Citation Nr: 21007164 Decision Date: 02/08/21 Archive Date: 02/08/21 DOCKET NO. 13-08 579 DATE: February 8, 2021 ORDER Entitlement to service connection for left pinky finger and hand arthritis is denied. Entitlement to service connection for small scaphoid cyst of left hand is granted. FINDINGS OF FACT 1. The Veteran’s left pinky finger and hand arthritis was not shown as chronic in service and did not manifest to a compensable degree within the applicable presumptive period; continuity of symptomatology is not established, and the disability is not otherwise etiologically related to an in-service injury or disease. 2. The Veteran’s small scaphoid cyst of left hand is related to an in-service fracture. CONCLUSIONS OF LAW 1. The criteria for service connection for a left pinky finger and hand arthritis are not met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 1137, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.307, 3.309. 2. The criteria for service connection for small scaphoid cyst of left hand are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active military service from March 1965 to December 1968. This matter is on appeal from a December 2009 rating decision. The Veteran testified before the undersigned Veterans Law Judge during an August 2016 hearing. In August 2018, the Veteran was notified that a transcript of the hearing was unavailable, and was given the opportunity to have another hearing. The Veteran declined a second hearing. This case was previously remanded by the Board of Veterans’ Appeals (Board) in December 2018 to obtain additional treatment records and to provide the Veteran with a VA examination. The Veteran was provided an examination with accompanying medical opinion in September 2019; an addendum opinion was obtained in November 2019. Accordingly, the Board finds that VA substantially complied with the December 2018 Board remand. See 38 U.S.C. § 5103A(b); Stegall v. West, 11 Vet. App. 268, 271 (1998); D’Aries v. Peake, 22 Vet. App. 97, 105 (2008). In finding substantial compliance, the Board acknowledges the representative’s argument that the addendum is not adequate as it referenced, in part, whether the Veteran's right thumb is related to the small scaphoid cyst of the left hand, considering that the left hand is at issue. December 2020 brief. For the reasons set forth below, the Board is granting service connection for the small scaphoid cyst of left hand. Further, the addendum opinion did correctly address whether left thumb arthritis is secondary to the cyst. As such, the Board reiterates that there has been substantial compliance with the December 2018 remand. The Board also remanded the issue of service connection for a left wrist disability. As such was granted in a November 2019 rating decision, that issue is no longer on appeal. 1. Entitlement to service connection for a left pinky finger and hand arthritis The Veteran contends that he has a left pinky finger and hand disorder related to an in-service injury. November 2010 Notice of Disagreement (NOD). Certain chronic diseases will be presumed related to service, absent an intercurrent cause, if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service (or within an applicable presumptive period) with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013). The Veteran has a current diagnosis of arthritis as evidenced by a September 2019 VA examination. Arthritis is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. However, the disability was not shown as chronic in service, did not manifest to a compensable degree within a presumptive period, and was not noted in service with attributable continuity of symptomatology. Service treatment records (STRs) reflect treatment for a fracture of the fifth left metacarpal in September 1968; no diagnosis of arthritis was shown. VA treatment records show the Veteran was not diagnosed with arthritis in the left pinky finger until the September 2019 VA examination, decades after his separation from service and decades outside of the applicable presumptive period. While the Veteran is competent to report having experienced symptoms of left pinky finger and hand pain since service, he is not competent to provide a diagnosis in this case or determine that these symptoms were manifestations of arthritis as the Veteran has not demonstrated the necessary medical expertise. The issue is medically complex, as it requires knowledge of interpretation of complicated diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372, 1377, 1377 n.4 (Fed. Cir. 2007). Indeed, arthritis is a disability established by X-ray findings. 38 C.F.R. § 4.71a, Diagnostic Code 5003. Service connection for arthritis may still be granted on a direct basis; however, the preponderance of the evidence is against finding that a medical nexus exists between the Veteran’s left pinky finger and hand arthritis and an in-service injury, event or disease. 38 U.S.C. §§ 1110, 1131; Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303. The September 2019 VA examiner opined that the Veteran’s mild arthritis of the left distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints of the index, middle, ring, and little fingers is not at least as likely as not related to an in-service injury, event, or disease, including an in-service fracture. The rationale was that there was no fracture or trauma of those fingers noted on the radiograph in September 1968 or by orthopedics treating his injury. Those changes were most consistent with mild osteoarthritis, which occurs with normal aging. The Veteran is 74 years old. The examiner’s opinion is supported by a November 2019 VA treatment record showing that arthritis in the fingers are age-related arthritic changes. In a November 2019 addendum opinion, the examiner opined that the subjective complaints of pain in the little finger are related to the mild arthritis in the DIP and PIP joints. The examiner further opined that the Veteran's left thumb arthritis is not caused or aggravated by the small scaphoid cyst. The rationale is that he had early arthritis (cysts) in scaphoid, but severe narrowing of the middle joint; mild arthritis in one area would not cause severe arthritis in another area. The examiners’ opinions are probative, because they are based on an accurate medical history and provides an explanation that contains clear conclusions and supporting data. Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008). While the Veteran believes his left pinky finger and hand arthritis is related to an in-service injury, event, or disease, including an in-service fracture, he is not competent to provide a nexus opinion in this case. This issue is also medically complex, as it requires the ability to interpret complicated diagnostic medical testing. Jandreau, 492 F.3d at 1377 n.4. Consequently, the Board gives more probative weight to the competent medical evidence failing to show a relationship to service in denying this claim. 2. Entitlement to service connection for a small scaphoid cyst of left hand The Veteran contends that he has a left hand disorder related to an in-service injury. November 2010 NOD. The Board concludes that the Veteran has a current disability that is related to an in-service fracture. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a). The September 2019 VA examination shows the Veteran has a current diagnosis of a small scaphoid cyst of left hand. During service, the Veteran was seen for a fracture of the of the fifth left metacarpal in September 1968. Thus, the question becomes whether the current disability is related to service. On this question there is a probative opinion in favor of the claim. The evidence in favor of the claim includes the September 2019 examiner’s opinion. The rationale was that the Veteran sustained a distal fracture (wrist) in service as noted on radiograph in September 1968. This bone abuts the scaphoid or navicular bone (same bone). Those cysts are often indicators of early degenerative changes. Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran’s current small scaphoid cyst of left hand is related to service. Accordingly, after resolving all doubt in favor of the Veteran, the Board finds that service connection for small scaphoid cyst of left hand is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. ROBERT C. SCHARNBERGER Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board L. Barstow, 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.