Citation Nr: 21061614 Decision Date: 10/04/21 Archive Date: 10/04/21 DOCKET NO. 15-41 877 DATE: October 4, 2021 REMANDED Entitlement to service connection for right hand venous malformation is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Navy from September 1964 to September 1968. In addition, the Veteran served in the Navy Reserve. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a February 2014 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans' Law Judge at a December 2017 Travel Board hearing. A transcript of the hearing has been associated with the claims file. Previously, the Veteran's claim was denied in a July 2020 Board decision. A May 2021 order of the United States Court of Appeals for Veterans Claims (Court) implemented an April 2021 Joint Motion for Partial Remand (JMPR), vacating and remanding the July 2020 Board decision as to the Veteran's claim for entitlement to service connection for a right hand venous malformation. As such the issue of entitlement to service connection for a right hand venous malformation is again before the Board. Entitlement to service connection for right hand venous malformation is remanded. The Veteran contends that service connection is warranted for a right hand venous malformation. The Board finds in light of the points raised by the parties to the JMPR and the Board's review of the claims file, additional development is warranted. The April 2021 JMPR finds that the Board erred in satisfying its duty to assist in providing an adequate medical opinion regarding aggravation and the presumption of soundness. First, as to the Veteran's service connection claim the April 2021, the parties to the JMPR noted that the Veteran's right hand venous malformation was a congenital disease not noted on entry and the presumption of soundness applies. The parties note that the prior VA opinion failed to adequately address the aggravation element of the presumption of soundness and provide an opinion as to whether there is clear and unmistakable evidence that the Veteran's preexisting right hand venous malformation was not aggravated by service. The parties noted that the July 2019 VA examiner and January 2020 supplemental opinion did not provide a requested opinion as to whether there was clear and unmistakable evidence that the Veteran's right hand venous malformation was not aggravated by service. Further, lay statements note the Veteran in July 2019 reported a 40-year history of a painful bump on his right hand arising when it is cold, which was not addressed. The Veteran was afforded a VA examination in July 2019. The examiner noted a vascular malformation of the right index finger status post excision. The examiner noted that the Veteran's claimed vascular malformation was not aggravated beyond its natural progression by an in-service event, injury or illness. The vascular malformation was a venous malformation which is a disease resulting from inborn error in the development of the venous network. Venous malformation slowly expands overtime, and the development of symptoms depend on location, size and mass effect of the venous malformation on the adjacent tissue. A January 2020 supplemental VA opinion has been associated with the claims file. The examiner noted that the claimed condition, which clearly and unmistakably existed prior to service, was not aggravated beyond its natural progression by an in-service event, injury or illness. The examiner noted that the Veteran reported on and off swelling of the mass for 20 years in 2013, 26 years after active duty. Therefore, the venous malformation pre-existed military service and had a natural progression of slowly growing over time, not an aggravation of the pre-existing condition by military service. A remand is warranted for a supplemental VA opinion to fully address the presumption of soundness and whether the Veteran's right hand venous malformation was aggravated by service. The matter is REMANDED for the following action: 1. Schedule the Veteran for an opinion by an appropriate clinician to determine the nature and etiology of his right hand venous malformation and whether: (a.) Is it clear and unmistakable (obvious manifest and undebatable) that the Veteran had a preexisting right hand venous malformation and if so that it was clearly and unmistakably not aggravated (i.e., increased in disability, beyond the natural progress of the disease) during service? Clear and unmistakable evidence means evidence that cannot be misinterpreted and misunderstood, i.e., it is undebatable. Quirin v. Shinseki, 22 Vet. App. 390, 396 (2009). Temporary or intermittent flare-ups of a preexisting injury or disease are not sufficient to be considered "aggravation in-service." If aggravation is found, identify to the extent possible the baseline level of disability prior to the aggravation and determine what degree of additional impairment is attributable to aggravation of residuals of the right hand venous malformation by the Veteran's service. Review of the entire claims file is required. The examiner must provide a complete rationale for all findings and opinions, and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Attention is invited to the Veteran's lay statements in July 2019 report a 40-year history of a painful bump arising when it is cold, which was not addressed. In addition, the Veteran also reported in 2013, on and off swelling of the mass for 20 years. J.W. FRANCIS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K.R. Kardian, 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.