Citation Nr: 21076235 Decision Date: 12/22/21 Archive Date: 12/22/21 DOCKET NO. 16-25 077 DATE: December 22, 2021 REMANDED Entitlement to service connection for trigger thumb, left hand, is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to May 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from April 2016 and September 2016 rating decisions of a Department of Veterans Affairs (VA) Regional Office (RO). The issues were previously remanded by the Board in April 2019 and May 2021 for additional development. While the Board regrets further delay, the issues must again be remanded to ensure that there is a complete record upon which to decide these issues and to afford the Veteran every possible consideration. The Veteran's November 2021 motion to advance his case on the docket due to illness has been granted. 1. Service connection for trigger thumb, left hand. As the Board noted in its previous remand, the Veteran was afforded a VA Hand and Finger Conditions examination in August 2019. In finding that the Veteran's disability is less likely than not related to his active service, the examiner's etiological opinion recites evidence from the Veteran's service treatment records and post-service treatment records, including the Veteran's July 1977 Report of Medical History that shows he reported joint pain and post-service treatment records from many years after service indicating complaints relating to his left thumb trigger finger and related treatment. The Veteran has reported that he injured his left thumb and left third digit during obstacle course training per the medical opinion. The medical opinion also provides general information concerning tendons and lists the major risk factors for trigger finger. The examiner opined that, while the Veteran might have been at risk for trigger finger during service due to his history from the time he served, there is no evidentiary support from the available medical records that his injury was caused by his service or was incurred during his active service. The Board, in May 2021, found the medical opinion to be incomplete because it is based, in part, upon an absence of contemporaneous documentation of an in-service hand or finger injury as it appears the Veteran's lay statements concerning the subject were discounted solely because there was no objective evidence indicating he was seen and treated for such an injury during his active service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (holding that the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible); Cf. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that a VA opinion was inadequate where the examiner did not comment on the Veteran's report of in-service injury and relied on lack of evidence in service medical records to provide a negative opinion). Therefore, the matter was remanded for an addendum opinion, which was obtained in July 2021. Unfortunately, for reasons similar to the above, the July 2021 opinion is also incomplete as the examiner again provide a negative opinion based on no evidence of a hand injury in service and a lack of evidence of a hand injury in the medical record until 2009. The examiner again failed to address the Veteran's July 1977 Report of Medical History that shows he reported joint pain. As such, an addendum is again necessary. The Board also notes that the Veteran has reported medical treatment by both VA and private physicians. After the Board's previous remand on these issues and the issuance of a July 2021 Supplemental Statement of the Case (SSOC) continuing denials of his claim, the Veteran submitted a VA Form 21-4142, Authorization to Disclose Information to the Department of Veterans Affairs, and a VA Form 21-4142a, General Release for Medical Provider Information to the Department of Veterans Affairs. On his VA Form 21-4142a he listed several private providers, including Viewpoint Health, the Hand and Upper Extremity Center of Georgia, the Foot and Ankle Clinic of Oakwood, and Atlanta Area Orthopedics and Imaging. The RO, however, rejected the Veteran's records request as incomplete, and there is no evidence within the file that the Veteran was notified that the medical record request was rejected. Therefore, remand is also necessary to obtain the Veteran's outstanding records. The Veteran should be notified that his medical record release was rejected and given an opportunity to re-submit appropriately executed VA Forms 21-4142 and 21-4142a. 2. Entitlement to a TDIU. Given that final adjudication of the Veteran's claim for service connection could result in eligibility for a TDIU or result in additional evidence speaking to the Veteran's employability, the issue of entitlement to a TDIU is inextricably intertwined with the claim for service connection being remanded herein, and the issues should be considered together. See 38 C.F.R. § 4.16(a); Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). Accordingly, the issue of entitlement to a TDIU must be remanded as well. The Board notes that, since its previous remands, additional disabilities have been awarded service connection, to include right knee and right foot disabilities, and a claim for service connection for a left knee disability is still under development at the AOJ. The most recent SSOC on this issue provided in July 2021 did not address these disabilities as to the Veteran's TDIU claim. After the Board's ordered development as to his left thumb claim and the completion of all remaining development on the left knee claim, the Veteran's TDIU claim should be readjudicated with consideration of all service-connected disabilities. The matters are therefore REMANDED for the following actions: 1. Ask the Veteran to identify any outstanding treatment records relevant to his claims. All identified VA records should be added to the claims file. All other properly identified records should be obtained if the necessary authorization to obtain the records is provided by the Veteran. The Veteran should specifically be informed that his previous records authorization forms submitted in July 2021 were rejected. If any records are not available, or he identifies sources of treatment but does not provide authorization to obtain records, appropriate action should be taken (see 38 C.F.R. § 3.159(c)-(e)), to include notifying the Veteran of their unavailability. 2. After records development is completed, the claims file should be sent to an appropriate examiner to offer an opinion as to the etiology of the Veteran's trigger thumb, left hand. The clinician must review the Veteran's claims file and opine as to whether it is it at least as likely as not (50 percent probability or greater) that the Veteran's trigger thumb, left hand is related to an in-service injury, event, or disease, including a hand or finger injury sustained during obstacle course movements. The clinician should specifically address any reported symptoms during the applicable time period, including the Veteran's July 1977 Report of Medical History that shows he reported swollen or painful joints. In providing the requested opinions, consider the Veteran's description of his in-service symptoms and treatment as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported 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? If the clinician determines that the Veteran's reported swollen or painful joints in July 1977 were not manifestations of his trigger thumb, left hand, or that his trigger thumb, left hand is not related to any aspect of active service, including a hand or finger injury sustained during obstacle course movements, the examiner should discuss what other factor(s) caused the above symptoms or caused his trigger thumb, left hand. The need for a physical examination is left to the discretion of the examiner. A rationale for all opinions offered is requested as adjudicators are precluded from making any medical findings. 3. If any benefit sought on appeal remains denied, to include the claim for entitlement to a TDIU, the Veteran and his representative should be furnished with a SSOC and be given the opportunity to respond. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board R. Scarduzio, 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.