger was bent at an odd angle, and the Veteran indicated he felt intermittent symptoms of pain since the injury. The Veteran also reported that he performed a lot of typing in the course of his duties during active service, and his injury adversely affected his ability to type. However, the Veteran used over the counter pain medications instead of seeking treatment for his complaints. The Veteran’s History of Assignments in his military personnel records shows that he was assigned to the United States Naval Security Group Activity in Kamiseya, Japan from March 1962 to July 1963. A Report of Enlisted Performance Evaluation for the period from May 1962 to September 1962 also reported that the Veteran’s primary duties consisted of administrative work. Subsequent enlisted performance evaluations in the military personnel records also indicated that the Veteran continued to perform administrative work, including typing, after the time of the reported injury. In the Veteran’s service treatment records (STRs), the August 1959 enlistment examination noted that the Veteran had a 1.5 inch linear scar on the heel of his left hand. However, no left pinky finger defects were noted; and the Veteran did not report a history of any relevant complaints in the August 1959 Report of Medical History. In October 1961, an STR noted that the Veteran had reported to sick bay complaining of a swollen right ankle after he twisted his ankle while playing basketball. He was referred to Portsmouth Naval Hospital, and he was found to have an acute right ankle sprain. The record did not document any left pinky finger complaints, and no left pinky finger problems were noted in a subsequent November 1961 Service Exam. In September 1962, an entry stated that the Veteran had been examined and found physically qualified for transfer. A subsequent STR from the United States Army Hospital in Zama reported that the Veteran was hospitalized from December 10, 1962 to December 26, 1962 after he sustained a twisting injury to the right ankle while playing football. However, no left pinky finger issues were noted in the summary of the Veteran’s treatment. A July 1963 reenlistment examination also did not document any left pinky finger abnormalities. In addition, the Veteran did not report any relevant problems in a February 1965 Report of Medical History. A June 1969 discharge examination stated that the Veteran’s upper extremities were normal, and no left pinky finger problems were documented. After service, Dr. M., DO, noted in a September 2017 private treatment record that the Veteran presented for an evaluation of his left small finger and left ankle. Dr. M. stated that the Veteran had sustained a dislocation of his left small finger approximately 55 years ago. The Veteran reported that he reduced it himself, and his finger was splinted from December 1962 to January 1963 during a period when was hospitalized in Japan. Dr. M. noted that the Veteran had recently developed a deformity of the finger without any recurrent trauma. It had been progressively worse over the past year. Dr. M. observed that x-rays of the small finger revealed no obvious deformities, but x-rays of the ankle revealed some degenerative changes. The assessment was swan neck deformity of the left small finger and degenerative joint disease of the left ankle. The Veteran later provided additional details in a December 2017 statement. He noted that the swan neck deformity assessed by Dr. M. in the September 2017 record had developed over the past year. However, the Veteran had been unable to straighten out his finger since the time of the injury. The Veteran also stated that his physician had x-rayed his finger and diagnosed the swan neck deformity in addition to informing the Veteran that it had developed arthritis. Although it appears that the Veteran was referencing Dr. M.’s evaluation of his left pinky finger, the Board notes that the only arthritis identified by Dr. M. in the provided record was for the left ankle. The assessment for the left pinky finger was limited to swan neck deformity. The remaining evidence of record also lacks evidence of a diagnosis for arthritis in the left pinky finger. Regarding the Veteran's report that he has experienced symptoms of a left pinky finger disorder since his injury during service, the Board notes that the Veteran is competent to attest to observable symptomatology and events that he experienced. 38 U.S.C. § 1153(a); 38 C.F.R. § 3.303(a); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board also finds the Veteran's reported history to be credible. The Board acknowledges that the left pinky finger injury was not specifically noted in the STRs. However, the reported circumstances surrounding the injury, including the period of hospitalization for the right ankle after the sports injury, are well documented in the STRs. Although it appears that the Veteran mistakenly remembered that the 1962 injury occurred during a basketball game rather than the football game described in the STRs, the Board finds that the mistake is understandable given that the Veteran experienced an additional right ankle injury during service while playing basketball in 1961. The Veteran also provided potential explanations for the lack of evidence in the STRs of an injury. He explained during the November 2019 Board hearing that he did not seek treatment for his left pinky finger complaints after the injury, and he relied on over the counter pain medications to alleviate his symptoms. The Veteran additionally clarified that his finger was not straight after the injury, but the swan neck deformity had only become apparent in the year before he sought the September 2017 evaluation from Dr. M. The Board also finds it significant that Dr. M. did not indicate that the Veteran’s current swan neck deformity was inconsistent with the details of his reported in-service injury. After considering the findings in the September 2017 treatment record as well as the Veteran's competent and credible reports of left pinky finger symptoms since his injury during active service, the Board finds that the most probative evidence establishes a nexus between the Veteran's current left pinky finger disorder and service. 38 U.S.C. § 5107(b); 38 C.F.R. § 3.102. As such, entitlement to service connection for a left pinky finger disorder, diagnosed as swan neck deformity of the left small finger, is warranted. See 38 C.F.R. § 3.303(a) (service connection must be considered on the basis of the places, types, and circumstances of his service as shown by his service records, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence); see also Buchanan v. Nicholson, 451 F.3d 1331, 1335 (Fed. Cir. 2006) ("[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself"). GAYLE STROMMEN Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board K.C. Spragins, Counsel 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.