Citation Nr: 20007260 Decision Date: 01/28/20 Archive Date: 01/28/20 DOCKET NO. 19-22 950 DATE: January 28, 2020 REMANDED The issue of entitlement to an increased rating for a right hand disability, currently rated as 10 percent disabling for a muscle strain (injury to Muscle Group VIII), is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1962 to September 1970. This matter is before the Board following his appeal of a February 2019 rating decision. In November 2019, the Veteran testified at a Travel Board before the undersigned Veterans Law Judge (VLJ). The Veteran contends that his service-connected right hand disability is more severe than as contemplated by the currently-assigned 10 percent rating. The Board finds that an additional VA examination is needed before it may determine the appropriate rating(s) to assign for all of the current manifestations of the Veteran’s right hand disability, particularly in light of his November 2019 testimony. In this regard, the Veteran (who is, notably, a doctor) competently testified regarding manifestations of his right hand disability that were not addressed by a February 2019 VA examiner, including limitation of thumb motion and numbness. As a result, an additional comprehensive VA examination is needed on remand. See Allday v. Brown, 7 Vet. App. 517, 526 (1995) (where the record does not adequately reveal current state of disability, fulfillment of duty to assist requires a contemporaneous medical examination); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994). On remand, updated and outstanding treatment records should be obtained, if any. The matters are REMANDED for the following action: 1. Ask the Veteran to identify outstanding private treatment records relating to his right hand disability, if any. After obtaining any necessary authorization forms from the Veteran, obtain any pertinent records identified and associate them with the claims file. If any requested records are unavailable, the claims file should be annotated as such and the Veteran and his representative notified of such. In addition, obtain updated and outstanding VA treatment records and associate them with the claims file. 2. After the development requested in item 1 has been completed to the extent possible, schedule the Veteran for a VA examination to determine the current severity of his service-connected right hand disability. The claims file must be reviewed in conjunction with the examination. All tests deemed necessary should be conducted and the results reported. All objective and subjective symptoms should be described in detail. To the extent possible, the examiner must identify any symptoms and functional impairments due to residuals of a gunshot wound to the right hand in service, to include any pain, limitation of motion, sensory issues, and motor issues, and discuss the effect of the disability on the Veteran’s occupational functioning and activities of daily living. In addition to completing the appropriate DBQs, the examiner should provide the foregoing: (a) Based upon a review of the medical records, the Veteran’s competent hearing testimony, and/or statements elicited from the Veteran during the examination, state whether the Veteran experiences flare ups of his service-connected right hand disability, and how he characterizes the additional functional loss during a flare. If the Veteran describes experiencing flare-ups, identify the (i) frequency; (ii) duration; (iii) precipitating factors; and, (iv) alleviating factors. (b) Based upon the information elicited as a result of the foregoing, state whether it is at least as likely as not (50 percent probability or greater) that during a flare-up right hand range of motion is manifested by limitation of thumb motion with a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Please explain why or why not. (c) Based upon the information elicited as a result of the foregoing, state whether it is at least as likely as not (50 percent probability or greater) that repetitive use over time results in limitation of thumb motion with a gap of more than two inches (5.1 cm.) between the thumb pad and the fingers, with the thumb attempting to oppose the fingers. Please explain why or why not. A complete rationale for any opinion rendered must be provided. If the clinician cannot provide the requested opinion without resorting to speculation, he or she should please expressly indicate this and provide a supporting rationale as to why that is so. S. C. Krembs Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Fagan 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.