Citation Nr: 21065812 Decision Date: 10/27/21 Archive Date: 10/27/21 DOCKET NO. 17-44 162 DATE: October 27, 2021 REMANDED Entitlement to service connection for a bilateral hand disability, other than service-connected left-hand scar, is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1973 to October 1974. He appeals a May 2015 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in December 2018. A transcript is of record. Most recently, in April 2021, the Board remanded the Veteran's claim to the AOJ for further action consistent with the Board's remand directives. As such, the case has returned to the Board for further appellate proceedings. Regrettably, the Board finds that further evidentiary development is necessary and remands the case to ensure compliance with the Board's prior remand instructions. The Board notes that the AOJ has since granted service connection for a left-hand scar. See July 2021 rating decision. As such, the Board has recharacterized the issue on appeal to service connection for a bilateral hand disability, other than service-connected left-hand scar. In April 2021, the Board remanded the claim for an examination and opinion where the examiner was to determine the nature and etiology of the Veteran's bilateral hand disability. See April 2021 Board remand directives. Specifically, the examiner was asked to address (1) "the effect, if any, of the Veteran's exposure to cold weather in Alaska and the alleged injury from a hydraulic hose, and (2) discuss the Veteran's alleged onset of arthritis in a June 2012 psychosocial assessment." Id. The Veteran attended a June 2021 VA examination. However, the examiner's report failed to adequately address the second point outlined above as required by the prior April 2021 Board remand. While the June 2021 VA examiner discussed the Veteran's exposure to cold weather while in Alaska and the injury from a hydraulic hose, he did not discuss the Veteran's June 2012 statement regarding arthritis in his hands during a psychosocial evaluation. See June 2021 VA examination report. In response to the prompt to discuss the Veteran's alleged onset of arthritis in a June 2012 psychosocial assessment, the examiner gave a blanket response without any actual reference to the treatment note in question. He stated that "the arthritis is from age related deterioration of the hands and not a specific in-service event." See August 2021 VA examination report. The examiner noted that the October 1974 discharge exam noted no chronic hand disabilities, nor were there any within a year of separation or for decades afterwards. As rationale, the examiner stated, "See above." Id. The Board finds that this response does not adequately address the April 2021 prior remand directives. Specifically, the June 2021 VA examiner's report indicated that the Veteran was diagnosed with bilateral degenerative arthritis of the hands in 2020. See June 2021 VA examination report. By giving a diagnosis date of 2020 on his examination report, without any actual discussion of the Veteran's self-report of arthritis of the hands in June 2012, the Board finds that the June 2021 examiner did not review the requested treatment record from June 2012; even so, he most definitely did not "discuss the Veteran's alleged onset of arthritis in June 2012" as required by the Board's prior remand directives. Moreover, the Board notes there is also an additional statement from the Veteran in July 2012 where he reported "chronic pain in hands due to arthritis." See July 26, 2012 VA treatment note. On remand, both statements regarding the onset of the Veteran's arthritis of the hands from 2012 shall be addressed. As such, the Board finds that there has not been substantial compliance with its remand directives and an additional remand is required. See Stegall v. West, 11 Vet. App. 268, 271 (1998) (where the remand orders of the Board are not complied with, the Board errs as a matter of law when it fails to ensure substantial compliance). The matters are REMANDED for the following action: 1. Obtain any outstanding VA and/or private treatment records relevant to treatment the Veteran received for his bilateral hand disability that are not already of record. All obtained records should be associated with the evidentiary record. If any identified records are not obtainable (or none exist), the Veteran and his representative should be notified, and the record clearly documented. 2. After completing directive #1 above, obtain an opinion from an appropriately qualified clinician to determine the nature and etiology of the Veteran's bilateral hand disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the reviewing clinician. The opinions must include a notation that this record review took place. It is up to the discretion of the reviewing clinician whether a physical examination of the Veteran is needed to answer the questions below. The reviewing clinician should answer the following: (a.) Is it at least as likely as not that the Veteran's bilateral hand disability, including bilateral arthritis, was incurred in, or is otherwise related to, his time on active service? The examiner should specifically discuss the Veteran's alleged onset of arthritis in both a June 5, 2012 psychosocial assessment and a July 26, 2012 VA treatment note. In rendering these opinions, the reviewing clinician is advised that the Veteran is competent to report his symptoms and history. Such reports must be acknowledged and considered in formulating any opinion. If the reviewing clinician rejects the Veteran's reports, he or she must provide an explanation for such rejection. The reviewing clinician is not to improperly discount the Veteran's lay statements or mistakenly rely on an absence of medical evidence in the record to support his or her conclusions. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the reviewing clinician must provide a complete explanation for why an opinion cannot be rendered. In so doing, the reviewing clinician must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. 3. After completing the above to the extent possible, readjudicate the claim. If any benefit sought remains denied, provide the Veteran and his representative with a supplemental statement of the case (SSOC), and return the case to the Board. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Katie Poe, 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.