Citation Nr: 20037572 Decision Date: 06/02/20 Archive Date: 06/02/20 DOCKET NO. 11-04 520 DATE: June 2, 2020 REMANDED Entitlement to service connection for bilateral erosive osteoarthritis of proximal and distal interphalangeal joints, to include as secondary to service-connected right wrist degenerative joint disease right carpometacarpal joint and old nonunion fracture of the navicular bone is remanded. Entitlement to total disability based on individual unemployability due to service-connected disabilities (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty in the Army from September 1959 to August 1961. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a September 2010 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). In June 2014 and March 2019, the Board remanded the Veteran’s appeal to the RO for further evidentiary development.   1. Entitlement to service connection for bilateral erosive osteoarthritis of proximal and distal interphalangeal joints associated with right wrist degenerative joint disease right carpometacarpal joint and old nonunion fracture of the navicular bone is remanded. An October 2019 VA opinion concluded that it was less likely than not that the Veteran’s erosive osteoarthritis (right and left) was caused or aggravated by the service-connected right wrist condition. The rationale was that the etiology of erosive arthritis is obscure, but hormonal influences, metabolic disorders, and autoimmunity have been implicated in this condition. The rationale also states that no mention of previous trauma, such as the Veteran’s right wrist fracture, is seen to be a precursor of developing erosive osteoarthritis. Although this opinion indicates that it is being provided regarding both causation and aggravation questions regarding the service-connected right wrist, the rationale does not clearly address whether the service-connected right wrist fracture residuals could have aggravated the bilateral erosive osteoarthritis and appears to focus on the causation question. Therefore, the opinion does not substantially comply with the Board’s prior remand directives. Stegall v. West, 11 Vet. App. 268, 271 (1998). Additionally, although the rationale appears to indicate that the trauma of the Veteran’s right wrist fracture did not result in the erosive osteoarthritis, the opinion does not clearly address whether the erosive osteoarthritis was directly related to the in-service parachute jump in 1961, although lay statements of record, including an August 2006 statement from the Veteran, indicate that the Veteran experienced pain and swelling to the hand after the parachute jump injury. Other opinions of record also do not directly speak to this question. Therefore, remand is necessary for an addendum opinion that addresses direct service connection and clearly addresses whether the service-connected right wrist fracture aggravated the bilateral erosive osteoarthritis. 2. Entitlement to TDIU is remanded. In January 2020, the Veteran underwent VA examinations for traumatic brain injury and headaches. These VA examination reports provided new information as to the Veteran’s functional impairment from the service-connected disabilities of TBI and migraine headaches, which is pertinent to his claim for TDIU. When new and pertinent evidence created by VA is associated with the claims file, the Board cannot issue a decision unless there is a waiver of review by the Agency of Original Jurisdiction (AOJ) or a Supplemental Statement of the Case addressing the new evidence. See 38 C.F.R. §§ 19.31, 19.37, 20.1304. On April 1, 2020, the Board mailed a letter to the Veteran to inform him of the existence of this evidence and to provide him with an opportunity to waive initial review of the evidence by the AOJ. The Veteran did not reply; therefore, via the terms of the letter sent to the Veteran, the Board assumes that the Veteran does not want the Board to decide his appeal at this time, and the Board will remand the appeal for the AOJ to review the new evidence and issue a Supplemental Statement of the Case that considers this evidence in conjunction with the claim seeking TDIU. In addition, as the Veteran does not currently meet the schedular criteria for TDIU, a decision on the remanded issue of service connection for bilateral erosive osteoarthritis of proximal and distal interphalangeal joints could significantly impact a decision on the issue of TDIU; therefore, the issues are inextricably intertwined. A remand of the claim for TDIU is required for that reason as well. The matters are REMANDED for the following actions: 1. Obtain and associate with the claims file VA treatment records from January 2020 to the present. 2. Obtain an addendum medical opinion from an appropriate clinician. An examination should not be scheduled unless the clinician finds it necessary. The clinician must provide opinions on the following questions: (a.) Whether the Veteran’s erosive osteoarthritis of proximal and distal interphalangeal joints in the right and left hands is at least as likely as not related to an in-service injury, event, or disease, including a parachuting accident in July 1961. The examiner should consider the lay statements of record that the Veteran experienced right-hand pain and swelling after the injury. (b.) Whether it is at least as likely as not that erosive osteoarthritis of proximal and distal interphalangeal joints of the right and left hands (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service. (c.) Whether it is at least as likely as not that the Veteran’s erosive osteoarthritis of proximal and distal interphalangeal joints of the right and left hands is aggravated by (i.e., any worsening of the condition beyond its natural progression) the Veteran’s service-connected right wrist disability. A complete rationale for all opinions must be provided. If the clinician cannot provide a requested opinion without resorting to speculation, it must be so stated, and the clinician must provide the reasons why an opinion would require speculation. The clinician must indicate whether there was any further need for information or testing necessary to make a determination. Additionally, the clinician must indicate whether any opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the particular examiner. 3. After completing the development above, readjudicate the Veteran’s claims in light of all the evidence of record, including the evidence added to the record since the December 2019 SSOC (in particular, the January 2020 VA examination reports on TBI and migraine headaches). If any benefit on appeal remains denied, a supplemental statement of the case must be provided to the Veteran. After the Veteran has had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. M. SORISIO Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board R. Dean 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.