Citation Nr: 21008660 Decision Date: 02/17/21 Archive Date: 02/17/21 DOCKET NO. 14-32 516 DATE: February 17, 2021 REMANDED Entitlement to service connection for left hand and finger arthritis is remanded. REASONS FOR REMAND The Veteran served on active duty from August 1976 to August 1979 and from February 1982 to June 1987. This matter comes before the Board of Veterans’ Appeals (Board) from a March 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified at a hearing with the undersigned Veterans Law Judge in April 2019. The matter was previously before the Board in April 2020, where it was remanded for additional development. While the Board regrets further delay, the Veteran’s appeal must once again be remanded. The Veteran asserts that he has a left hand disability that is related to his military service. He noted at his hearing before the undersigned, as well as during a January 2015 VA examination, that his in service duties included driving vehicles without power steering and manually changing tires, as well as construction work that included bricking up walls and lifting concrete. While service connection was awarded in June 2016 for right hand arthritis based, in part, on the Veteran’s various Military Occupational Specialties, his claim for a left hand disability was denied based on the examiner’s finding of no current disability. As the Board noted previously, however, the January 2015 examination report noted the Veteran’s subjective reports of pain as well as reduced motion of the left thumb and ring finger, and pain alone can serve as a functional impairment and therefore qualify as a disability. See Saunders v. Wilkie, 886 F.3d 1356, 1367-68 (Fed. Cir. 2018). As such, the Board remanded the Veteran’s claim in April 2020 for a new VA examination and medical opinion to determine the nature and etiology of any left hand and/or finger disability, to include any pain resulting in functional impairment. The examination was afforded in September 2020. While the examiner did diagnose the Veteran with degenerative arthritis in his left hand, she opined that it was less likely than not incurred in or caused by his military service, explaining that the record indicated a congenital (i.e., present from birth) “condition” noted during service, with no reports of left hand pain for years after service. The rationale for the September 2020 opinion itself is unclear. The opinion states that the current left hand arthritis is not caused by or aggravated by the “left hand and finger arthritis during service.” However, the opinion also notes the only left hand problem during service was deformity of the little finger noted during a Medical Evaluation Board (MEB) in January 1987. The examiner notes no left hand arthritis during service and gave a date of diagnosis for left hand arthritis in 2020. It is unclear if the examiner is suggesting the finger deformity noted at the MEB constituted arthritis or if the examiner simply noted “left hand and finger arthritis during service” as that is how the question was posed to her. Clarification is necessary. The matter is therefore REMANDED for the following actions: Send the claims file to an appropriate examiner to offer an opinion as to the following: a) Did the Veteran have arthritis in the left hand or fingers during service or within the first year after service? Of note, a January 1987 report of medical history indicates a deformed left pinky finger. b) Is the Veteran’s left hand arthritis at least as likely as not (50 percent or greater probability) related to an in-service event, injury or disease, to include his military duties such as driving vehicles without power steering, manually changing tires, bricking up walls and lifting concrete? It is noted that the Veteran is already separately service-connected for degenerative arthritis of the right hand based on the opinion of a January 2015 VA examiner who determined that his right hand arthritis was “at least as likely as not related to multiple causes including repetitive use both in service and following service and the aging [process].” The need for an additional 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. Nathan Kroes 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.