Citation Nr: 21071681 Decision Date: 12/01/21 Archive Date: 12/01/21 DOCKET NO. 16-57 125 DATE: December 1, 2021 REMANDED The issue of entitlement to service connection for a left elbow disability is remanded. The issue of entitlement to service connection for a left hand disability is remanded. REASONS FOR REMAND The Veteran served on active duty from December 1976 to August 1982. In October 2020, the Board remanded the issues on appeal for further development. For the reasons outlined below, the Board finds that remand is again needed. 1. The issue of entitlement to service connection for a left elbow disability is remanded. The Board finds that additional development is needed prior to final adjudication of the issues on appeal. First, the record indicates that there may be outstanding relevant records from the Social Security Administration (SSA) to be obtained and associated with the claim file. See VA examination report, May 2013. Upon remand, the Board asks that the AOJ obtain relevant records from the SSA pertaining to any application or award of disability benefits to the Veteran. In addition, the Board finds that a new VA examination and opinion are needed regarding the claimed left elbow disability. The diagnosis in the January 2021 VA examination report is left elbow osteoarthritis associated with old non-displaced fracture. The Board seeks clarification as to what is meant by "old non-displaced fracture." The September 2021 VA opinion indicates that the Veteran was injured in a motor vehicle accident in December 2014, and that this "could be the cause of his left elbow fracture." (Emphasis added). The Board notes that the time between the motor vehicle accident and the January 2021 VA examination is a little more than six years. Based on the qualifying language in the opinion (i.e., "could be"), as well the relatively short amount of time elapsed, it is unclear to the Board that this accident is the "old" fracture referred to in the diagnosis. (The Board notes that the January 2021 VA examination report and September 2021 VA opinion were authored by different examiners.) Accordingly, upon remand, the Board asks that an examiner clarify what is meant by "old non-displaced fracture." In the new opinion, the Board asks that the examiner also address the Veteran's contention, recorded in the January 2021 VA examination report, that he "denies history of left elbow fracture." In addition to the above, the Board finds that a new VA opinion is needed regarding secondary service connection. In the October 2020 remand, the Board directed that if a disability was identified, distinct from those already service-connected, then an opinion should be obtained that addressed potential secondary service connection. However, while the directions to the examiner in the September 2021 VA opinion request an opinion regarding secondary service connection, the provided response does not specifically address this contention. In particular, the Board notes that the rationale does not discuss the service-connected cervical spondylosis and/or left upper extremity radiculopathy in relation to the left elbow, neither as a potential cause or aggravator of the diagnosed left elbow disability. Accordingly, this opinion is inadequate, and a new opinion is needed. 2. The issue of entitlement to service connection for a left hand disability is remanded. The Board also finds that a new VA examination and opinion are needed regarding the claimed left hand disability. The Board acknowledges the January 2021 VA examination report, which notes that "[t]he Veteran does not have a current diagnosis associated with any claimed" left hand condition. Nevertheless, the Board seeks clarification of the following. In the medical history portion of the January 2021 VA examination report, it states: "4/9/19 x-rays left hand were normal." However, in the Diagnostic Testing portion of the report, "no" is indicated in response to the question: "Have imaging studies of the hands been performed and are the results available?" Given the potential significance of x-ray images in diagnosing arthritis, the Board finds it relevant that x-ray images were not addressed consistently in the VA examination report. Accordingly, the Board finds that a new VA examination and opinion are needed for the claimed left hand disability. Finally, the Board asks that in providing an opinion both for the claimed left elbow and hand disabilities, the examiner address the Veteran's lay statements and in-service duties. At the February 2020 VA examination, the following was reported: The veteran states that he developed a problem with his left elbow and hand as a result of moving a heavy object during his active-duty service. He states that he was working with another service member carrying a heavy tow bar. The veteran states that the other service member lost his grip and dropped his end. This had a jarring effect on his left arm resulting in injury to the hand, elbow, shoulder and neck region. The veteran states that his injury was sufficiently severe such as to put him on bedrest for about a month after the injury. He continues to experience ongoing problems with his left elbow. The Veteran's DD 214s identify his specialty as Unit/Organization Supplyman and Unit Supply Specialist. A notation in the Veteran's service treatment records states that the Veteran's "MOS supply involves hvy [sic] lifting." See STR, April 1980. The Board concedes that the Veteran engaged in heavy lifting in service. Accordingly, the Board asks that the examiner consider and address the Veteran's statements and in-service duties when drafting the opinions. The matters are REMANDED for the following action: 1. After securing any necessary consent forms from the Veteran, obtain any outstanding treatment records, to include any VA and/or private treatment records, pertaining to the issues on appeal. In addition, obtain relevant records from the SSA pertaining to any application or award of disability benefits to the Veteran. All efforts should be documented in the claim file. If any records could not be obtained, this should be noted in the claim file. 2. Upon completion of the above, schedule the Veteran for VA examinations to clarify the diagnosis of his claimed left elbow and left hand disabilities and to address the etiology of any diagnosed disability(ies). The Board notes that pain with functional impairment can be considered a disability for VA purposes. See Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018). Any images needed for diagnosis should be taken. Direct Service Connection For each disability diagnosed, the examiner is asked to address whether it is at least as likely as not (i.e., a 50 percent or greater probability) that it was incurred in, or is otherwise related to, the Veteran's active duty service. In addition, the examiner is asked to address the following: (a) Regarding the claimed left elbow disability: The Board asks that an examiner address whether it is at least as likely as not that the "old non-displaced fracture" cited in the January 2021 VA examination report occurred during active duty service. The diagnosis in the January 2021 VA examination report is left elbow osteoarthritis associated with old non-displaced fracture. The September 2021 VA opinion indicates that the Veteran was injured in a motor vehicle accident in December 2014, and that this "could be the cause of his left elbow fracture." (Emphasis added). The Board notes that the time between the motor vehicle accident and the January 2021 VA examination is a little more than six years. Based on the qualifying language in the opinion (i.e., "could be"), as well the relatively short amount of time elapsed, it is unclear to the Board that this accident is the "old" fracture referred to in the diagnosis. The Board asks that an examiner clarify what is meant by "old non-displaced fracture." In the new opinion, the Board asks that the examiner also address the Veteran's contention, recorded in the January 2021 VA examination report, that he "denies history of left elbow fracture." (b) Regarding the claimed left hand disability: The Board asks that an imaging studies needed be performed, and any existing images be addressed. The Board acknowledges the January 2021 VA examination report, which notes that "[t]he Veteran does not have a current diagnosis associated with any claimed" left hand condition. Nevertheless, the Board seeks clarification of the following. In the medical history portion of the January 2021 VA examination report, it states: "4/9/19 x-rays left hand were normal." However, in the Diagnostic Testing portion of the report, "no" is indicated in response to the question: "Have imaging studies of the hands been performed and are the results available?" Given the potential significance of x-ray images in diagnosing arthritis, the Board finds it relevant that x-ray images were not addressed consistently in the VA examination report. (c) Regarding both claimed disabilities: The Board asks that in providing an opinion both for the claimed left elbow and hand disabilities, the examiner address the Veteran's lay statements and his in-service duties. At the February 2020 VA examination, the following was reported: The veteran states that he developed a problem with his left elbow and hand as a result of moving a heavy object during his active-duty service. He states that he was working with another service member carrying a heavy tow bar. The veteran states that the other service member lost his grip and dropped his end. This had a jarring effect on his left arm resulting in injury to the hand, elbow, shoulder and neck region. The veteran states that his injury was sufficiently severe such as to put him on bedrest for about a month after the injury. He continues to experience ongoing problems with his left elbow. The Veteran's DD 214s identify his specialty as Unit/Organization Supplyman and Unit Supply Specialist. A notation in the Veteran's service treatment records states that the Veteran's "MOS supply involves hvy [sic] lifting." See STR, April 1980. The Board concedes that the Veteran engaged in heavy lifting in service. Secondary Service Connection If the examiner is able to identify disabilities, distinct from those already service-connected, the examiner should also provide opinions as to whether it is at least as likely as not that each left elbow and left hand disability is proximately due to, or the result of, or aggravated (permanently worsened) beyond normal progression by the Veteran's service-connected cervical spondylosis, degenerative disc disease of the lumbar spine, and/or left upper extremity radiculopathy. The VA examiner should be given access to the claim file. The examiner should state that a review of the claim file was completed. The examiner must provide a comprehensive report including complete rationales for all opinions and conclusions reached, citing the objective medical findings leading to the conclusions. A detailed rationale is requested for all opinions provided. 3. If upon completion of the above action the issues are denied, the case should be returned to the Board after compliance with appellate procedures. E. I. VELEZ Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Foster, 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.