Citation Nr: 21075363 Decision Date: 12/20/21 Archive Date: 12/20/21 DOCKET NO. 18-04 568 DATE: December 20, 2021 REMANDED Entitlement to service connection for a nerve condition or pain, stiffness, numbness, and tingling of the hands (formerly claimed as a bilateral hand condition) is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Air Force from November 1968 to February 1972, and from November 1973 to June 1979. He had service in the Republic of Vietnam. The matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2017 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Seattle, Washington. The claim was remanded by the Board in July 2019 and in June 2021. In determining the scope of a claim, the Board must consider the Veteran's description of the claim, symptoms described, and the information submitted or developed in support of the claim. Clemons v. Shinseki, 23 Vet. App. 1(2009). In light of the decision in Clemons and the Veteran and his wife describing his current hand symptoms as pain, stiffness, numbness, and tingling, the Board has expanded the Veteran's claim, and the issue has been recharacterized as stated on the title page. This will provide the most favorable review of the Veteran's claim in keeping with the holding in Clemons. 1. Entitlement to service connection for a nerve condition or pain, stiffness, numbness, and tingling of the hands (formerly claimed as a bilateral hand condition) is remanded. Based on the July 2021 Board remand, a VA hand examination was obtained in September 2021. See September 2021 Hand and Fingers Disability Benefits Questionnaire (DBQ). At the September 2021 VA examination, the examiner noted that the Veteran reported pain, stiffness, numbness, and tingling of the hand and finger. However, as to the Veteran's report of numbness and tingling the examiner stated, "Report on the numbness and tingling cannot be assessed on the hand and finger disability questionnaire." This explanation is insufficient to address the directives of the Board's remand, as there is no limit on DBQs that can be utilized to address the Veteran's claim. In fact, a Veteran's disability should not be limited because of the DBQ. The examiner could have specifically written out on the DBQ the Veteran's condition, especially where it was a Medical Opinion DBQ and was not identified as to a specific disability. Based on the foregoing, the Board finds that the claim must be remanded to appropriately assess the Veteran's condition, which may include a nerves examination. "[O]nce the Secretary undertakes the effort to provide an examination [or opinion,] . . . he must provide an adequate one."). See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007). Here, that was not accomplished. The matters are REMANDED for the following action: 1. Schedule the Veteran for the appropriate VA examination to assess the nature of his pain, stiffness, numbness, and tingling of the hand and fingers, which may include a nerves examination. The examiner must review the claims file. 2. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: a. Is the claimed condition at least as likely as not related to service, including herbicide exposure? b. Is it "at least as likely as not (50 percent probability or greater)" that the Veteran's claimed condition BEGAN IN or is related to his time in the service, yes or no? c. If the condition is peripheral neuropathy, is the peripheral neuropathy early-onset? d. The examiner must elicit from the Veteran a further and full account of his relevant symptoms, including the specific (or approximate month of the) onset date of the Veteran's symptoms and the duration of any continuity of symptomatology from onset to the present day. e. The examiner must specifically discuss the Veteran's conceded exposure to Agent Orange and other chemicals during his military service in the Republic of Vietnam. The term "at least as likely as not" does not mean "within the realm of medical possibility." Rather, it means that the weight of medical evidence both for and against a conclusion is so evenly divided that it is as medically sound to find in favor of the conclusion (e.g., etiology) as it is to find against the conclusion. The examiner is advised that the Veteran is competent to report his symptoms and history, and such reports must be acknowledged and considered in formulating any opinion. THE EXAMINER SHOULD ALSO BE AWARE THAT IN RENDERING AN OPINION, IT MUST "CONTAIN NOT ONLY CLEAR CONCLUSIONS WITH SUPPORTING DATA, BUT ALSO A REASONED MEDICAL EXPLANATION CONNECTING THE TWO." SEE NIEVES-RODRIGUEZ V. PEAKE, 22 Vet. App. 295, 301 (2008). Furthermore, if medical literature is relied upon in rendering this determination, the VA examiner should identify and specifically cite each reference material utilized. If the examiner determines that he/she cannot provide an opinion without resorting to speculation, the examiner should explain the inability to provide an opinion, identifying precisely what facts could not be determined. In particular, he/she should comment on whether an opinion could not be provided because the limits of medical knowledge have been exhausted or whether additional testing or information could be obtained that would lead to a conclusive opinion. Jones v. Shinseki, 23 Vet. App. 382, 389 (2010) (The Agency of Original Jurisdiction should ensure that any additional evidentiary development suggested by the examiner be undertaken so that a definite opinion can be obtained.) YVETTE R. WHITE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. J. Cho, 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.