Citation Nr: 21070494 Decision Date: 11/24/21 Archive Date: 11/24/21 DOCKET NO. 17-61 091 DATE: November 24, 2021 ORDER Entitlement to service connection for a left middle finger knuckle disorder, characterized as arthritis, is granted. REMANDED An initial compensable rating for a right elbow disability, status post fracture, is remanded. FINDING OF FACT The Veteran's left middle finger knuckle disorder, characterized as arthritis, is etiologically related to his active-duty service. CONCLUSION OF LAW The criteria for entitlement to service connection for a left middle finger knuckle disorder, characterized as arthritis, have been met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from January 1981 to January 1985. The Veteran testified at a Board of Veterans' Appeals (Board) hearing in July 2021 before the undersigned Veterans Law Judge. A transcript of the hearing is of record. Service Connection The law provides that service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military service. 38 U.S.C. § 1110; 38 C.F.R. §§ 3.303, 3.304. Service connection may be granted for any disease diagnosed after discharge when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303 (d). Generally, establishing service connection requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313, 1316 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999). 1. Entitlement to service connection for a left middle finger knuckle disorder, characterized as arthritis The Veteran is seeking service connection for a left middle finger knuckle disorder, which is claimed as arthritis. He specifically attests that he injured his knuckle during an altercation with another soldier and that it has persisted since then. 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. While the Veteran's medical records are silent for specific diagnosis of a left middle finger disorder, they are clear in showing that the Veteran has a noted lack of range of motion and use. Following a review of the evidence of record, the Board concludes that service connection is warranted in this matter. The Veteran's service treatment records document treatment for his left hand after his 1982 fight. These records specific note that his left third (middle) finger was large and swollen. The Veteran testified that he was in the hospital for a week following the fight. Following service, the Veteran first sought treatment for his left middle finger knuckle in 2002. He testified that prior to 2002, he had pain in his left middle finger knuckle but that it was not enough for him to seek treatment. At his hearing, the Veteran noted that his left middle finger knuckle is larger than the others on that hand and has been so since his 1982 fight. The Veteran was provided with a VA examination in February 2016. The examiner opined that the Veteran's left middle finger knuckle disorder was less likely than not related to active-duty service noting that there were no documented diagnoses or treatment of an arthritic condition of that finger in the Veteran's service records. The examiner also noted that the Veteran's disorder began in 2002. The Board finds this opinion problematic for several reasons. The examiner did not discuss the Veteran's lay statements and misattributed the date the disability arose to when the Veteran first sought treatment for his knuckle versus when the Veteran said the disorder began. The Board notes that as a lay person, the Veteran is not competent to diagnose any particular condition, that the observed symptoms of his left middle finger knuckle, such as pain, stiffness, and altered appearance are within the ambit of lay observation. See Layno v. Brown, 6 Vet. App. 465, 470 (1994) (a Veteran is competent to report on all things of which he has personal knowledge derived from his own senses); See also Jandreau v. Shinseki, 492 F.3d 1372, 1377 n.4 (Fed. Cir. 2007); 38 C.F.R. § 3.159 (a)(2). Thus, the Board finds the Veteran credible and competent to report the occurrence and continuity of symptoms of his left middle finger knuckle since service. The Board thus finds that the preponderance of evidence, including the Veteran's competent and credible statements of his left middle finger knuckle disorder, demonstrates that this disorder is affirmatively related to his active-duty service and has persisted since then. His claim is granted. 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. REASONS FOR REMAND 1. An initial compensable rating for a right elbow disability, status post fracture, is remanded. The Veteran is seeking an initial compensable rating for his right elbow disability. At his Board hearing, the Veteran testified to severe symptoms and worsening of his disability, including pain when resting his elbow or if he were to be bumped by another person. As the Veteran has testified as to worsening symptoms attributable to his right elbow and expressed his willingness to appear for a new examination, the Board will also remand this claim for further development. See Snuffer v. Gober, 10 Vet. App. 400, 402-403 (1997); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); Cf. VAOPGCPREC 11-95 (April 7, 1995). The Veteran had previous examination in February 2016 for his right elbow. The examiner did not document the points at which painful motion began for the Veteran's right elbow range of motion. When the new examination is provided, the RO should seek this information. Accordingly, the Veteran's claim for an initial compensable rating for his right elbow is remanded for additional development. The matters are REMANDED for the following action: 1. Obtain all treatment records that are available from any VA facility from which the Veteran has received treatment. Invite the Veteran to submit evidence in support of his claim. 2. Schedule the Veteran for a new VA examination to determine the current severity of his right elbow disability. The claims folder must be made available to and be reviewed by any examiner. All tests deemed necessary should be conducted and the results reported in detail. The full range of motion testing must be performed in both active and passive motion, in weightbearing and non-weightbearing with range of motion measurements of the opposite undamaged joint. The examiner is asked to notate the points at which the Veteran begins to experience painful motion for each type of motion tested. If the examiner is unable to conduct the required testing or concludes that the required testing is not necessary in this case, they should clearly explain why that is so. The examiner should address in detail the additional functional impairment and range of motion loss due to factors such as pain, weakened movement, excess fatigability, incoordination, and flare-ups for the Veteran's right elbow disorder. The examiner should estimate any additional loss of motion to the best of their ability. If it is not possible to provide a specific measurement without speculation, the examiner should state 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 (does not have the knowledge or training). B.T. KNOPE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Q. Hernan, Attorney Advisor