Citation Nr: 20034530 Decision Date: 05/18/20 Archive Date: 05/18/20 DOCKET NO. 16-19 673A DATE: May 18, 2020 ORDER Entitlement to service connection for symptoms of intermittent left-hand pain and numbness, as secondary to service-connected residuals of left index finger fracture, is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s intermittent left-hand pain and numbness is caused by his service-connected residuals of left index finger fracture. CONCLUSION OF LAW The criteria for entitlement to service connection for symptoms of intermittent left-hand pain and numbness, as secondary to service-connected residuals of left index finger fracture, have been met. 38 U.S.C. §§ 1110, 5103, 5103A, 5107 (2012); 38 C.F.R. §§ 3.102, 3.159, 3.303 (2019). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1990 to November 1995. This matter was initially before the Board in September 2018. The Veteran’s claim was remanded for further development. Specifically, an additional VA examination was requested to opine as to whether it is at least as likely as not that the Veteran’s reported symptoms of intermittent left-hand pain and numbness are attributable to his service-connected left index fracture. Entitlement to service connection for symptoms of intermittent left-hand pain and numbness, as secondary to service-connected residuals of left index finger, fracture. Service connection may be granted for a current disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). The requirement that a current disability exist is satisfied if the claimant had a disability at the time the claim for VA disability compensation was filed or during the pendency of the claim. McClain v. Nicholson, 21 Vet. App. 319, 321 (2007). Service connection is warranted for a disability proximately due to or the result of service-connected disease or injury. 38 C.F.R. § § 3.310(a). The Veteran contends that he has a current disability of left-hand nerve damage that is related to an in-service injury in 1993, which caused his service-connected left index finger fracture. In July 2013, the Veteran filed a claim for “broken left index finger: nerve damage/loss of sensation,” as secondary to his service-connected left index finger fracture. The Veteran was afforded a VA examination in September 2013. The examiner opined that the Veteran’s nerve damage with loss of sensation is less likely than not proximately due to or the result of his service-connected left index fracture. The examiner reasoned that there were no findings of a peripheral nerve condition. However, the examiner did not identify the cause of the Veteran’s hand numbness. The Veteran underwent a second examination in October 2019. The examiner was specifically asked to opine as to whether it is at least as likely as not that the Veteran’s reported symptoms of intermittent left-hand pain and numbness are attributable to his service-connected left index fracture. The examiner provided the following rationale: Although the Veteran has subjective complaints of tingling and numbness at fracture site which is tip of left index finger, there are no objective findings and no diagnosis due to non-conformity or pattern with reference to numbness and tingling distribution. Additionally, the claimed condition is outside the scope of the current exam. Therefore, a positive secondary service connection cannot be established at this time. Similar to the September 2013 VA examination, the examiner failed to address the cause of the Veteran’s hand pain and numbness. Additionally, the examiner’s rationale is unclear as he states “the claimed condition is outside the scope” of the exam. However, the sole purpose for his examination was to determine the etiology of the Veteran’s “claimed condition” and what his symptoms are attributable to. Therefore, the Board finds that the October 2019 and September 2013 examinations are inadequate for adjudicative purposes. Conversely, in a January 2013 VA examination for his service-connected left index finger fracture, the examiner opined that the Veteran had tenderness or pain to palpation for joints or soft tissue of either hand, including thumb and fingers. Specifically, the examiner describes the Veteran’s symptoms as “[t]enderness to compression of the left index finger distal interphalangeal joint and the same finger distal phalanx.” Given the inadequacies of the October 2019 and September 2013, and a January 2013 VA examination reporting tenderness in the left hand, there has been conflicting evidence as to whether the Veteran’s subjective symptoms are attributable to his residuals of left index finger fracture. However, in Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018), the Federal Circuit held that a diagnosis is not required in order to meet the current disability element of the claim; rather, pain or other symptoms can constitute disability if they cause impairment in earning capacity. While the precise diagnosis of the current left-hand disability is unclear, it is not a requirement for service connection pursuant to Saunders. The evidence is at least evenly balanced as to whether the Veteran’s current symptom of intermittent hand numbness and pain is due to his service-connected left index finger fracture. Therefore, the benefit of the doubt is resolved in favor of the Veteran and the claim for entitlement to service connection for left hand pain and numbness, as secondary to service-connected left index finger fracture is granted. 38 U.S.C. § 5107(b); see Dela Cruz v. Principi, 15 Vet. App. 143 (2001); see also 38 C.F.R. § 3.102. See Wise v. Shinseki, 26 Vet. App. 517, 531 (2014) (“By requiring only an ‘approximate balance of positive and negative evidence’..., the nation, ‘in recognition of our debt to our veterans,’ has ‘taken upon itself the risk of error’ in awarding... benefits.”). T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board T. Adeleke, 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.