Citation Nr: 21003671 Decision Date: 01/22/21 Archive Date: 01/22/21 DOCKET NO. 10-43 721 DATE: January 22, 2021 REMANDED Entitlement to a temporary total evaluation based on surgery and need for convalescence for residuals, fracture, left ring finger is remanded. Entitlement to a rating in excess of 10 percent for residuals of a left ring finger fracture is remanded. REASONS FOR REMAND The Veteran served on active duty from April 1979 to March 1983. This matter came before the Board of Veterans Appeals (Board) on appeal from an October 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veteran’s Law Judge during an August 2018 hearing. The transcript of the hearing is of record. A September 2018 Board decision remanded the issues on appeal for further development. 1. Entitlement to a temporary total evaluation based on surgery and need for convalescence for residuals, fracture, left ring finger The Veteran contends that he is entitled to a temporary total disability rating due to a June 2009 hand surgery that required convalescence. The Board finds that the record is unclear regarding the relationship of the surgery to the Veteran’s service-connected ring finger fracture residuals and that remand for a VA opinion is required. Prior to the June 2009 surgery, April 2009 private treatment records noted the prior fusion of the PIP joint of the ring finger and indicated that the Veteran was beginning to show clawing in the ring and little fingers. Additional April 2009 private treatment records stated that the Veteran was there for follow up of ulnar neuropathy clawing and carpal tunnel. The provider found subluxation of the ulnar nerve and recommended transposing it. The provider also recommended carpal tunnel release and anti-claw transfers, including transferring superficialis from middle to ring and little to bring fingers out of the hyperextended position. May 2009 private records stated that the Veteran wanted surgery, and the provider scheduled him for subcutaneous transposition ulnar nerve with a carpal tunnel release and transfer of the superficialis of the middle finger to the ring and little fingers. June 2009 private treatment records indicate that the Veteran had transposition of the ulnar nerve for “flexion of the clawing of his ring and little finger.” The record indicates that the Veteran also had carpal tunnel release. The provider stated that the Veteran would be out of work for 12 weeks for healing. October 2009 private records stated that the Veteran asked about the etiology of his clawing. The provider stated that it could be due to direct trauma or to the ulnar nerve at the elbow (not related to an injury). The provider also stated that it “could have been the result of injury to his hand.” The Board notes that the private treatment records show that the June 2009 surgery involved carpal tunnel release and that the Veteran is not service connected for carpal tunnel syndrome (CTS). However, the record shows that the surgery also involved transposition of the ulnar nerve to address clawing in the ring and little finger, and the October 2009 private record raises the question of whether the clawing was due to the service connected disability as the provider stated that it could be due to hand injury. The Board notes that the use of the word “could” renders the opinion speculative and inadequate for review but finds that it nevertheless indicates that the left ring finger clawing may have been associated with the service connected disability and a VA opinion is required to clarify the etiology. 2. Entitlement to a rating in excess of 10 percent for residuals of a left ring finger fracture As the issue of a temporary total rating has been remanded, the increased rating issue must also be remanded as it pertains to the same disability and the period on appeal includes the period for which the Veteran has requested a temporary total rating. The issues are therefore inextricably intertwined. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are “inextricably intertwined” when the adjudication of one issue could have “significant impact” on the other issue). The matters are REMANDED for the following action: 1. Obtain a VA opinion from an appropriate provider regarding the relationship of the Veteran’s left ring finger clawing to his service connected ring finger disability. The examiner should review the file and provide a complete rationale for all opinions expressed. The opinion should address whether the clawing in the left ring finger noted in the April 2009 and June 2009 private treatment records is due to the service-connected left ring finger disability. The opinion should address the October 2009 private records regarding the etiology of the Veteran’s clawing. (Continued on next page)   2. If upon completion of the above action the appeal remains denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board A. Arnold, 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.