Citation Nr: 21070896 Decision Date: 11/26/21 Archive Date: 11/26/21 DOCKET NO. 20-02 825 DATE: November 26, 2021 ORDER Entitlement to financial assistance in purchasing an automobile or other conveyance is granted. FINDING OF FACT The Veteran's service-connected lung cancer results in loss of use of the upper extremities. CONCLUSION OF LAW The criteria for establishing eligibility for financial assistance for an automobile or other conveyance are met. 38 U.S.C. §§ 3901, 3902, 5103, 5103A, 5107; 38 C.F.R. §§ 3.102, 3.159, 3.350, 3.808. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Army from October 1962 to June 1966, and from May 1969 to January 1978, including service in the Republic of Vietnam. This matter comes to the Board of Veterans' Appeals (Board) from an August 2018 Rating Decision. On appeal, the Veteran contends he qualifies for the benefit sought because he has lost the use of his hands and the ability to walk due to complications of his service-connected lung cancer. Financial assistance may be provided to an "eligible person" in acquiring an automobile or other conveyance and adaptive equipment, or automotive adaptive equipment only. 38U.S.C. §3902(a)(b). Eligibility for assistance to purchase a vehicle and adaptive equipment is warranted where one of the following exists as the result of injury or disease incurred or aggravated during active service: (1) loss or permanent loss of use of one or both feet; (2) loss or permanent loss of use of one or both hands; (3) permanent impairment of vision of both eyes, meaning central visual acuity of 20/200 or less in the better eye, with corrective glasses, or central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that the widest diameter of visual field subtends an angular distance no greater than 20 degrees in the better eye; (4) severe burn injury precluding effective operation of an automobile; (5) amyotrophic lateral sclerosis; or, (6) for adaptive equipment only, ankylosis of one or both knees or one or both hips. 38C.F.R. §3.808. The loss of use of a hand or a foot will be held to exist when no effective function remains other than that which would be equally well served by an amputation stump at the site of election below the knee with use of a suitable prosthetic appliance. The determination will be made on the basis of the actual remaining function, whether the acts of balance, propulsion, etc., could be accomplished equally well by an amputation stump prosthesis. 38 C.F.R. §§ 3.350(a)(2)(i), 4.63. The Veteran's service-connected disabilities include lung cancer, rated 60 percent disabling. The Veteran has been in receipt of a total disability rating based on individual unemployability due to service-connected disabilities (TDIU) since October 9, 2001. In June 2020, the Board remanded the case for further development. In its remand, the Board acknowledged that in an August 2019 opinion, an examining VA physician opined that it is at least as likely as not that the Veteran's lung cancer causes paraneoplastic syndrome, which has caused paralysis of the hand and is noted to require the use of a wheelchair. See VA examination report (August 2019); see also VA examination report (July 2019). However, the Board remanded the appeal to obtain a medical opinion as the evidence of record did not address whether the Veteran's service-connected disability resulted in permanent loss of use of a hand or foot. In May 2021, an examining VA physician opined that the Veteran's loss of use of his hands and feet from paraneoplastic syndrome induced progressive cerebellar ataxia coupled with severe hand contractures coupled led to severe functional impairment that no effective function remains other than that which would be equally well served by an amputation with prosthesis. The physician explained that the Veteran's severe contractures prevent gripping and cause decrease dexterity, and his progressive cerebellar ataxia has caused him to be permanently wheelchair bound. The physician further explained that the Veteran's balance issues led to use of a strap to secure him in the wheelchair and that he needs assistance in all of his activities of daily living. The Board finds that the May 2021 medical opinion provides the most persuasive evidence pertaining to whether acts of balance and propulsion could be accomplished equally well by an amputation stump with prothesis. 38 C.F.R. §§ 3.350 (a)(2). Indeed, the examining physician made clear that the Veteran's paraneoplastic syndrome induced progressive cerebellar ataxia coupled with severe hand contractures coupled result in severe functional impairment of the hands and feet, which precludes independent balance and propulsion. As the August 2019 opinion shows that it is, at least as likely as not that the Veteran's lung cancer causes his paraneoplastic syndrome, the Board resolves any doubt in the Veteran's favor and finds that his service-connected lung cancer results in actual loss of use of the upper extremities. Accordingly, entitlement to financial assistance in purchasing an automobile or other conveyance is warranted. In reaching its conclusion, the Board acknowledges that in October 2020, a nurse practitioner opined that it is less likely than not that the Veteran's paraneoplastic syndrome results in the functional loss of use of his hands. The nurse practitioner reasoned that the Veteran's medical records show that his hand contractures are consistent with Dupuytren contracture, and medical literature does not indicate that paraneoplastic syndrome causes Dupuytren contracture. The Board finds that the May 2021 and August 2019 opinions indicating that the Veteran's service-connected cancer causes paraneoplastic syndrome, which results in the current functional impairment of his hands outweighs the unfavorable October 2020 medical opinion. In this regard, the Board finds persuasive the fact that the May 2021 and August 2019 opinions were issued by separate physicians, who agreed on the cause of the Veteran's hand impairment. Additionally, the October 2020 nurse practitioner's opinion acknowledges that the cause of Dupuytren contracture is unknown and does not explain why the Veteran's paraneoplastic syndrome does not result in his current functional loss of the hands. Overall, the Board finds that the May 2021 and August 2019 opinions are more probative as to the cause of the Veteran's functional loss than the October 2020 opinion. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Joshua R. Castillo, 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.