Citation Nr: 21022730 Decision Date: 04/19/21 Archive Date: 04/19/21 DOCKET NO. 92-06 772 DATE: April 19, 2021 ORDER Entitlement to service connection for left hand somatoform disorder, secondary to service-connected schizophrenia, on a causation basis, is granted. FINDING OF FACT The Veteran’s left hand somatoform disorder is proximately due to his service-connected schizophrenia. CONCLUSION OF LAW The criteria for service connection for left hand somatoform disorder, as secondary to service-connected schizophrenia, on a causation basis, are met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from November 1977 to July 1983, and also had periods of active duty for training. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from rating decisions of the agency of original jurisdiction (AOJ). Much of the procedural history in this appeal has been recounted in past Board and AOJ decisions. As noted in the Board’s November 2019 remand, in June 2013, the Board found that recent written submissions from the Veteran indicated an implied claim for service connection for left hand disorder, to include as due to his service-connected finger disabilities, and the Board remanded the implied service connection issue for additional development. At the time the November 2019 remand was issued, the appeal also included the issues of entitlement to service connection for left wrist disability, to include arthritis and osteopenia; entitlement to service connection for left elbow disability, to include left ulnar neuropathy; and entitlement to special monthly compensation (SMC) based on loss of use of the left hand due to service-connected disability(ies). In a November 2020 rating decision, the AOJ awarded service connection for left elbow disability, left ulnar neuropathy, and limitation of motion of the left wrist. This represents a full grant of the benefits sought on appeal as to the issues of entitlement to service connection for left wrist disability and left elbow disability, to include left ulnar neuropathy. Therefore, these matters are no longer on appeal before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1997). With respect to the Veteran’s claim of entitlement to SMC based on loss of use of the left hand due to service-connected disability(ies), in November 2020, the AOJ issued a supplemental statement of the case (SSOC) that continued to deny this claim. In December 2020, the Veteran opted the claim into the modernized review system, also known as the Appeals Modernization Act (AMA), by submitting a VA Form 10182, Decision Review Request: Board Appeal, identifying the November 2020 SSOC. Therefore, that issue is no longer a part of the Veteran’s appeal in the legacy system. Instead, the issue of entitlement to SMC based on loss of use of the left hand due to service-connected disability(ies), will be addressed in a future Board decision as a part of the Board’s AMA docket. Service Connection Service connection will be granted if the evidence demonstrates that current disability resulted from an injury suffered or disease contracted in active military, naval, or air service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303(a). Establishing service connection generally requires competent evidence of three things: (1) current disability; (2) in-service injury or disease; and (3) a relationship between the two. Saunders v. Wilkie, 886 F.3d 1356, 1361 (Fed. Cir. 2018). Consistent with this framework, service connection is warranted for a disease first diagnosed after service when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Service connection is also warranted for disability which is proximately due to or the result of service-connected disease or injury. 38 C.F.R. § 3.310. In this case, as noted by the Board’s November 2019 remand, evidence received during the course of the appeal indicates that either the Veteran’s service-connected schizophrenia and/or medications taken to treat the schizophrenia may have caused or aggravated a left hand disability. Unfortunately, per an August 2019 Veterans Health Administration opinion report, a VA orthopedist was unable to answer the secondary service connection questions regarding any potential link between the Veteran’s mental health and orthopedic disabilities as such questions were “outside the scope of practice of orthopedic surgery.” Thus, the Board remanded the appeal so that an appropriate medical professional could address whether the Veteran’s current left hand disability was secondary to his service-connected schizophrenia, either due to somatic symptoms and/or medication taken to treat the schizophrenia. The Veteran underwent a VA examination in October 2020 and, in addition to his already-service-connected left fifth metacarpal fracture, the examiner noted a diagnosis of left hand somatoform disorder. Ultimately, the examiner opined that the Veteran’s left hand somatoform disorder was at least as likely as not proximately due to, or the result of, the Veteran’s service-connected schizophrenia. The examiner reasoned that the current severity of the service-connected schizophrenia warranted by proximity an association with the left hand somatoform disorder, such that the somatoform disorder began subsequent to his service-connected schizophrenia, and that it was the direct result of the schizophrenia. The examiner reasoned that patients with schizophrenia also could suffer from conversion symptoms and, while the Veteran did have a history of a mild to moderate injury to the left hand, his current left hand somatoform disorder was more likely than not due to his schizophrenia. The examiner also noted that the Veteran’s reliance upon braces and slings for his left hand and his focus on pain was out of proportion with his history and the objective evidence, but that such was typical of somatoform disorders in schizophrenia patients. Accordingly, in light of the October 2020 opinion and after resolving all doubt in favor of the Veteran, the Board finds that service connection for left hand somatoform disorder, as secondary to the Veteran’s service-connected schizophrenia, on a causation basis, is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102. Brian J. Elwood Acting Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board James R. Springer, 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.