Citation Nr: A21020567 Decision Date: 12/27/21 Archive Date: 12/27/21 DOCKET NO. 200527-88742 DATE: December 27, 2021 REMANDED Entitlement to service connection for a recurrent left third (middle) finger disability is remanded. Entitlement to service connection for a recurrent left fifth (pinky) finger disability is remanded. Entitlement to service connection for posttraumatic stress disorder (PTSD) is remanded. Entitlement to an initial rating in excess of 30 percent for other specified trauma/stressor related disorder is remanded. REASONS FOR REMAND The Veteran had active service from August 1983 to October 1993. In November 2017, the Agency of Original Jurisdiction granted service connection for other specified trauma/stressor related disorder; assigned a 30 percent rating for that disability and denied service connection for a left third (middle) finger disability, a left fifth (little) finger disability, and PTSD. In April 2020, the Veteran was provided a statement of the case addressing the issues on appeal. In his May 2020 Decision Review Request: Board Appeal (Notice of Disagreement), VA Form 10182, the Veteran opted in from the May 2020 statement of the case and elected the Direct Review docket. Therefore, the Board of Veterans' Appeals (Board) may only consider the evidence of record at the time of the April 2020 statement of the case. 38 C.F.R. § 20.301. 1. Entitlement to service connection for both a recurrent left third (middle) finger disability to include injury residuals and a recurrent left fifth (pinky) finger disability to include injury residuals is remanded. The Veteran asserts that service connection for recurrent left third and fifth finger injury residuals is warranted as the claimed disabilities were incurred as the result of documented in service left land hand injuries. The service treatment records note that the Veteran sustained left hand injuries. A February 1986 states that the Veteran reported having injured his left hand when a valve fell on his left hand trapping it against another valve while aboard the USS Frederick. The Veteran was diagnosed with a left hand crushing injury. Clinical documentation dated in October 1988 relates that the Veteran reported having been bitten on the left hand by a dog. The Veteran was diagnosed with left third middle finger dog bite residuals. The report of the Veteran's August 1993 physical examination for service separation states that the Veteran exhibited left hand scar residuals including a left palm scar, a left fifth finger scar, and a left fifth fingernail abnormality. Pain alone may constitute a recurrent disability if it causes functional impairment. Saunders v. Wilkie, 886 F.3d 1356. The Department of Veterans Affairs' (VA) duty to assist includes, in appropriate cases, the duty to conduct a thorough and contemporaneous medical examination which is accurate and fully descriptive. McLendon v. Nicholson, 20 Vet. App. 79 (2006); Green v. Derwinski, 1 Vet. App. 121, 124 (1991). When VA undertakes to obtain an evaluation, it must ensure that the evaluation is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). The report of an April 2020 hand examination conducted for the Department of Veterans Affairs (VA) states that the Veteran complained of left hand pain and tingling and an inability to completely close the fingers completely. He reported an inability to play the guitar any longer and avoiding picking up cups of hot coffee due to his fear of dropping them. No left hand disability was diagnosed. No left hand scar residuals were reported on examination. The examiner concluded that "the claimed condition was less likely than not (less than 50 percent probability) incurred in or caused by the claimed in-service injury, event, or illness." He commented that "there is no current diagnosis from these incidents that affect the left hand or the left middle finger from the dog bite accident in 1988 or from the other incidents noted. The physician did note address whether the left hand pain and functional impairment reported by the Veteran constituted a recurrent disability. Given such deficiency, the Board finds that the examination report is essentially no probative value. That is a pre decisional error. 2. Entitlement to service connection for PTSD and an initial rating in excess of 30 percent for other specified trauma/stressor related disorder is remanded. The Veteran contends that an initial 70 percent rating is warranted for the psychiatric disability. He asserts further that the psychiatric disability should be recharacterized so as to include PTSD. The Veteran was last afforded a VA psychiatric examination in October 2017. A January 2020 VA treatment record states that the Veteran was diagnosed with PTSD, a panic disorder, not otherwise specified insomnia, and anxiolytic dependence. In light of the worsening psychiatric symptoms noted in the January 2020 VA treatment record, the Board finds that further VA psychiatric evaluation is needed. That is a pre decisional error. The matters are REMANDED for the following action: 1. Schedule the Veteran for a VA hand examination, conducted by a physician other than who conducted the April 2020 examination, to assist in determining the nature and etiology of any identified recurrent left third and left fifth finger disabilities. The examiner must review the record and should note that review in the report. A rationale for all opinions should be provided. The examiner should: (a) Diagnose all left hand disabilities found. The examiner must state whether the pain and neurological impairment reported by the Veteran constitutes a recurrent disability. (b) Opine as to whether it is at least as likely as not (50 percent probability or greater) that any identified recurrent left third finger and left fifth finger disabilities had their onset during active service or is related to any incident of service, including the documented left hand crush injury and dog bite. 2. Schedule the Veteran for a VA psychiatric examination. The examiner must review the record and should note that review in the report. The examiner should opine as to the levels of social and occupational impairment caused by the service-connected psychiatric disability and should describe the symptoms, their frequency, and their severity, that result in those levels of social and occupational impairment. J. T. HUTCHESON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board T. Douglas 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.