Citation Nr: 21015441 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 12-04 415 DATE: March 17, 2021 ORDER Entitlement to service connection for a bilateral thumb disability, diagnosed as a bilateral thumb strain, is granted. FINDING OF FACT The most probative evidence reflects that the Veteran’s bilateral thumb disability, diagnosed as a bilateral thumb strain, was incurred during active duty. CONCLUSION OF LAW The criteria to establish service connection for a bilateral thumb disability, diagnosed as a bilateral thumb strain, have been met. 38 U.S.C. §§ 1101, 1110, 1111, 1112, 5103(a), 5103(A), 5107; 38 C.F.R. §§ 3.102, 3.159, 3.303, 3.304, 3.307, 3.309. REASONS AND BASES FOR FINDING AND CONCLUSIO The Veteran served on active duty from July 2007 to September 2011, October 2012 to March 2013, in May 2013, and from December 2013 to February 2014. This case comes before the Board of Veteran’s Appeals (Board) on appeal of a December 2011 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). This Veteran’s appeal was previously before the Board in May2018 and August 2020, when it was determined that remand was necessary to ensure that VA fulfilled its duty to assist the Veteran in substantiating his appeal. The Board’s prior remand directives have been substantially completed, and the Veteran’s appeal has been returned to the Board for further appellate consideration. Entitlement to service connection for a bilateral thumb disability, diagnosed as a bilateral thumb strain, is granted. Service connection may be granted on a direct basis as a result of disease or injury incurred in service based on nexus using a three-element test: (1) the existence of a present disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred in or aggravated by service. See 38 C.F.R. §§ 3.303(a), (d); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009).  Analysis The record reflects that the Veteran reported bilateral thumb pain during his first period of active duty while performing the duties of his Military Occupational Specialty (MOS) as an automotive mechanic. He claims that this pain has continued to the present and underlies a bilateral thumb disability for which service connection should be granted. For the reasons outlined below, the Board agrees. Consequent to the Board’s August 2020 remand, the Veteran was provided a VA examination in September 2020 in connection with his appeal. After a review of the record, the VA examiner diagnosed a bilateral thumb strain that initially manifested in 2010 – during the first period of the Veteran’s active duty. While this would appear to suffice the criteria to establish service connection for this disability, the examiner provided a negative nexus opinion based on a lack of “chronicity of care” despite the stated belief that “this condition is related to service.” The Board notes that the September 2020 VA examiner’s opinion is contradictory and based on an inaccurate factual premise, as the controlling laws do not preclude direct service connection due to a lack of chronicity of care. Notwithstanding these deficiencies, closer review of this seemingly unfavorable opinion shows that such supports the Veteran’s assertions of in-service incurrence of a bilateral thumb strain. Indeed, the September 2020 VA examiner stated the belief that the Veteran’s in-service and current diagnoses of this disability were related; however, the negative nexus was based on the misplaced belief that a positive nexus could not be rendered without “chronicity of care.” In light of above, the Board concludes that the most probative evidence of record supports a conclusion that the Veteran’s bilateral thumb strain was incurred during the Veteran’s active duty. As such, service connection for this disability is warranted. SCOTT W. DALE Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Gamache, 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.