Citation Nr: 21015445 Decision Date: 03/17/21 Archive Date: 03/17/21 DOCKET NO. 14-25 151 DATE: March 17, 2021 ORDER Entitlement to service connection for status post left middle finger laceration/crush injury is granted. FINDING OF FACT The evidence is at least evenly balanced as to whether the Veteran’s current status post left middle finger laceration/crush injury began during active service. CONCLUSION OF LAW With reasonable doubt resolved in favor of the Veteran, the criteria for service connection for status post left middle finger laceration/crush injury have been met. 38 U.S.C. §§ 1110, 5107; 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty in the United States Navy from November 1996 to January 2012. This matter initially came before the Board of Veterans’ Appeals (Board) from an April 2012 rating decision. This matter was initially before the Board in May 2018 and March 2020, where it was remanded for additional development. Entitlement to service connection for left middle finger/hand disability. Service connection may be granted for current disability resulting from disease or injury incurred in or aggravated by service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303. Service connection may also be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires evidence of (1) current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). For the purposes of service connection, pain alone, without any underlying pathology or disease process, can constitute current disability if there is objective evidence that the pain causes functional impairment resulting in a decrease of earning capacity. Saunders v. Shinseki, 886 F.3d 1356, 1363 (Fed. Cir. 2018). A veteran bears the evidentiary burden to establish all elements of a service connection claim, including the nexus requirement. See Fagan v. Shinseki, 573 F.3d 1282, 1287-88 (2009). In making its ultimate determination, the Board must give a veteran the benefit of the doubt on any issue material to the claim when there is an approximate balance of positive and negative evidence. See Id. at 1287 (quoting 38 U.S.C. § 5107(b)). To deny a claim on its merits, the evidence must preponderate against the claim. Alemany v. Brown, 9 Vet. App. 518, 519 (1996). Turning to the evidence, the report of a July 2019 VA hand and finger conditions examination reflects that the Veteran was diagnosed as having status post left middle finger laceration/crush injury. He reported during the examination that he was left hand dominant and that he experienced pain in the palmar surface of his hand with prolonged writing. He also reported in his October 2012 notice of disagreement and on his July 2014 substantive appeal (VA Form 9) that he experienced loss of sensation, numbness, and an occasional vibrating in his left middle finger and left hand pain when performing day to day tasks (including writing, picking up objects, and holding objects for prolonged periods). These symptoms impacted his ability to write and caused problems with his daily tasks at work. Therefore, there is evidence of current left middle finger/hand disability manifested by pain and other symptoms and current disability has been demonstrated. There is also evidence of left middle finger/hand injuries in service and evidence of continuous symptoms in the years since service. In this regard, the Veteran’s service treatment records (STRs) notate treatment for a left hand injury and a left middle finger injury when a forklift hatch fell on his left hand and caused a soft tissue injury and when his left middle finger got caught in a machine and was crushed, resulting in a laceration to the finger. See November 1997 and December 1997 STRs.  Moreover, the Veteran filed his claim of service connection for left middle finger/hand disability in February 2012 (the month after his separation from service) and his post-service medical records and lay statements indicate that he has experienced continuous left middle finger/hand symptoms in the years since service. The Veteran is competent to report continuous left middle finger/hand symptoms in the years since service. See Jandreau v. Nicholson, 492 F.3d 1372, 1377 (Fed. Cir. 2007); see also Buchanan v. Nicholson, 451 F.3d 1331, 1337 (Fed. Cir. 2006). The Board acknowledges that he has provided some information which is inconsistent with a continuity of left middle finger/hand symptomatology in the years since service. Specifically, he reported on a December 2011 Report of Medical History form completed for purposes of separation from service that he was neither experiencing, nor had he ever experienced, any impaired use of his hands or swollen/painful joints. However, the December 2011 report is itself inaccurate because, as explained above, there is evidence of left middle finger/hand injuries in his service treatment records. Also, there is no other evidence to explicitly contradict his reports and they are generally consistent with the evidence of record. Thus, the Board finds that the Veteran’s reports of continuous left middle finger/hand symptoms in the years since service are credible. The Veteran was afforded a VA examination in September 2019. The examiner opined that it was less likely than not that the Veteran’s left middle finger condition was caused by service. The examiner reasoned that, “[a]lthough the initial injury took place during service, there is no current pathology. The physical exam was normal, and his reported symptoms of hand cramping/pain in the palmar aspect of the hand with writing are not consistent with the middle finger injury claimed, or the crush injury/laceration noted in records.” In the March 2020 Board Remand, the Board determined that the Veteran should be afforded an additional VA examination to opine as to whether his left hand pain was caused by service since the September 2020 examiner stated that the Veteran’s left hand pain is a functional loss. The Veteran was afforded another VA examination in March 2020. The examiner provided both a negative and positive nexus opinion. Regarding the negative nexus opinion, the examiner stated the following: Although STR reflects an injury to the left middle finger (a laceration injury). The physical exam of the hand and its functions was normal, and his reported symptoms of hand cramping/pain in the palmar aspect of the hand with writing are not consistent with the middle finger injury claimed, or the crush injury/laceration noted in records. Given no functional impairment on exam, no other injury is diagnosed and no nexus reasonable. Regarding the positive nexus opinion, the examiner stated the following: “Veteran history and STR reflects finger laceration and injury on 12/4/97 - wound irrigated and dressed (no sutures). Veteran [active duty] from November 22, 1996 to January 6, 2012. Given STR documentation a nexus is reasonable.” An addendum opinion was needed to clarify the examiner’s positive and negative nexus opinions in the March 2020 examination. In an August 2020 addendum opinion, the examiner clarified that the negative opinion rendered was regarding the Veteran’s subjective hand pain diagnosis, and the positive opinion was regarding the Veteran’s already service-connected left middle finger scar. The examiner stated the following: “[t]he [V]eteran’s records reflect a simple laceration and suture to the left middle finger for which there is no continued complaint. There are no other residuals for this aside from the already service connected scar.” Regarding the Veteran’s symptoms of hand cramping, the examiner reasoned that cramping of the hand in and of itself, with no intervention or seeking of medical treatment/diagnostics, does not reflect a medical pathology. The examiner also stated that there is no correlation between the Veteran’s left middle finger scar and hand cramps without evidence of tissue or nerve damage. Lastly, the examiner added that cramping can occur for any multitude of reasons, which can include dehydration, or “simple “writer's cramp” as suggested.” Any statement that his hand cramps are due to service would be speculative because “there is no medical pathological basis to be found based upon history, exam and available records.” The September 2019, March 2020, and August 2020 opinions are of little, if any, probative value because they are largely based on a finding that the Veteran did not have any current left middle finger/hand disability other than his already service-connected scar. As explained above, however, the Veteran has provided competent and credible reports of left middle finger/hand pain, cramping, and numbness which cause functional impairment, and pain alone can constitute current disability. Moreover, the September 2019 examiner provided a diagnosis of status post left middle finger laceration/crush injury. Also, the opinions do not take into account the Veteran’s competent and credible reports of continuous left middle finger/hand symptoms in the years since service. In this regard, a medical opinion is inadequate if it does not take into account the Veteran’s reports of symptoms and history (even if recorded in the course of the examination). Dalton v. Peake, 21 Vet. App. 23 (2007). In sum, the evidence reflects that the Veteran experienced left middle finger/hand injury in service and that there have been continuous left middle finger/hand symptoms in the years since service. He also experiences current status post left middle finger laceration/crush injury manifested by pain and other symptoms. There is no adequate medical opinion that is contrary to a conclusion that the current status post left middle finger laceration/crush injury had its onset in service. Thus, the evidence is at least evenly balanced as to whether the Veteran’s status post left middle finger laceration/crush injury had its onset in service. As the reasonable doubt created by this relative equipoise in the evidence must be resolved in favor of the Veteran, entitlement to service connection for status post left middle finger laceration/crush injury is warranted. 38 U.S.C. § 5107 (b); 38 C.F.R. § 3.102. See also Buchanan, 451 F.3d at 1335 (“[N]othing in the regulatory or statutory provisions [relating to evidence to be considered] require both medical and competent lay evidence; rather, they make clear that competent lay evidence can be sufficient in and of itself”). Brian J. Elwood Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board Adeleke, Tomi 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.