Citation Nr: 21076924 Decision Date: 12/28/21 Archive Date: 12/28/21 DOCKET NO. 16-43 063 DATE: December 28, 2021 REMANDED The issue of entitlement to an increased rating for a left hand disability is remanded. REASONS FOR REMAND An additional examination addressing the nature and current severity of the Veteran's left hand disability is warranted. By way of history, a July 2008 rating decision of the Agency of Original Jurisdiction (AOJ) granted service connection for the Veteran's status post left hand nerve damage with a residual scar and assigned a 20 percent rating based on ulnar nerve impairment. A March 2009 rating decision continued the existing 20 percent rating of the Veteran's left hand disability based on ulnar nerve impairment, and it granted an additional 10 percent rating on the basis of limitation of motion of the left long and ring fingers. The Veteran's current appeal originates from the AOJ's July 2015 request for a medical examination of the Veteran's left hand disability. Following an August 2015 examination of the Veteran's peripheral nerves, the August 2015 rating decision that is currently on appeal continued the existing 20 percent rating of the Veteran's left hand disability. The August 2015 rating decision changed the Diagnostic Code used to rate the Veteran's nerve impairment from 8716, which applies to neuralgia of the left ulnar nerve, to 8513, which applies to incomplete paralysis of all radicular groups. The Veteran presented testimony during his July 2021 hearing suggesting that his left hand disability had worsened since the time of his August 2015 examination, specifically noting that his left hand had developed Dupuytren's contracture. The Veteran additionally presented private treatment records documenting his 2021 treatment for a left hand disability, including Dupuytren's contracture. With the Veteran's left hand symptoms apparently increasing in severity, the Veteran should be provided with additional examinations to address the current nature and severity of his left hand disability. This matter is REMANDED for the following action: Schedule the Veteran for VA examinations to determine the current nature and severity of his left hand disability. These examinations should address all manifestations of the Veteran's left hand disability, including nerve impairment and limitation of motion of the fingers. The claims folder and a copy of this Remand must be provided to the examiner in conjunction with the examination. The examiner should state whether the Veteran experiences Dupuytren's contracture. If the Veteran does experience Dupuytren's contracture, the examiner should indicate whether the condition is (1) a symptom and/or manifestation of his service connect left hand disability or (2) a separate and distinct disability that is unrelated to his service connected left hand disability. Rationale must be provided in answering both questions. The examiner should test all ranges of motion of the left hand, and the examiner should note if repeated range of motion testing results in additional limitation of motion, or in functional loss, or there is weakened movement, excess fatigability, or incoordination attributable to the Veteran's disability, expressed in terms of the degree of additional range of motion loss due to any weakened movement, excess fatigability, or incoordination. The examiner should describe whether pain, weakness, fatigue or incoordination significantly limits functional ability during flare-ups or repetitive use over time, and if so, the examiner must estimate range of motion during flare-ups or repetitive use over time based upon relevant information elicited from the Veteran, review of the claims file, and the current examination results pertaining to the frequency, duration, characteristics, severity, and functional loss during flare-ups and repetitive use over time. The examiner must test and record the range of motion in active motion, passive motion, weight-bearing, and non-weight-bearing for both hands. MICHAEL A. HERMAN Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J.A. Flynn, 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.