Citation Nr: 21003203 Decision Date: 01/19/21 Archive Date: 01/19/21 DOCKET NO. 20-00 367A DATE: January 19, 2021 REMANDED Entitlement to service connection for arthritis of the left hand is remanded. Entitlement to service connection for arthritis of the right hand is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1962 to June 1970 to include service in the Republic of Vietnam. These matters come before the Board of Veterans' Appeals (Board) on appeal from an October 2018 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In his timely filed January 2020 form 9, the Veteran requested a Board hearing. However, in June 2020 correspondence, the Veteran withdrew his hearing request noting that he was “unable to make appearance in Washington, DC at any forthcoming hearing date.” No subsequent hearing requests have been received. 1. Entitlement to service connection for arthritis of the left hand is remanded. 2. Entitlement to service connection for arthritis of the right hand is remanded. Remand is warranted for the Veteran’s claims of entitlement to service connection for right hand arthritis and entitlement to service connection for left hand arthritis, because the record does not contain an adequate opinion with respect to the Veteran’s arthritic disabilities. Specifically, the Veteran contends that he is entitled to service connection for arthritis in his bilateral hands. In his February 2019 notice of disagreement for entitlement to service connection for arthritis of the right hand, the Veteran asserted that his military occupational specialty as a combat engineer placed much wear and tear on his arms, hands and fingers, which resulted in his current bilateral hand arthritis. The Veteran was afforded a VA examination for his hands in November 2018. The examiner noted that the Veteran has current disabilities of left hand arthritis and right hand arthritis. Where VA provides the veteran with an examination in a service connection claim, the examination must be adequate. Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, while the examiner opined that the Veteran’s bilateral hand arthritis is less likely than not related to the Veteran’s military service, the examiner did not provide supporting rationale for the opinion. As the record establishes current disabilities of arthritis of the right hand and arthritis of the left hand, and there is evidence of an in-service injury or event, namely the Veteran’s MOS as a combat engineer, an opinion as to whether there is a nexus, or causal relationship between the Veteran’s current disability and an in-service injury is warranted. An opinion must be supported by adequate reasons and basis. Here, because no rationale has been provided, the opinion is not adequate. As such, the November 2018 exam is not adequate; remand is required to obtain an adequate etiological opinion. Additionally, in his February 2019 notice of disagreement for entitlement to service connection for arthritis of the left hand, the Veteran asserted that in addition to his MOS as a combat engineer, his shoulder arthritis, neuropathy and herpes have affected his hands. Notably, the November 2018 VA examination indicates that the Veteran was treated for right hand herpes simplex during military service. Consistent with this, February 1965 service treatment records note a diagnosis of right hand herpes simplex, recurrent. Moreover, the Veteran is currently service connected for left shoulder strain with rotator cuff tear and AC joint osteoarthritis and peripheral neuropathy of the left upper extremity. Accordingly, an opinion as to whether the Veteran’s arthritis of the bilateral hands is the result of or has been aggravated beyond its natural progression as a result of the Veteran’s service connected disabilities is warranted. As such, the Veteran’s claims are remanded for addendum VA opinions. The matters are REMANDED for the following action: 1. Obtain all outstanding VA treatment records. 2. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s arthritis of the left hand is at least as likely as not related to his military service to include his military occupational specialty as a combat engineer. The examiner should also opine whether the Veteran’s arthritis of the left hand is proximately due to or aggravated beyond its natural progression by the Veteran’s service connected disabilities of herpes simplex, left shoulder arthritis or neuropathy of the bilateral lower extremity. The term “aggravated beyond the natural progression” means any incremental increase in disability—any additional impairment of earning capacity—in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence. The examiner should assume that the Veteran’s statements are credible for the limited purpose of providing the requested medical opinions. 3. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran’s arthritis of the right hand is at least as likely as not related to his military service to include his military occupational specialty as a combat engineer. The examiner should also opine whether the Veteran’s arthritis of the right hand is proximately due to or aggravated beyond its natural progression by the Veteran’s service connected disabilities of herpes simplex, left shoulder arthritis or neuropathy of the bilateral lower extremity. The term “aggravated beyond the natural progression” means any incremental increase in disability—any additional impairment of earning capacity—in non-service-connected disabilities resulting from service-connected conditions regardless of its permanence. The examiner should assume that the Veteran’s statements are credible for the limited purpose of providing the requested medical opinions. Jennifer White Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Wimbish, 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.