Citation Nr: 20021071 Decision Date: 03/24/20 Archive Date: 03/24/20 DOCKET NO. 18-33 921A DATE: March 24, 2020 REMANDED The claim of entitlement to service connection for arthritis of the left hand is remanded. The claim of entitlement to service connection for a left wrist disability is remanded. The claim of entitlement to service connection for a ganglion cyst of the left hand is remanded. REASONS FOR REMAND Service treatment records indicate that the Veteran had a wart removed from his left middle finger in January 1967. He is in receipt of VA disability benefits for a painful scar as a residual of the wart removal. The Veteran asserts that he has disabilities of the left hand and wrist that are related to the residuals the in-service wart removal. He has also stated that he sustained an injury to his left wrist during basic training, when a ganglion cyst ruptured. Review of the record reflects that an earlier VA examination report dated in April 1975 includes the Veteran’s report of trouble with his left middle finger during basic training. He noted that his current symptoms included shooting pain up his arm when he gripped something. VA treatment records reflect that in February 2018, when he was seen to establish care, the Veteran reported a history of left hand pain. The provider stated that it was possible that left hand pain was related to carpal tunnel syndrome given the distribution and examination findings. He indicated that differential diagnoses included osteoarthritis. On VA examination in March 2018, the diagnoses included ganglion cyst and osteoarthritis. The examiner concluded that these diagnoses were not residuals of the in-service wart removal. However, examiner did not provide an opinion regarding whether any current left hand or wrist diagnoses were aggravated by the service-connected wart removal residuals. The Board therefore concludes that an additional examination is necessary to determine whether the Veteran has any additional disability of the left hand or wrist that was caused or aggravated by the service-connected wart removal residuals. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination to determine the etiology of his claimed left hand arthritis, left wrist disability, and left hand ganglion cyst. The claims file must be made available to the examiner. All necessary tests and studies should be accomplished, and all clinical findings should be reported in detail. Following review of the record and examination of the Veteran, the examiner should identify all diagnoses referable to the Veteran’s left hand and wrist. If no diagnosis is warranted, any functional loss of the left hand and wrist should be noted. The examiner should provide an opinion regarding whether it is at least as likely as not that any such condition was incurred in, or is otherwise related to, active service. The examiner should also provide an opinion with respect to whether it is at least as likely as not that any such condition was caused or aggravated by the Veteran’s service-connected wart removal residuals of the left middle finger. In rendering these opinions, the examiner is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran’s reports, he or she must provide an explanation for such rejection. The examiner is not to improperly discount the Veteran’s lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 2. Then, readjudicate the Veteran’s claims, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Barone, 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.