Citation Nr: 21073097 Decision Date: 12/07/21 Archive Date: 12/07/21 DOCKET NO. 17-21 971 DATE: December 7, 2021 REMANDED Entitlement to service connection for a right hand disability, claimed as hand numbness, is remanded. Entitlement to service connection for a skin disability, claimed as due to exposure to herbicides, is remanded. REASONS FOR REMAND The Veteran served on active military in the United States Marine Corps from June 1971 to February 1974. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a November 2016 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). In August 2019, the Veteran testified at a Board video conference hearing before the undersigned Veterans Law Judge. A transcript of the hearing is of record. This matter was previously before the Board in October 2020 at which time the issues presently on appeal were remanded for additional development. Right Hand Disability The Veteran contends that he injured his right hand in service. Specifically, he reports that he broke his knuckles playing handball in 1971 and he broke his joints again in 1972 after an aircraft generator dropped on his hand. Service treatment records reflect that he had a history of broken bones in his right hand prior to service. His March 1971 enlistment examination and x-ray findings were negative upon entry. The Board remanded the matter in October 2020 to obtain a medical nexus opinion regarding the Veteran's claimed hand disability and his reported injuries in service. He underwent a QTC examination in May 2021 and was diagnosed as having degenerative joint disease in the right hand. The examiner addressed the likelihood of a nexus between the Veteran's right hand degenerative joint disease and service. However, there is a neurological component to this claim which has not yet been addressed. In this regard, the Veteran claimed service connection for hand numbness in July 2016, and he reported in his substantive appeal in April 2017 that the crush injury to his right hand in service caused numbness in his right hand. Medical records show that he underwent electromyography/nerve conduction velocity studies in December 2016 revealing right (and left) distal median neuropathy. Also, a more recent consult report in July 2021 shows that the Veteran was four years out from bilateral carpal tunnel release and that two weeks earlier he began experiencing tingling in his fingers. He also complained of right ring finger pain. In consideration of the evidence outlined above, the Veteran should be afforded a neurological examination. This is especially so when considering his assertion in his substantive appeal in April 2017 that VA failed to assist him by obtaining a medical examination to address a nexus between the crush injury and resulting right hand numbness. See Barr v. Nicholson, 21 Vet. App. 303 (2007) (once VA undertakes the effort to provide an examination, it must provide an adequate one). Skin Disability The Veteran asserts that the etiology of his skin disability is a virus possibly related to his exposure to herbicides. This is based on his August 2019 hearing testimony and from the reports he made to a QTC skin examiner in May 2021. He testified that he was hospitalized at a private hospital in November 2015 for an unknown virus. This is consistent with VA treatment records in November 2015 which show that he was discharged from a hospital earlier that month for possible pneumonitis. Later in November 2015, the Veteran reported to VA emergency department complaining that he felt "terrible". Testing at that time revealed that he had herpes zoster. In May 2021, the Veteran underwent a VA examination for his claimed skin disability, and he was diagnosed as having recurrent herpes. He told the examiner that a rash has been appearing recurrently in the upper buttock area about every six weeks since 1973. The examiner opined that it is less likely than not that the Veteran's current recurrent herpes infection in the buttock region is etiologically related to service, including exposure to herbicide. He explained that he would not speculate on whether the Veteran contracted herpes simplex via sexual contact during his service years, but that the condition was not related to his inservice herbicide exposure. This rationale is inadequate since it still leaves open the possibility that the Veteran acquired the virus in service, just not due to herbicide exposure. Accordingly, to more accurately assess whether the Veteran's recurrent herpes is related to service, an addendum medical nexus opinion must be obtained that is supported by well-reasoned rationale. Barr v. Nicholson, 21 Vet. App. 303 (2007). While the Board regrets the additional delay, a remand is necessary to ensure that due process is followed and that there is a complete record upon which to decide the appellant's claims so that he is afforded every possible consideration. 38 U.S.C. § 5103A; 38 C.F.R. § 3.159. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA neurological examination for his claimed right-hand disability. The examiner must review the claims file. The examiner is asked to determine whether the Veteran has a neurological disability of the right hand and, if so, if such disability is at least as likely as not related to service? Provide a rationale to support the opinion(s). In providing the requested opinion, consider the Veteran's description of his two right hand injuries in-service and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported injuries and symptoms in service and thereafter represented the onset of his current 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. Obtain an addendum opinion from an appropriate clinician regarding whether the Veteran's claimed skin disability, diagnosed as herpes, is at least as likely as not related to service. After a review of the record, the examiner should offer his or her opinion as to the following inquiry: Whether it is at least as likely as not (a 50 percent or greater probability) that the Veteran's diagnosed herpes is etiologically related to, or was incurred during, his active military service. In rendering such opinion, the examiner should, at a minimum, consider and discuss the Veteran's report that a rash has been appearing in the upper buttock area, recurrently, since 1973, about every 6 weeks. The examiner should also consider possible dormant states of the virus. A complete rationale should be provided for any opinion expressed. If the examiner is unable to reach an opinion as to any of the information requested above without resorting to speculation, he or she should explain the reasons for such inability and comment on whether any further tests, evidence, or information would be useful in rendering the opinion being sought. 3. Then, readjudicate the appeal. If a decision is adverse to the Veteran, issue a supplemental statement of the case and allow appropriate time for response. Then, return the case to the Board. Kristin Haddock Veterans Law Judge Board of Veterans' Appeals Attorney for the Board A. Shawkey, 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.