Citation Nr: 21003379 Decision Date: 01/21/21 Archive Date: 01/21/21 DOCKET NO. 18-05 150 DATE: January 21, 2021 REMANDED Entitlement to a rating in excess of 10 percent for residuals of right hand fourth and fifth finger fractures, is remanded. REASONS FOR REMAND The appellant is a Veteran who served on active duty from September 1986 to September 1991. This matter is before the Board of Veterans’ Appeals (Board) on appeal from a May 2016 rating decision. In January 2021, a virtual Board hearing was held before the undersigned. Entitlement to a rating in excess of 10 percent for residuals of right hand fourth and fifth finger fractures Further development of the record is necessary to comply with VA’s duty to assist the Veteran in the development of facts and medical evidence to properly adjudicate this claim. The most recent examination to assess the severity of the Veteran’s service-connected residuals of right hand fourth and fifth finger fractures was in December 2017. At the January 2021 Board hearing, the Veteran (and his spouse) testified that the disability has worsened since that examination. Considering the duration of the intervening period since he was last examined, and the reports of worsening, a contemporaneous examination to assess the current severity of the disability is necessary. See Snuffer v. Gober, 10 Vet. App. 400 (1997). Furthermore, at the January 2021 Board hearing, the Veteran raised additional matters that involve medical questions which require medical guidance. Specifically, he asserted that his fourth and fifth finger fractures residuals disability also involves his third (middle/long) finger; if confirmed by a medical provided, such involvement may impact on the rating assigned for the disability. He demonstrated for the undersigned that he had limited range of motion (to an extent that none could be straightened) of the third, in addition to the fourth, and fifth fingers. The extent of such limitation (possibly including favorable or unfavorable ankylosis) has bearing on the diagnostic code (Code) under which the rating for the service-connected disability is assigned; measurement/clarification of the actual extent by a medical professional is needed. [The disability has been rated under Code 5309; however, depending on the findings and clarification received on remand, a higher rating under Codes 5218, 5219, 5222, or 5223 may be warranted.] Accordingly, remand for an adequate examination is necessary to determine the nature and severity of the Veteran’s service-connected residuals right hand fourth and fifth finger fractures (particularly considering his recently filed claim for service connection for frostbite residuals of the bilateral hands (and feet)). See January 2021 VA Form 21-526EZ. The matter is REMANDED for the following: 1. Secure for the record updated (to the present, any not already associated with the record) complete clinical records of all VA evaluations and treatment the Veteran has received for his right hand/fingers. 2. Thereafter, arrange for the Veteran to be examined by an appropriate clinician to ascertain the nature and severity of his service-connected residuals of right hand fourth and fifth finger fractures disability. The entire record (to include this remand and any new records received pursuant to the development ordered above) must be reviewed by the examiner in conjunction with the examination. [Any tests or studies deemed necessary for proper evaluation must be completed.] The examiner must have available for review 38 C.F.R. § 4.71a, Codes 5216-5230 (i.e., the portions of VA’s Rating Schedule pertaining to evaluation of ankylosis or limitation of motion of single or multiple digits of the hand, including the notes immediately preceding such section). The examiner should respond to the following: (a) Describe all symptoms (and related functional impairment) of the Veteran’s service-connected residuals of right hand fourth and fifth finger fractures disability. The findings must include reports of range of motion studies for pain on both active and passive motion. The examiner should also describe the functional impairment of the disability during flare-ups, to the extent possible reporting such impairment in terms of additional degrees of limitation of motion. [If an opinion cannot be provided without resort to speculation, indicate whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or the examiner lacks the requisite knowledge or training.] (b) Opine whether any disability (including limitation of range of motion) of the right long (middle) finger is a manifestation of the service-connected residuals of fourth and fifth finger fractures disability. (c) Review 38 C.F.R. § 4.71a, Codes 5216-5230 (including the criteria following Code 5215 and immediately prior to Code 5216), and opine (with explanation) whether the disability (as it presents on examination) meets or approximates (is most appropriately rated under) the criteria in Codes 5218, 5219, 5222, 5223, or some other appropriate Code. (d) To the extent possible, distinguish symptoms (and related impairment) attributable to the Veteran’s service-connected residuals of right hand fourth and fifth finger fractures disability from any attributable solely to a co-existing nonservice-connected disability (such as a vascular disease or frostbite residuals). (e) Describe in detail the impact that the residuals of right hand fourth and fifth finger fractures disability has on the Veteran’s daily activity and occupational functioning. All opinions must include rationale, with citation to supporting factual data and medical principles as deemed appropriate. GEORGE R. SENYK Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board J. Dupont, 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.