Citation Nr: 21025682 Decision Date: 04/28/21 Archive Date: 04/28/21 DOCKET NO. 14-15 505 DATE: April 28, 2021 ORDER 1. Entitlement to service connection for a left hand disability other than radiculopathy of the left upper extremity is granted. 2. Entitlement to service connection for a right hand disability other than radiculopathy of the right upper extremity is granted. FINDINGS OF FACT 1. A left hand disability (other than radiculopathy of the left upper extremity) has been diagnosed as bilateral hand strain with arthritic issues, and in March 2021, a private physician opined that “it would be difficult to separate [the Veteran’s] arthritic from neurologic pain.” 2. A right hand disability (other than radiculopathy of the right upper extremity) has been diagnosed as bilateral hand strain with arthritic issues, and in March 2021, a private physician opined that “it would be difficult to separate [the Veteran’s] arthritic from neurologic pain.” CONCLUSIONS OF LAW 1. The criteria for service connection for a left hand disability order (other than radiculopathy of the left upper extremity) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020); Mittleider v. West, 11 Vet. App. 181 (1998). 2. The criteria for service connection for a right hand disability (other than radiculopathy of the right upper extremity) have been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020); Mittleider v. West, 11 Vet. App. 181 (1998). REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The Veteran had active service from September 1974 to September 2000. This matter originally came to the Board of Veterans Appeals (Board) from a September 2002 rating decision, which, in pertinent part, declined to reopen the Veteran’s previously denied claims for service connection for right and left hand disabilities. In March 2005, the Veteran testified at a hearing held at the regional office (RO) before the undersigned, and a transcript of the hearing has been added to the record. In May 2006, the Board issued a decision, which reopened the claims for service connection for right and left hand disabilities and remanded them for additional evidentiary development. The issues were again remanded in November 2010, September 2012, and June 2013. In January 2014, the Board issued a decision denying the Veteran’s claims seeking entitlement to service connection for right and left hand disabilities other than radiculopathy of the right and left upper extremities. The Veteran subsequently appealed this decision to the U.S. Court of Appeals for Veterans Claims (Court). Pursuant to Joint Motion for Partial Remand (JMPR) in August 2015, the Court remanded the matter to the Board for further development. The Board then remanded the matter for additional development in February 2016, February 2018, and most recently, in January 2020. 1. Entitlement to service connection for a left hand disability other than radiculopathy of the left upper extremity is granted. 2. Entitlement to service connection for a right hand disability other than radiculopathy of the right upper extremity is granted. Service connection may be granted for a disability resulting from a disease or injury incurred in or aggravated by active service. To establish a right to compensation for a disability, a Veteran must show: (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 or aggravated during service. The Veteran is already service connected for degenerative disc disease and degenerative joint disease of the cervical spine and radiculopathy of the right and left upper extremities as secondary to the service-connected cervical spine disability. In the context of his current appeal, he has asserted entitlement to service connection for a bilateral hand disability, other than radiculopathy of the upper extremities. Following a review of the evidence of record, and after resolving any reasonable doubt in favor of the Veteran, the Board finds that the preponderance of the evidence weighs in favor of a grant of the Veteran’s claims. The reasons for this decision follow. First, the Board notes as early as April 2000, the Veteran reported that he began waking up in the middle of the night with hand pain, and that he had been diagnosed with arthritis. During the pendency of the appeal, VA examination reports from December 2010 and January 2013 document a diagnosis of bilateral hand strain, separate from the Veteran’s service-connected upper extremity neurologic disability. In March 2021, a private physician noted that the Veteran had “a combination of both neurologic as well as arthritic issues in both hands.” Thus, there is evidence of a current disability. The relevant issue in this case is whether the Veteran’s claimed bilateral hand disability (other than his service-connected upper extremity radiculopathy) is related to his active service or his service-connected degenerative disc disease and degenerative joint disease of the cervical spine. As noted above, these matters were most recently remanded by the Board in January 2020. At that time, the Board noted that a VA examiner was previously asked to specifically note any diagnosis the Veteran had related to his right and/or left hand other than radiculopathy during the entirety of the period on appeal. To the extent that the Veteran did not have disabilities that were previously diagnosed or documented as possible diagnoses by VA examiners and private treatment providers, such as hand strain, arthritis, gouty arthritis, carpal tunnel syndrome (CTS), painful neuroma, epidermal inclusion cyst, giant cell tumor, and glomus tumor, the examiner was asked to provide a rationale for why the examiner’s diagnosis differed from those of VA examiners and private treatment providers. The March 2019 VA examiner diagnosed the Veteran with only right hand CTS and explained why the Veteran did not have a diagnosis of left hand CTS or arthritis in the bilateral hands but did not address any of the other various diagnoses documented in the claims file involving the Veteran’s hands. In March 2020, the same VA examiner again noted that the Veteran had mild right CTS with no CTS on the left based on a March 2018 private nerve conduction study. The examiner further noted that April 2016 imaging of the hands was normal, with well-maintained joint spaces and no fracture, dislocation, or bony abnormality. However, the examiner again did not address any of the other multiple diagnoses documented in the claims file involving the Veteran’s right and/or left hands, including the December 2010 and January 2013 VA examination. In September 2020, the same VA examiner concluded that the Veteran’s service-connected bilateral upper extremity based upon paralysis of the median nerve is the same condition as his carpal tunnel syndrome with involvement of the median nerve. The examiner stated that a March 2018 private nerve conduction study showed mild median nerve pathology only on the right and none on the left, and that since the March 2019 VA examination, there was no evidence or documentation of any exacerbation/aggravation of his carpal tunnel syndrome. In an October 2020 VA addendum opinion, the same examiner noted that service treatment records were silent for related signs, symptoms, and/or diagnoses of a hand or wrist condition during active service and opined that there was no study or documentation to relate the Veteran’s service-connected degenerative disease of the cervical spine and radiculopathy as the causative etiology or exacerbators for his bilateral hand pathology. As above, neither the September 2020 or October 2020 addendum opinions addressed whether any of the other various diagnoses documented in the claims file involving the Veteran’s right and/or left hands. Significantly, since the most recent October 2020 VA addendum opinion, the Veteran has submitted a March 2021 private nexus opinion rendered by Douglas D. Pritchard, M.D. Therein, Dr. Pritchard noted that the Veteran had been his patient for some time and had been treated for hand pain. He noted that the Veteran was treated for both left and right hand pain during active duty and stated that he thought the Veteran had “a combination of both neurologic as well as arthritic issues in both hands.” Additionally, he stated that “it would be difficult to separate arthritic from neurologic pain.” The Board is mindful that if it is not possible to distinguish between service-connected and nonservice-connected symptoms because they are so intertwined, then all such symptoms will be attributed to the service-connected disability. See 38 C.F.R. §§ 3.102, 4.14; Mittleider v. West, 11 Vet. App. 181, 182 (1998). Given the above, the Board finds that the March 2021 private weighs in favor of the Veteran’s claims, as the private physician addressed an alternate diagnosis regarding the Veteran’s hands, which the prior VA examiner did not do; moreover, the private physician concluded that it would be difficult to separate the Veteran’s (nonservice-connected) arthritic and (service-connected) neurologic pain. Thus, after resolving any reasonable doubt in favor of the Veteran, the Board finds that the Veteran’s claims should be granted in light of the holding in Mittleider and that service connection for left and right hand strain with arthritis is warranted. A. P. SIMPSON Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board D. Chad Johnson, 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.