Citation Nr: 21002266 Decision Date: 01/13/21 Archive Date: 01/13/21 DOCKET NO. 09-04 930 DATE: January 13, 2021 REMANDED Entitlement to service connection for a disorder of the right hand, to include degenerative arthritis, is remanded. Entitlement to service connection for a disorder of the left hand, to include degenerative arthritis, is remanded. Entitlement to service connection for a disorder of the right leg, to include degenerative arthritis, is remanded. Entitlement to service connection for a disorder of the left leg, to include degenerative arthritis, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from November 1964 to October 1969 and from October 1977 to November 2003. These matters come before the Board of Veterans’ Appeals (Board) on appeal of a rating decision issued by the Department of Veterans Affairs (VA). The Board observes that the Veteran’s claim relating to the lower extremities has been construed as service connection for a disorder of the bilateral legs, to include degenerative arthritis. This is a broad claim that encompasses several potential disorders. In November 2019, the Board listed the issues on appeal, in part, as service connection for a left and right knee disorder. However, the Veteran has also contended that he has a hip and foot disorder, to include degenerative arthritis, that is related to service. See Medical Treatment – Government Facility, August 2020. Thus, the Board has recharacterized the Veteran’s claim to encompass the functional impairment due to a bilateral leg disorder. In November 2019, the Board remanded these matters for an addendum medical opinion regarding the hands and knees. The agency of original jurisdiction (AOJ) obtained a medical opinion in January 2020. Regrettably, the Board finds that the record does not reflect substantial compliance with the Board’s remand directives, and further clarification is necessary. Stegall v. West, 11 Vet. App. 268, 271 (2011). The Board finds that a new VA examination and medical opinion are required. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (when VA provides a medical opinion, it must be adequate). Firstly, the Board’s remand directives in November 2019 asked the examiner to provide an opinion as to whether any of the Veteran’s disorders were due to an undiagnosed disorder or medically unexplained chronic multi-symptom illness related to service in Southwest Asia. However, the January 2020 clinician did not address this theory of entitlement. Secondly, the January 2020 clinician found that the record did not show any complaints of a hand condition during active duty service. This conclusion is not supported by the evidence because service treatment records show that the Veteran complained of left-hand numbness in 1991 and left-hand weakness in 1992. Thus, the clinician apparently did not consider relevant medical evidence in his opinion. Thirdly, the Veteran has submitted evidence relating to pain and impairment in his feet, hips, and knees, which suggests that he intends to claim benefits for multiple areas of the leg. However, the record shows that he has yet to be afforded an adequate VA examination for his hip and feet disorders. On remand, the Veteran’s hips and feet should be examined to clarify the nature and extent of his disorders and to determine whether they had onset during or are related to service. Fourthly, the Veteran has contended that his functional impairment of the legs and hands began during active duty service. In this regard, the Board notes that under Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018), pain alone may be considered a disability for VA purposes if it results in objective evidence of functional loss, even in the absence of a diagnosed disorder. The VA examination should consider whether the Veteran experiences pain resulting in functional loss in the legs and hands that had its onset during or is causally related to military service. The Board notes that the Veteran submitted lay statements in August 2020. He asserted, among other things, that his degenerative joint disease began while on active duty, was diagnosed in his shoulder and feet, and that the illness has spread throughout his body. To clarify, the issues currently before the Board are service connection for hand and leg disorders, and any degenerative joint disease not located on the hands or legs may not be considered. To the extent that the Veteran wishes to file a claim for benefits for a shoulder disorder, he remains free to do so by submitting the appropriate form prescribed by the secretary. 38 C.F.R. § 3.155. The Board regrets the delay occasioned by multiple remands, and appreciates the Veteran’s patience as VA works to fulfill its statutory obligation to assist him in obtaining information necessary to substantiate his claims for benefits. The matters are REMANDED for the following actions: 1. Please secure for the record copies of complete updated clinical records of all VA and non-VA treatment the Veteran has received for the disorders on appeal. 2. Schedule the Veteran for a VA examination and medical opinion discussing the nature and etiology of his hand and leg disorders. As part of the evaluation, the examiner should complete disability benefits questionnaires for the hands, hips, knees, and feet. The examiner is asked to review the claims file, and to opine on the following: (a) Please identify all disorders of the hands and legs, to include pain causing functional loss, diagnosed during or proximate to the appeal period. (b) Is it at least as likely as not that any hand or leg disorder, to include pain causing functional loss, had its onset during or is causally related to service? (c) Is it at least as likely as not that any disorder of the hands or legs is proximately due to, a result of, or aggravated by a service-connected disorder? (d) If arthritis of the hands or legs is diagnosed, is it at least as likely as not that it manifested within one year of the Veteran’s separation from military service? (e) Is it at least as likely as not that any disorder of the hands or legs is a symptom of an undiagnosed illness or medically unexplained chronic multi-symptom illness related to service in Southwest Asia? A complete rationale should be provided for all opinions. The examiner is asked to consider and discuss relevant lay and medical evidence, to specifically include: • Service treatment records, including the reports of left hand pain in 1991 and left hand weakness in 1992 • The Veteran’s lay contentions that his hand and leg disorders, to include degenerative joint disease, began during active military service • The Veteran’s lay contentions that he has experienced pain causing functional loss in his hands and legs continuing since military service The examiner is reminded that the term “at least as likely as not,” does not mean “within the realm of medical possibility,” but rather that the evidence of record is so evenly divided that, in the examiner’s expert opinion, it is as medically sound to find in favor of the proposition as it is to find against. ANTHONY C. SCIRÉ, JR Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Reed, 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.