Citation Nr: 20022582 Decision Date: 04/01/20 Archive Date: 04/01/20 DOCKET NO. 15-14 335A DATE: April 1, 2020 REMANDED Entitlement to service connection for a right hand disability is remanded. Entitlement to service connection for tinnitus is remanded. Entitlement to service connection for a right foot skin disability is remanded. Entitlement to a rating in excess of 0 percent for a right wrist scar is remanded. REASONS FOR REMAND 1. Entitlement to service connection for a right hand disability is remanded. The Veteran contends that he is entitled to service connection for a right hand disability of degenerative joint disease, because the claimed disability is related to an in-service ganglion cyst removal surgery. In an August 2008 VA addendum examination, the examiner noted that evaluation and imaging studies were performed on the right hand. The examiner diagnosed right hand degenerative joint disease. The examiner opined that the claimed disability was less likely than not related to the in-service cyst removal. The rationale provided was that pain from the excision continued in-service but did not increase until recently. The examiner stated that imaging showed mild to moderate degenerative joint disease that was not caused by the ganglion cyst excision. When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The August 2009 VA examiner did not provide a thorough rationale for the medical opinion. The examiner acknowledged the Veteran’s reports of continuity of symptomatology but did not appear to take that into consideration for the rationale. It appears that the examiner concluded that despite the continued pain, because the pain did not increase until recently, the claimed disability was unrelated to service. Therefore, the Board finds that an examination is necessary to provide a thorough rationale and properly consider continuity of symptomatology. 2. Entitlement to service connection for tinnitus is remanded. The Veteran contends that he is entitled to service connection for tinnitus because the claimed disability is the result of in-service noise exposure. In an August 2009 VA examination, the examiner diagnosed tinnitus. The examiner opined that the claimed disability was not caused by active service. The rationale provided was that due to the silence of the service medical records at separation, and a lack of an in-service diagnosis, the claimed disability was not related to service. When VA obtains an examination or opinion, the examination or opinion must be adequate. Barr v. Nicholson, 21 Vet. App. 303 (2007). The Board finds the August 2009 examination to be insufficient for adjudication. The basis of a disability not being shown or diagnosed in service medical records, alone, is not sufficient to determine that a disability is not related to service or could not have manifested thereafter as a result of service. As a result, the Board finds that examination to be of less probative value, and a new examination is necessary. 3. Entitlement to service connection for a right foot skin disability is remanded. The Veteran contends that he is entitled to service connection for a skin disability on the right foot because the claimed disability is the result of active service. After review of the procedural history of this appeal, the Board finds that it is before the Board on a de novo basis, and it is unnecessary to first consider whether new and material evidence has been submitted. The Board cannot make a fully-informed decision on the issue of entitlement to service connection for a right foot skin disability because no VA examiner has opined on the etiology of the disability or whether it is related to in-service foot treatment. VA must provide the Veteran with an examination where the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but (1) contains competent evidence of diagnosed disability or symptoms of disability, (2) establishes an in-service event, injury or disease, or the presence of a presumptive disease during the pertinent period, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease, or with another service-connected disability. McLendon v. Nicholson, 20 Vet. App. 79 (2006). Due to the in-service documentation of foot callus treatment, the Board finds that a VA examination is necessary to determine the etiology of the claimed right foot skin disability. 4. Entitlement to a rating in excess of 0 percent for a right wrist scar is remanded. In a December 2019 statement, the Veteran asserted that the right wrist scar had increased in severity since the Veteran was msot recently examined by VA. The Veteran has not had a VA examination since August 2008. The Veteran should be provided an opportunity to report for a VA examination to ascertain the current severity and manifestations of the right wrist scar. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA examination of the right hand. The examiner must review the claims file and should note that review in the report. The physician is advised that the Veteran is competent to report his symptoms and history, and those reports must be specifically acknowledged and considered in making any opinions. The physician should provide the reasons and bases for all opinions in the examination report. The physician should respond to the following: (a.) Is it at least as likely as not (50 percent or greater probability) that any diagnosed right hand disability is related to service or any incident of service, to include removal of a ganglion cyst? (b.) Is it at least as likely as not (50 percent or greater probability) that any right hand disability was caused by the service-connected residuals of a ganglion cyst removal? (c.) Is it at least as likely as not (50 percent or greater probability) that any right hand disability has been aggravated (increased in severity beyond the natural progress of the disorder) by the service-connected residuals of a ganglion cyst removal? 2. Schedule the Veteran for a VA audiology examination with an examiner who has not previously examined him in conjunction with this claim. The examiner must review the claims file and should note that review in the report. All indicated tests and studies should be accomplished and the findings reported in detail. The examiner should provide a rationale for all opinions provided. The examiner should opine as to whether it is as likely as not (50 percent or greater probability) that any diagnosed tinnitus had its onset during active service, is related to in-service noise exposure; or is otherwise related to service. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology. The examiner should consider when there was a threshold shift in hearing results when comparing the entrance and separation examinations. 3. Schedule the Veteran for a VA examination conducted by the appropriate clinician to determine the nature and etiology of any skin disability. The examiner must review the claims file and note that review in the report. All indicated tests and studies should be accomplished and the findings reported in detail. The examiner should opine as to whether it is as likely as not (50 percent or greater probability) that any skin disability had its onset during active service or otherwise originated during active service, or is related to any event, injury, or disease in service, to include treatment for calluses. If the examiner determines that the skin disability is not the result of active service, and another etiology can be determined, the examiner should provide an opinion as to what likely caused the skin disability, taking into account the Veteran’s full post-service work and medical history. The examiner should discuss the Veteran’s lay statements regarding the history and continuity of symptomatology. The examiner should provide a complete rationale for all conclusions. 4. Schedule the Veteran for an examination by an appropriate clinician to determine the current severity of a service-connected right wrist ganglion cyst scar. The examiner must review the claims file and should note that review in the report. The examiner should provide a full description of the disability and report all signs and symptoms necessary for rating the Veteran’s disability under the rating criteria. The examiner should provide measurements of the scar and should state whether the scar is painful or unstable. Harvey P. Roberts Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Department of Veterans Affairs 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.