Citation Nr: 21012595 Decision Date: 03/04/21 Archive Date: 03/04/21 DOCKET NO. 15-00 027 DATE: March 4, 2021 REMANDED Entitlement to service connection for a right hand condition, claimed as cold injury residuals, is remanded. Entitlement to service connection for a right foot condition, claimed as cold injury residuals, is remanded. Entitlement to service connection for a left hand condition, claimed as cold injury residuals, is remanded. Entitlement to service connection for a left foot condition, claimed as cold injury residuals, is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1996 to October 2000. These matters are before the Board of Veterans’ Appeals (Board) on appeal from a January 2012 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). They are in the legacy appeals system. In August 2020, the Veteran’s representative attempted to withdraw; as an appeal to the Board had already been filed, such is not permissible absent a showing of good cause under 38 C.F.R. § 20.6(a)(2). To date, good cause has not been demonstrated. While the Veteran has expressly filed a claim of service connection for cold injury to both hands and both feet, in light of Clemons v. Shinseki, 23 Vet. App. 1 (2009), the Board finds that it is appropriate to characterize the claims broadly as seeking entitlement to service connection for conditions of the hands and feet, to include any condition that may be causing his claimed symptoms, even if this is determined to be unrelated to his claimed cold injury. The captioning above has been changed to reflect this expanded interpretation of the Veteran’s claim. Entitlement to service connection for bilateral hand condition and bilateral foot condition Once VA has provided a VA examination, it is required to provide an adequate one, regardless of whether it was legally obligated to provide an examination in the first place. Barr v. Nicholson, 21 Vet. App. 303 (2007). A medical examination report must contain not only clear conclusions with supporting data, but also a reasoned medical explanation connecting the two. See Nieves- Rodriguez v. Peake, 22 Vet. App. 295 (2008); Stefl v. Nicholson, 21 Vet. App. 120, 124 (2007). The Veteran was afforded a VA examination for cold injuries in July 2019 and the examiner concluded that the Veteran had no disability, cold injury, or any symptoms of the hands or feet. In Febraury 2020 the Board found this examination and opinion inadequate for rating purposes because it failed to discuss a December 2012 treatment record that assessed neuropathy of the toes due to frostbite. The Board remanded these issues for a new examination and opinion that noted every hand or foot condition reflected within the claim period (December 2009 to present), to include neuropathy of the toes, assessed in December 2012. VA obtained new examinations and opinions of August 2020 using diability benefit questionaires (DBQ) for hand and finger conditions, foot conditions, and cold injuries. The examiner provided an opinion with each DBQ and each opinion was against granting the Veteran’s claims. Unfortunately, these opinions are still inadequate for rating purposes. Regarding the feet, the examiner discussed a treatment record from December 2011, which merely suggested a follow-up with the neruology department for possible neuropathy of the toes, not the December 2012 record which listed an assessment of neuropathy of the toes due to frostbite. This opinion is inadequate because it failed to discuss the one record explicitly required by the remand order. Regarding the hands, the examiner observed objective signs of pain on movement, severe pain on palpation of the PIP joints, and recorded the Veteran’s reports of intermittent numbness. The examiner then stated that the Veteran’s hands were normal on examination and opined that there was no diagnosis for either hand. The examiner noted a primary care note from May 2019 and a VA exam for October 2018 discussing left upper extremity neuralgia and then relied on the presence of symptoms only on the left side to opine that that the left upper extremity symtoms were less likely than not the result of bilateral cold injury in service. The examiner did not attempt to reconcile this with the Veteran’s previous complaints of bilateral numbness or the examiner’s own observations of bilateral pain with movement and palpation during the August 2020 examination. This opinion is inadequate because it relies without explanation on the finding that there were only left side symptoms when the facts in the examination itself as well as the Veteran’s medical records clearly contradict this conclusion. Finally, regarding the claimed cold injuries, the examiner noted the Veteran’s report of symptoms including combinations of numbness, cold sensitivity, color changes, and locally impaired sensation in each of the Veteran’s hands and feet as well as sharp pain, tingling, and numbness in his fingers and toes. The examiner also noted functional impairment including difficulty with any fine motor tasks because the Veteran’s fingers become numb with use. The examiner then stated that no diagnosis was warranted because the claims file was silent for objective evidence of a cold injury. This opinion is inadequate for two reasons. First, even if the Veteran is not diagnosed with a specific medical condition, the presence of symptoms which impact his ability to maintain employment is sufficient to count as a disability for VA compensation purposes. Second, the examiner did not present any reason for crediting or discounting the Veteran’s account of his in-service cold injury before concluding that there was no evidence of an in-service cold injury. Unfortunately, new opinions—based on full review of the record and supported by stated rationales—are needed to fairly resolve the appellant’s claims. See 38 U.S.C. § 5103A; 38 C.F.R. § 3.159; McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The matters are REMANDED for the following action: 1. Obtain opinions from an appropriate clinician regarding the Veteran’s claimed residuals of cold injury to both of his hands and both of his feet. The examiner must review the claims file. If a diagnosis cannot be provided but the Veteran’s condition manifests in symptoms that cause functional impairment, then the examiner should consider them a “disability” for the purpose of providing the requested opinions below. Please note every hand or foot condition reflected within the claim period (December 2009 to present), to include neuropathy of the toes, assessed in December 2012. The examiner is asked to provide a response to the following for each of the Veteran’s hands and each of the Veteran’s feet: (a.) Does the Veteran have a disability which is at least as likely as not related to service, including the Veteran’s claimed in-service frostbite while stationed in Germany? (b.) Does the Veteran have a disability which is at least as likely as not proximately due to a service-connected disability, such as his fibromyalgia or back disability? (c.) Does the Veteran have a disability which is at least as likely as not aggravated, i.e., worsened beyond its natural progression, by a service-connected disability, such as his fibromyalgia or back disability? Provide a rationale to support each opinion. In providing each requested opinion, consider the Veteran’s description of his in-service injury and symptoms as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran’s reported injury and symptoms in service and thereafter represented the onset of a current disability, this should be noted. Stated another way, do the Veteran’s reports about his symptoms align with how a currently diagnosed disability is known to develop or are the Veteran’s reports generally inconsistent with medical knowledge or implausible? If the examiner determines that the required opinions cannot be provided without further testing or an in-person examination, then arrange for the appropriate testing and/or in-person examination. 2. After the above development, and any additionally indicated development, has been completed, readjudicate the issues on appeal. If any benefit sought is not granted to the Veteran’s satisfaction, send the Veteran and his representative a Supplemental Statement of the Case and provide an opportunity to respond. If necessary, return   the case to the Board for further appellate review. L. M. BARNARD Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board M. Zimmerman 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.