Citation Nr: 21013551 Decision Date: 03/09/21 Archive Date: 03/09/21 DOCKET NO. 13-05 671 DATE: March 9, 2021 ORDER Entitlement to service connection for a left hand disorder, to include degenerative arthritis, upper extremity polyneuropathy, and status post trigger finger repair of the thumb is granted. Entitlement to service connection for a right hand disorder, to include degenerative arthritis, upper extremity polyneuropathy, and status post trigger finger repair of the thumb is granted. FINDINGS OF FACT 1. Resolving reasonable doubt in the Veteran’s favor, his right hand disorder, to include arthritis, upper extremity polyneuropathy, and status post trigger finger began during active service. 2. Resolving reasonable doubt in the Veteran’s favor, his left hand disorder, to include arthritis, upper extremity polyneuropathy, and status post trigger finger began during active service. CONCLUSIONS OF LAW 1. The criteria for service connection for a right hand disorder are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. 2. The criteria for service connection for a left hand disability 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 served on active duty from September 1969 to March 1972. This matter is before the Board of Veterans’ Appeals (Board) on appeal from an August 2011 rating decision. The Veteran testified before the undersigned during an April 2016 hearing. This matter was initially before the Board in August 2016, when the Board remanded it for additional development. It returned to the Board in June 2018, and the Board denied entitlement to service connection for a bilateral hand disorder. The Veteran appealed the June 2018 decision to the U.S. Court of Appeals for Veterans Claims (Court). The parties filed a Joint Motion for Remand (JMR), which the Court granted in February 2019. Pursuant to the February 2019 JMR, the Board remanded this matter for additional development in February 2020. The matter is now returned to the Board for further appellate review. This appeal is advanced on the Board's docket pursuant to 38 C.F.R. § 20.902(c) (2019); 38 U.S.C. § 7107 (a)(2) (2012). 1. Entitlement to service connection for a left hand disorder, to include degenerative arthritis, upper extremity polyneuropathy, and status post trigger finger repair of the thumb 2. Entitlement to service connection for a right hand disorder, to include degenerative arthritis, upper extremity polyneuropathy and status post trigger finger repair of the thumb Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Establishing service connection generally requires evidence of (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the current disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). The Board must consider all the evidence of record and make appropriate determinations of competence, credibility and weight. See Washington v. Nicholson, 19 Vet. App. 362, 368 (2005). When there is an approximate balance of positive and negative evidence regarding any material issue, reasonable doubt will be resolved in favor of the claimant. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. The Veteran contends that his bilateral hand disorder began during service, to include having his hands run over by a tank while serving in the Republic of Vietnam. In an August 2016 Board decision, the Board conceded the tank incident as described by the Veteran; therefore, the in-service event is established. The medical records reflect the Veteran has current bilateral hand disorders of trigger finger, thumb; degenerative arthritis; and upper extremity polyneuropathy. Thus, the question becomes whether a current bilateral hand disorder is related to service. The Veteran submitted a January 2021 private medical opinion by Dr. D.A. Dr. D.A. concluded that it is at least as likely as not that the Veteran’s bilateral hand disorder is due to his hands being run over by a tank. Dr. D.A. provided the Veteran an in-person examination, performed relevant testing, reviewed the Veteran’s claims file, reviewed the relevant VA examinations, reviewed post-service medical records, and reviewed the lay statements of record. The Veteran reported to Dr. D.A. that he hid for cover under a tank and when he began to crawl out, he placed his hands behind the tank, the tank rolled over his hands, and his thumbs became stuck in the tracks. The Veteran reported having his hands bandaged and experiencing sensitivity and sore hands with jolting pain since the event. Dr. D.A. addressed the Veteran’s lack of continuity of treatment from the event until 2011. Dr. D.A. reported he did not consider the break in treatment to be a break in etiology; rather, he noted the Veteran continued to experience pain but he reported a high pain tolerance, would work through his pain, and often did not take time off. Furthermore, Dr. D.A. reported the Veteran has no other reported history of trauma, the Veteran’s hand condition is far beyond what he would expect to see in someone that had not experienced trauma; and the Veteran’s current bilateral hand disability cannot be explained as age-related or working with his hands for many years. Dr. D.A. concluded the Veteran’s conceded high impact trauma, having his hands run over by a tank, resulted in a progressive condition that started in service and gradually worsened over time. The Board finds this medical opinion highly probative. See Barr v. Nicholson, 21 Vet. App. 303, 311; see also Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 304 (2008) (probative value of a medical opinion is derived from it being factually accurate, fully articulated, and soundly reasoned). VA provided the Veteran multiple examinations throughout the appeals period to determine the nature and etiology of the Veteran’s bilateral hand disorder. Most recently, VA provided the Veteran examinations in November 2020 where the examiner provided negative nexus opinions, citing to the absence of contemporaneous documentation of the in-service hand injury and noting that the Veteran was employed post-service in a position that required heavy utilization of his hands. The November 2020 VA medical opinions are inadequate. First, in the Board’s August 2016 Decision, it conceded the Veteran’s hands were run over by a tank; therefore, the absence of any notation in the Veteran’s service records to the incident is irrelevant. Second, the examiner did not provide any rationale to support the conclusion that the Veteran’s hand disorder was, in part, caused by his post-service employment. Id. Lastly, the Veteran has continuously maintained he experienced pain in his hands since service, but the examiner impermissibly disregarded the Veteran’s statements solely because there is no contemporaneous medical evidence of these symptoms. See Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006) (that reports of symptomatology are not supported by contemporaneous clinical evidence does not render them inherently not credible). In sum, the Board finds that the positive opinion of Dr. D.A. is highly probative as it reflects consideration of all relevant facts. Thus, the Board finds the evidence of record that weighs for and against the claim that the current hand disability is related to his injury in service is at least in a state of equipoise. Accordingly, after resolving the benefit of reasonable doubt in favor of the Veteran, the Board finds that entitlement to service connection for bilateral hand disabilities is warranted. 38 U.S.C. §§ 1131, 5107; Gilbert v. Derwinski, 1 Vet. App. 49 (1990). M. HYLAND Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Zachery S.C. Luce, Associate 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.