Citation Nr: 20008495 Decision Date: 01/31/20 Archive Date: 01/31/20 DOCKET NO. 19-26 793 DATE: January 31, 2020 REMANDED Entitlement to an initial compensable rating for a left fifth finger disability is remanded. REFERRED The issue of entitlement to service connection for a left hand disability is referred to the agency of original jurisdiction (AOJ) for initial adjudication. See March 2019 VA Form 21-526EZ. REASONS FOR REMAND The Veteran served on active duty in the United States Army from November 1992 to November 1994. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2018 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The record reflects that the Veteran has frequently changed addresses. He is encouraged to keep VA adjudicators apprised of his current address. The Veteran asserts that VA adjudicators erroneously denied his claim for a left fifth finger disability as a result of misreading the notation on his enlistment examination report of a right fifth finger disability that pre-existed service. See March 2018 Notice of Disagreement (NOD); September 2019 VA Form 9. If the Veteran wishes to seek revision of prior decision on the basis of a clear and unmistakable error (CUE), he should file a Motion for Revision on the Basis of CUE. The Veteran is advised that he may request representation by a Veteran Service Organization (VSO) that can assist him with filing a Motion for Revision on the Basis of CUE. With respect to the issue of entitlement to an initial compensable rating for a left fifth finger disability, remand is necessary for additional development. In this regard, the Veteran credibly reported that his fifth finger will “lock and not bend” and that his disability interferes with the use of his hands. See March 2018 Correspondence. The Veteran’s statement suggests the possibility of ankylosis, as ankylosis is defined as immobility and consolidation of a joint. See DORLAND’S ILLUSTRATED MEDICAL DICTIONARY 94 (31st ed. 2007). While the rating schedule does not allow a compensable rating for limitation of motion or ankylosis of the little finger, the schedule provides that ankylosis of the little finger may be rated by analogy as amputation, which would warrant a compensable rating, and permits the assignment of an additional rating for interference with overall function of the hand, if warranted. See 38 C.F.R. § 4.71a, Diagnostic Codes 5156, 5227 (Note); see also Sowers v. McDonald, 27 Vet. App. 472, 480 (2016). On remand, the Veteran should be examined to determine if there is ankylosis of the left fifth finger, as well as the impact of his finger disability on the function of his hand. Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain updated VA treatment records. 2. With any necessary assistance from the Veteran, obtain any outstanding relevant private treatment records. 3. Then schedule the Veteran for an examination to determine the current nature, extent, and severity of the left fifth finger disability. The claims file should be made available to and be reviewed by the examiner. All findings should be reported in detail. The examiner should respond to the following: (a) Assess the severity of the Veteran’s left fifth finger disability. Conduct all indicated tests and studies, to include range of motion studies. The joints involved should be tested for pain (1) on active motion, (2) on passive motion, (3) in weight-bearing, (4) in nonweight-bearing, and (5) with range of motion of the opposite undamaged joint. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so (i.e., ankylosis, too painful to test, etc.). (b) Considering the Veteran’s reported history of recurrent dislocations, as well as the nature of his disability, please also provide an opinion describing functional impairment of the left fifth finger disability due to flare-ups (recurrent dislocations), accounting for pain, incoordination, weakened movement, and excess fatigability on use, and, to the extent possible, report such impairment in terms additional loss of motion and impairment of the normal working movements of the left hand and its digits (i.e. gripping, lifting, pushing, pulling, pinching, turning). If unable to provide such an opinion without resorting to speculation, please provide a rationale for this conclusion, with specific consideration of the instructions in the VA Clinician’s Guide to estimate, “per [the] veteran,” what extent, if any, flare-ups affect functional impairment. The examiner must include a discussion of any specific facts that cannot be determined if unable to opine without speculation. (c) Please describe all impairments attributed to the left fifth finger disability picture, including any deformity, ankylosis (to include of any interphalangeal joint), or interference with the function of the hand. (d) Please opine as to whether the Veteran would be equally well-served by amputation of the left fifth finger and replacement with suitable prosthesis. In reaching his or her conclusions, the examiner should specifically review and consider the Veteran’s reports of recurrent dislocation with constant pain and that his left fifth finger will “lock and not bend” and that it interferes with the use of his hand. See March 2018 Correspondence. S. BUSH Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D.M. Badaczewski, Associate 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.