Citation Nr: 21067088 Decision Date: 11/03/21 Archive Date: 11/03/21 DOCKET NO. 17-40 891 DATE: November 3, 2021 ORDER The request to reopen the service connection claim for a neck disorder is granted. The request to reopen the service connection claim for a left knee disorder is denied. The request to reopen the service connection claim for a right knee disorder is denied. The request to reopen the service connection claim for hearing loss of the left ear is denied. The request to reopen the service connection claim for reduction in use of right hand due to burns is denied. Entitlement to service connection for a neck disorder is denied. REMANDED Entitlement to a compensable disability rating for service-connected dupuytren's contracture, palm of the right hand is remanded. Entitlement to a compensable disability rating for service-connected right hand surgical scar is remanded. FINDINGS OF FACT 1. Evidence received since the final January 2012 rating decision that denied service connection for a neck disorder is not previously of record and raises a reasonable possibility of substantiating the claim of service connection for a neck disorder. 2. Evidence received since the final January 2012 rating decision that denied service connection for a left knee disorder is not new and material. 3. Evidence received since the final January 2012 rating decision that denied service connection for a right knee disorder is not new and material. 4. Evidence received since the final December 2009 rating decision that denied service connection for hearing loss of the left ear is not new and material. 5. Evidence received since the final January 2012 rating decision that denied service connection for reduction in use of right hand due to burns is not new and material. 6. The preponderance of the evidence shows that the current diagnosis of degenerative arthritis of the cervical spine did not have its onset in service, is not presumed to have been incurred during active duty, and is not otherwise related to any active service injury or disease. CONCLUSIONS OF LAW 1. As new and material evidence has been received, the criteria to reopen the service connection claim for a neck disorder are met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156 2. The criteria to reopen the service connection claim for a left knee disorder are not met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. 3. The criteria to reopen the service connection claim for a right knee disorder are not met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. 4. The criteria to reopen the service connection claim for hearing loss of the left ear are not met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. 5. The criteria to reopen the service connection claim for reduction in use of right hand due to burns are not met. 38 U.S.C. §§ 5108, 7105(c); 38 C.F.R. § 3.156. 6. The criteria for service connection for a cervical spine (neck) disorder are not met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran served on active duty from October 1968 to August 1970, from January 1978 to July 1989, and from December 2003 to October 2004. This case is before the Board of Veterans' Appeals (Board) on appeal from Regional Office (RO) rating decisions dated in November 2013 and January 2014. In the November 2013 rating decision, the RO continued the denial of entitlement to service connection for painful left knee joint, painful right knee joint, left ear hearing loss, and reduction in use of right hand due to burns and continued the noncompensable disability ratings for service-connected dupuytren's contracture, palm of the right hand and right hand surgical scar. The Veteran's notice of disagreement (NOD) was received in November 2014. The RO issued a statement of the case (SOC) in June 2017. The Veteran's VA Form 9, substantive appeal to the Board, was received in August 2017. In the January 2014 rating decision, the RO continued the denial of entitlement to service connection for neck pain and grinding. The Veteran's notice of disagreement (NOD) was received in November 2014. The RO issued a statement of the case (SOC) in June 2017. The Veteran's VA Form 9, substantive appeal to the Board, was received in August 2017. NEW AND MATERIAL EVIDENCE Establishing service connection generally requires competent evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. 38 C.F.R. § 3.303; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Certain chronic diseases will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. Generally, a claimant has one year from the date of notice of an Agency of Original Jurisdiction (AOJ) rating decision to submit an NOD, and appeal that rating decision to the Board. With few exceptions, an unappealed rating decision becomes final. See, e.g. 38 C.F.R. § 3.156(b), (c). A finally decided service connection claim shall be reopened and reviewed if new and material evidence is presented or secured with respect to that claim. 38 U.S.C. § 5108; 38 C.F.R. § 3.156(a). VA regulation defines "new" evidence as evidence not previously submitted to agency decision makers and "material" evidence as evidence that, by itself or when considered with previous evidence of record, relates to an unestablished fact necessary to substantiate the claim. 38 C.F.R. § 3.156(a). New and material evidence can be neither cumulative nor redundant of the evidence of record at the time of the last final denial of the claim sought to be reopened and must raise a reasonable possibility of substantiating the claim. 38 C.F.R. § 3.156(a). In determining whether new and material evidence has been received, VA must initially decide whether evidence received since the prior final denial is, in fact, new. This analysis is undertaken by comparing the newly received evidence with the evidence previously of record. After evidence is determined to be new, the next question is whether it is material. The provisions of 38 U.S.C. § 5108 require a review of all evidence submitted by or on behalf of a claimant since the last final denial on any basis to determine whether a claim must be reopened. See Evans v. Brown, 9 Vet. App. 273, 282-83 (1996). Furthermore, for purposes of the "new and material" analysis, the credibility of the evidence is presumed. Justus v. Principi, 3 Vet. App. 510, 512-13 (1992). The threshold for determining whether new and material evidence raises a reasonable possibility of substantiating a claim is "low." Shade v. Shinseki, 24 Vet. App. 110, 117 (2010). When evaluating the materiality of newly submitted evidence, the focus must not be solely on whether the evidence remedies the principal reason for denial in the last prior decision; rather the determination of materiality should focus on whether the evidence, taken together, could at least trigger the duty to assist or consideration of a new theory of entitlement. See Id. at 118, 124 (Lance, J. concurring). 1. Whether new and material evidence has been received to reopen the service connection claim for a neck disorder. The Veteran contends that his current neck disorder is caused by or related to an in-service injury during military service. Specifically, he asserts that he injured his neck when he struck his head on the door while entering a HUMVEE causing trauma to his neck while stationed in Iraq in 2004. The Board concludes new evidence associated with the claims file since the final January 2012 rating decision denying service connection for neck pain and grinding relates to an unestablished fact necessary to substantiate the claim. 38 U.S.C. §§ 7103, 7105; 38 C.F.R. §§ 3.156, 3.303. The Veteran originally filed a service connection claim for a neck pain and grinding in April 2008. The RO denied the Veteran's service connection claim for neck pain and grinding in a December 2009 rating decision on the basis that the condition was neither occurred in nor was caused by service. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970, reserve treatment records from 1989 to 2004, VA treatment records from June 2009 to December 2009, private treatment records, and lay statements from the Veteran. Although notified of the denial in December 2009 at his then current address of record, the Veteran did not initiate an appeal with the rating decision. The Veteran filed a request to reconsider his service connection claim in December 2010. The RO continued the denial of service connection for neck pain and grinding in a January 2012 rating decision on the basis that the evidence fails to show that his condition was caused by military service. Although notified of the denial in January 2012, the Veteran did not initiate an appeal with the January 2012 rating decision within one year of the rating decision. Moreover, no new and material evidence pertinent to the claim was received within the one-year appeal period, nor were additional, relevant service records, warranting reconsideration of the claim, received at any time thereafter. See 38 C.F.R. § 3.156(b), (c). Accordingly, the January 2012 rating decision is final. See 38 C.F.R. § 20.1103. In January 2013, the RO received the Veteran's request to reconsider the Veteran's service connection claim for neck pain and grinding in January 2013. Additional evidence of record received since the final January 2012 rating decision includes service treatment records, private treatment records, VA treatment records, and a November 2013 VA examination. The December 2013 VA examination is new in that it was not of record at time of the January 2012 rating decision. The VA examination shows that the Veteran has a current diagnosis of degenerative arthritis of the cervical spine. This evidence is material as it shows that the Veteran has a current diagnosis of a neck disorder. There was no medical evidence of a diagnosis of a neck disorder at the time of the January 2012 rating decision. Thus, the diagnosis of degenerative arthritis of the cervical spine is unestablished fact necessary to substantiate the claim. As the evidence in the December 2013 VA examination is both new and material, the requirements for reopening the previously denied service connection claim for a neck disorder are met. See 38 C.F.R. § 3.156(a). 2. Whether new and material evidence has been received to reopen the service connection claim for a left knee disorder. 3. Whether new and material evidence has been received to reopen the service connection claim for a right knee disorder. The Veteran contends that his current bilateral knee disorders are caused by or related to military service. Specifically, he asserts that his bilateral knee pain is due to parachute training, prolonged running, and a 10 kilometer march in full gear with a fifty-five pound rucksack. The Board concludes new evidence associated with the claims file since the final January 2012 rating decision denying service connection for a bilateral knee disorder does not relate to an unestablished fact necessary to substantiate the claim. 38 U.S.C. §§ 7103, 7105; 38 C.F.R. §§ 3.156, 3.303. The Veteran originally filed a service connection claim for painful joints in both knees in April 2008. The RO denied the Veteran's service connection claims for painful right knee joint and painful left knee joint in a December 2009 rating decision on the basis that the Veteran's service treatment records show no complaints or treatment for right or left knee pain during military service and therefore, the condition was neither occurred in nor was caused by service. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970, reserve treatment records from 1989 to 2004, VA treatment records from June 2009 to December 2009, private treatment records, and lay statements from the Veteran. Although notified of the denial in December 2009 at his then current address of record, the Veteran did not initiate an appeal with the rating decision. The Veteran filed a request to reconsider his service connection claim in December 2010. The RO continued the denial of service connection for painful right knee joint and painful left knee joint in a January 2012 rating decision on the basis that that there is no evidence of a current diagnosis of chronic right and/or left knee condition related to military service. Although notified of the denial in January 2012, the Veteran did not initiate an appeal with the January 2012 rating decision within one year of the notice of the rating decision. Moreover, no new and material evidence pertinent to the claim was received within the one-year appeal period, and no additional, relevant service records, warranting reconsideration of the claim, were received at any time thereafter. See 38 C.F.R. § 3.156(b), (c). Accordingly, the January 2012 rating decision is final. See 38 C.F.R. § 20.1103. In January 2013, the RO received the Veteran's request to reconsider the Veteran's service connection claim for neck pain and grinding. Additional evidence of record received since the final January 2012 rating decision includes service treatment records, private treatment records, VA treatment records, and a November 2013 VA examination. The service treatment records associated with the claims file after the January 2012 rating decision are duplicates or copies of service treatment records that were in the claims file prior to the January 2012 rating decision and therefore, are not considered new. Private treatment records dated in October 2010 were also associated in the claims file after the January 2012 rating decision; however, a copy of these private treatment records was also in the claims file at the time of the January 2012 rating decision. Thus, the October 2010 private treatment record is not considered new evidence. VA treatment records from October 2012 to November 2016 and private medication profile from Peace Health, are new in that they were not of record at the time of the January 2012 rating decision. The VA treatment records from October 2012 to November 2016 and private medication profile are not material as they do not address the Veteran's bilateral knee disorder. Accordingly, having determined that new and material evidence has not been submitted, the Veteran's request to reopen the claim of entitlement to service connection for a right and left knee disorder is denied. 4. Whether new and material evidence has been received to reopen the service connection claim for hearing loss of the left ear. The Veteran contends that his current left ear hearing loss disorder is caused by or related to acoustic trauma during military service. Specifically, he asserts that his problem with hearing loss should be attributed to Basic Riffle Marksmanship during basic combat training in 1968, advanced infantry training in 1969, sustained aerial flight in helicopters on more than 25 combat assaults during service in Vietnam from 1968 to 1970, and field artillery duty. The Board concludes new evidence associated with the claims file since the final December 2009 rating decision denying service connection for a left ear hearing loss does not relate to an unestablished fact necessary to substantiate the claim. 38 U.S.C. §§ 7103, 7105; 38 C.F.R. §§ 3.156, 3.303. The Veteran originally filed a service connection claim for hearing loss in September 1970. A January 1971 rating decision denied service connection for hearing loss as there is no evidence of any treatment for hearing loss during active duty, on VA examination the hearing was found to be normal, and during the examination the Veteran reported that he had no problems with his hearing. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970, December 1970 VA examination, and lay statements from the Veteran. Although notified of the denial in a January 1971 letter at his then current address of record, the Veteran did not initiate an appeal with the rating decision. The Veteran filed another service connection claim for hearing loss in July 1989. A July 1990 rating decision denied service connection for left ear hearing loss as the examination showed hearing was within normal limits in the left ear. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970 and from January 1978 to July 1989, September 1989 VA examination, treatment records from Eugene Hospital and Clinic, and lay statements from the Veteran. Although notified of the denial in an August 1990 letter at his then current address of record, the Veteran did not initiate an appeal with the rating decision. The Veteran filed a service connection claim for hearing loss in the left ear in April 2008. The RO denied the Veteran's service connection claim for left ear hearing loss in a December 2009 rating decision on the basis that the February 2009 VA examination and private audiological evaluations did not show audiometric findings that met the criteria for hearing loss for VA purposes. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970 and from January 1978 to July 1989, reserve treatment records from 1989 to 2004, VA treatment records from June 2009 to December 2009, private treatment records, February 2009 VA examination, and lay statements from the Veteran. Although notified of the denial in December 2009, the Veteran did not initiate an appeal with the December 2009 rating decision within one year of the rating decision. Moreover, no new and material evidence pertinent to the claim was received within the one-year appeal period, nor were additional, relevant service records, warranting reconsideration of the claim, received at any time thereafter. See 38 C.F.R. § 3.156(b), (c). Accordingly, the December 2009 rating decision is final. See 38 C.F.R. § 20.1103. In January 2013, the RO received the Veteran's request to reconsider the Veteran's service connection claim for hearing loss of the left ear in January 2013. Additional evidence of record received since the final January 2012 rating decision includes service treatment records, private treatment records, and VA treatment records. The service treatment records associated with the claims file after the January 2012 rating decision are duplicates or copies of service treatment records that were in the claims file prior to the January 2012 rating decision and therefore, are not considered new. Private treatment records dated in October 2010 were also associated in the claims file after the January 2012 rating decision; however, a copy of these private treatment records was also in the claims file at the time of the January 2012 rating decision. Thus, the October 2010 private treatment record is not considered new evidence. VA treatment records from October 2012 to November 2016 and private medication profile from Peace Health, are new in that they were not of record at the time of the January 2012 rating decision. The VA treatment records, and private medication profile are not material as they do not document any treatment for hearing loss and do not indicate that the Veteran has a current hearing loss disability under VA regulations. Accordingly, having determined that new and material evidence has not been submitted, the Veteran's request to reopen the claim of entitlement to service connection for left ear hearing loss disorder is denied. 5. Whether new and material evidence has been received to reopen the service connection claim for reduction in use of right hand due to burns. The Veteran contends that he has reduction in the use of his right hand due to burns that occurred in 1986 from a malfunctioning grenade simulator that ignited prematurely in his right hand. The Board concludes new evidence associated with the claims file since the final January 2012 rating decision denying service connection for reduction in the use of his right hand due to burns does not relate to an unestablished fact necessary to substantiate the claim. 38 U.S.C. §§ 7103, 7105; 38 C.F.R. §§ 3.156, 3.303. The Veteran originally filed a service connection claim for reduction in the use of his right hand due to burns in April 2008. The RO denied the Veteran's service connection claim for reduction in the use of his right hand due to burns in a December 2009 rating decision on the basis that medical evidence of record fails to show that disabling residuals of the burns have been clinically diagnosed. The evidence of record at the time of that denial consisted of service treatment records from October 1968 to August 1970 and January 1978 to July 1989, reserve treatment records from 1989 to 2004, VA treatment records from June 2009 to December 2009, private treatment records, and lay statements from the Veteran. Although notified of the denial in December 2009 at his then current address of record, the Veteran did not initiate an appeal with the rating decision. The Veteran filed a request to reconsider his service connection claim in December 2010. The RO continued the denial of service connection for reduction in the use of his right hand due to burns in a January 2012 rating decision on the basis that the evidence fails to show that the Veteran has a current diagnosis of right hand limitation associated with the right hand burn in service. Although notified of the denial in January 2012, the Veteran did not initiate an appeal with the January 2012 rating decision within one year of the rating decision. Moreover, no new and material evidence pertinent to the claim was received within the one-year appeal period, nor were additional, relevant service records, warranting reconsideration of the claim, received at any time thereafter. See 38 C.F.R. § 3.156(b), (c). Accordingly, the January 2012 rating decision is final. See 38 C.F.R. § 20.1103. In January 2013, the RO received the Veteran's request to reconsider the Veteran's service connection claim for reduction in the use of his right hand due to burns in January 2013. Additional evidence of record received since the final January 2012 rating decision includes service treatment records, private treatment records, VA treatment records, and a November 2013 VA examination. The service treatment records associated with the claims file after the January 2012 rating decision are duplicates or copies of service treatment records that were in the claims file prior to the January 2012 rating decision and therefore, are not considered new. Private treatment records dated in October 2010 were also associated in the claims file after the January 2012 rating decision; however, a copy of these private treatment records was also in the claims file at the time of the January 2012 rating decision. Thus, the October 2010 private treatment record is not considered new evidence. VA treatment records from October 2012 to November 2016 and private medication profile from Peace Health, are new in that they were not of record at the time of the January 2012 rating decision. However, the VA treatment records, and private medication profile are not material as they do not evaluate or document any residual disorder associated with burns to the right hand. Accordingly, having determined that new and material evidence has not been submitted, the Veteran's request to reopen the claim of entitlement to service connection for reduction in the use of his right hand due to burns is not warranted. SERVICE CONNECTION As noted above, establishing service connection generally requires competent evidence of the following: (1) A current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) nexus between the claimed in-service disease and the present disability. 38 C.F.R. § 3.303; see Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009). Certain chronic diseases will be presumed related to service if they were shown as chronic (reliably diagnosed) in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013); Fountain v. McDonald, 27 Vet. App. 258 (2015); 38 C.F.R. §§ 3.303, 3.307, 3.309. 1. Entitlement to service connection for a neck disorder. The Veteran contends that he has a current cervical spine disorder that is related to his active duty service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. The Board concludes that, while the Veteran has a current diagnosis of degenerative arthritis of the cervical spine, the preponderance of the evidence weighs against finding that the Veteran's diagnoses of arthritis of the cervical spine began during service, is presumed to be related to active duty service, or is otherwise related to an in-service injury, event, or disease. 38 U.S.C. §§ 1110, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). Turning to the evidence of record, a December 2013 VA examination reveals that the Veteran reported no significant neck injury or back problem until he was in Iraq in 2004. He was wearing a helmet and truck helmet on door frame as he got into a HUMVEE. He was a passenger and rode to his scheduled conference that day and continued regular duty until the time of his scheduled return from Iraq in October 2004. He also recalls pain in his neck, back, and solders after a required 10k march with a 55 pound backpack. The Veteran noted that he has had increasing pain in his neck and back over the years. He currently experiences pain at the base of his neck, both sides, one hour per day, usually in the morning, after watching television, or driving for an hour. He did not experience radiating pain. Grating and grinding of the neck occur when he moves his neck. The examiner provided a diagnosis of age related degenerative arthritis of the cervical spine. The Veteran's service treatment records reveal that the Veteran did not receive treatment for a cervical spine or neck disorder during active duty service. However, an October 2004 Report of Medical Assessment the Veteran noted that he suffered from an injury while on active duty for which he did not seeking medical care. He explained that he experienced "Bump to head in August getting into HUMVEE." In the health care provided comments section there was a notation that the Veteran struck his head on door of vehicles while entering. Trauma caused injury to base of neck. The Veteran continued to have discomfort with right rotation of the cervical spine. He denied numbness or paresthesia in the upper extremities. Thus, there is medical evidence of a neck injury during active military service. The first lay evidence after service where the Veteran reported neck pain and grinding was in the April 2008 claim and the first medical evidence that the Veteran complained of a neck disorder after was in a February 2009 VA examination report. The Veteran was first diagnosed with a neck or cervical spine disability in December 2013. A December 2013 X-ray of the cervical spine showed arthritis. Thus, the first documentation of a neck problem after service was in 2008, approximately three and half years after discharge from active duty and the first medical evidence of a diagnosis of degenerative arthritis of the cervical spine was in 2013, about nine years after discharge from active duty. Although the Veteran is competent to report having experienced symptoms of neck pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis. The issue is medically complex, as it requires the ability to interpret diagnostic medical testing. See Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Regarding the issue of whether service connection is warranted on the basis of the presumption of service connection for chronic diseases, the weight of the above evidence is against manifestation of degenerative arthritis of the cervical spine in service or within the one-year presumptive period. See 38 U.S.C. § 1101(3), 1112(a)(1), 1113; 38 C.F.R. §§ 3.307 (a), 3.309(a). With respect to whether the Veteran's current degenerative arthritis of the cervical spine is related to active duty service, the claims file contains a negative medical opinion. Specifically, the December 2013 VA examiner determined that currently the Veteran's neck condition is more likely than not secondary to his age related degenerative changes. The examiner explained that with the currently available information, the Veteran as likely as not had neck strain documented in 2004. He had no post traumatic findings on his cervical spine x-ray, only degenerative changes, which are mor likely than not age related. The examiner stated that he did not find evidence of residual tissue damage related to his neck episode in 2004. The Veteran as likely as not has had increased severity of neck pain related to his strain in the past, but his current neck condition is more than likely secondary to his age related degenerative changes. The examiner stated that it would be speculation to attribute these changes to the single episode in 2004 with currently available information. This medical opinion is persuasive and probative as to the issue of whether the Veteran's current degenerative arthritis of the cervical spine is caused by or related active military service as the examiner provided a clear explanation for the medical opinion based a review of the claims file, evaluation of the Veteran, and general medical expertise as a physician. Although the Veteran believes his current cervical spine disorder is related to the excessive exercise during service, he is not competent to provide a nexus opinion in this case. The etiology of degenerative changes is medically complex, as it requires knowledge of interpreting complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007). The diagnosis and etiology of degenerative arthritis of the cervical spine cannot be competently addressed by the Veteran as a lay person based on personal observation, such as, visual observation or by any other senses. The current diagnosis of the cervical spine was based on interpretation of symptoms, and clinical and diagnostic tests, to include an X-ray, which requires medical knowledge. Based on the foregoing, the Board finds that the preponderance of the evidence shows that the Veteran's current cervical spine disorder did not have its onset in or are otherwise related to active service. Accordingly, service connection for a neck disorder is not warranted. REASONS FOR REMAND 1. Entitlement to a compensable disability rating for service-connected dupuytren's contracture, palm of the right hand. 2. Entitlement to a compensable disability rating for service-connected right hand surgical scar. The Veteran's most recent VA examination for his dupuytren's contracture, palm of the right hand, and his right hand surgical scar was conducted in April 2013. In the November 2014 NOD, the Veteran asserted that the Dupuytren's contracture, palm of the right hand has resulted in painful motion of the thumb, index finger, long finger, and ring finger. The lump under the right index finger causes painful and limited motion of the thumb and index finger. He also noted that the residual scarring from removal of the Dupuytren tumor from the ring finger caused thickening of the web between the ring and longer, causing painful and limited motion of the long finger. The Veteran's representative asserted that the Veteran is entitled to a new VA examination, because that the Veteran has reported increased painful motion and limitation of motion since his last examination in April 2013. A new examination is appropriate when there is an assertion (and indication) of an increase in severity since the last examination. See 38 C.F.R. § 3.159; see also Palczewski v. Nicholson, 21 Vet. App. 174, 181 (2007). Additionally, VA's duty to assist the Veteran includes obtaining a thorough and contemporaneous examination where necessary to reach a decision on the claim. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. Furthermore, since the April 2013 VA examination, the Court has held that 38 C.F.R. § 4.59 requires VA examination to include joint testing for pain on both active and passive motion, in weight-bearing and nonweight-bearing and, if possible, with range of motion measurement of the opposite undamaged joint. Correia v. McDonald, 28 Vet. App. 158, 168 (2016). The Court has held that that the examiner must "elicit relevant information as to the Veteran's flares or ask him to describe the additional functional loss, if any, she suffered during flares and then estimate the Veteran's functional loss due to flares based on all the evidence of record, including the Veteran's lay information, or explain why she could not do so." Sharp v. Shulkin, 29 Vet. App. 26, 34-36 (2017). In light of the foregoing, a new VA examination to determine the current severity of the Veteran's service-connected dupuytren's contracture, palm of the right hand and right hand surgical scar is necessary. The matters are REMANDED for the following action: 1. Arrange for the Veteran to undergo a VA examination, to determine the current nature and severity of Dupuytren's contracture, palm of the right hand, including, but not limited to whether there is muscle injury and/or neurological impairment. The claims file, including a copy of this remand, must be made available to and reviewed by the examiner and all necessary tests should be performed. All findings should be reported in detail. The right hand and fingers should be tested in both active and passive motion, in weight-bearing and non-weight-bearing, and, if possible, with range of motion measurement of the opposite undamaged joint. In this regard, the examiner should indicate whether the Veteran's limitation of motion is the functional equivalent of ankylosis. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, he or she should clearly explain why that is so. The examiner should describe any pain, weakened movement, excess fatigability, instability of station, and incoordination present. The examiner should also state whether the examination is taking place during a period of flare-up. If not, the examiner should ask the Veteran to describe the flare-ups he experiences, including frequency, duration, characteristics, precipitating and alleviating factors, severity and/or extent of functional impairment he experiences during a flare-up of symptoms and/or after repeated use over time. Based on the Veteran's lay statements and the other evidence of record, the examiner should provide an opinion estimating any additional degrees of limited motion caused by functional loss during a flare-up or after repeated use over time. If the examiner cannot estimate the degrees of additional range of motion loss during flare-ups or after repetitive use without resorting to speculation, the examiner should state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). All findings should be reported in detail and all opinions must be accompanied by a clear rationale. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports are to be considered in formulating any opinion; however, in providing the requested opinion, the clinician should consider the Veteran's reported symptoms, including the progression and severity of his reported symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms are inconsistent with the nature of the service-connected disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? 2. Arrange for the Veteran to undergo a VA examination to obtain a detailed assessment of the current severity of the Veteran's s right hand surgical scar. The claims file must be made available to and reviewed by the examiner. All tests deemed necessary should be conducted and the results reported in detail. After recording the Veteran's reported scar symptoms, the examiner is asked to note whether there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms are inconsistent with the nature of the service-connected disability. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? L. B. CRYAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board B. Berry, 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.