Citation Nr: 21026104 Decision Date: 04/29/21 Archive Date: 04/29/21 DOCKET NO. 17-29 796 DATE: April 29, 2021 REMANDED Entitlement to service connection for a right hip disorder, to include as secondary to service-connected disorders, is remanded. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected bilateral shoulder disorders, is remanded. Entitlement to service connection for headaches, to include as secondary to service-connected bilateral shoulder disorders, is remanded. Entitlement to an initial rating in excess of 10 percent disabled for a right wrist disorder is remanded. Entitlement to an initial rating in excess of 10 percent for a left wrist disorder is remanded. Entitlement to a separate rating for a right thumb disorder is remanded. Entitlement to a separate rating for a left thumb disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1984 to September 2014. 1. Entitlement to service connection for a right hip disorder, to include as secondary to service-connected disorders. The Veteran has raised the issue of entitlement to a right hip disorder as secondary to his service-connected disorders. He is currently service-connected for disorders of both knees and both ankles. The Board cannot make a fully-informed decision on this issue because no VA examiner has opined whether the Veteran’s right hip disorder is caused or aggravated by his service-connected disorders. Additionally, a December 2014 VA examiner noted that imaging reflected no right hip arthritis and diagnosed the Veteran with an unremarkable right hip. Since that time, May 2019 private medical records reflect abnormal hip heights and misalignment that create stress on the right hip joints. A VA examination is needed to determine any current diagnosed hip disorder, and whether any such disorder and/or hip pain is etiologically related to service or caused or aggravated by service-connected disorders. 2. Entitlement to service connection for a cervical spine disorder, to include as secondary to service-connected bilateral shoulder disorders, is remanded. 3. Entitlement to service connection for headaches, to include as secondary to service-connected bilateral shoulder disorders, is remanded. The issue of whether the Veteran’s cervical spine disorder and headaches are related to his service-connected right and left shoulder disorders has been raised by the record. See September 2020 Board Hearing. The Board cannot make a fully-informed decision on these issues because no VA examiner has opined whether these disorders are caused or aggravated by his service-connected right and left shoulder disorders. The Board notes that the Veteran underwent a December 2014 VA examination that indicated the Veteran had a diagnosis of neck strain that had resolved, and that imaging did not reflect arthritis. However, May 2019 private medical contain imaging results that reflect cervical degenerative disc disease among other issues. A VA examination is needed to determine any current diagnosed cervical spine or headache disorders, and whether any such disorders are etiologically related to service or caused or aggravated by service-connected right and left shoulder disorders. 4. Entitlement to an initial rating in excess of 10 percent disabled for a right wrist disorder is remanded. 5. Entitlement to an initial rating in excess of 10 percent disabled for a left wrist disorder is remanded. 6. Entitlement to a separate rating for a right thumb disorder is remanded. 7. Entitlement to a separate rating for a left thumb disorder is remanded. The Veteran is currently rated as 10 percent disabled for arthritis of the right wrist and thumb and 10 percent arthritis of the left wrist and thumb. He last underwent a VA examination for his wrist conditions in December 2014. Since that time, the evidence of record indicates the right and left wrist disorders have worsened. During the September 2020 Board hearing, the Veteran testified that his symptoms included pain, loss of thumb dexterity, and loss of grip strength requiring the Veteran to wear a brace. Another VA examination is needed to determine the current severity of the wrist and thumb disorders. See Snuffer v. Gober, 10 Vet. App. 400, 403 (1997). The Board notes that the Veteran is in receipt of the maximum schedular rating for limitation of motion caused by his wrist disorders under diagnostic code (DC) 5215. On remand, the VA examiner should determine if the Veteran experiences flare-ups in his wrists, and whether those flare-ups cause the functional equivalent of ankylosis. See DC 5214. Additionally, the examiner should separately evaluate the thumbs and hand digits. The matters are REMANDED for the following action: 1. Obtain VA treatment records since March 2021 and associate them with the claims file. 2. Schedule the Veteran for an examination by an appropriate examiner for an opinion regarding the nature and etiology of any diagnosed right hip disorder. The examiner should answer the following questions: (a) Is it at least as likely as not (50 percent or greater possibility) that any diagnosed right hip disorder or right hip pain is etiologically related to military service, to include the rigors of military service? The examiner should provide opinion as to whether there is any medical reason to accept or reject the Veteran’s belief that his current right hip disability results from 33 years of infantryman service, including carrying rucksacks and jumping from airplanes and helicopters (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s service-connected knee and ankle disorders caused or aggravated (a medically discernible increase in functional impairment e.g. increase in the severity, frequency or duration of symptoms or additional functional impairment beyond the expected baseline impairment) any diagnosed right disorder or right hip pain? In answering those questions, the examiner’s attention is directed towards the following: • private medical records reflecting a compound ilium and abnormal hip heights and misalignment that create stress on the right hip joints (see, e.g., May 2019 Private Medical Records); and • September 2020 hearing testimony indicating right hip pain may be related to 33 years of infantryman service, including carrying rucksacks and jumping from airplanes and helicopters. A comprehensive rationale must be furnished for all opinions expressed. 3. Schedule the Veteran for an examination by an appropriate examiner for an opinion regarding the nature and etiology of any diagnosed cervical spine disorder and headache disorder. The examiner should answer the following questions: (a) Is it at least as likely as not (50 percent or greater possibility) that any diagnosed cervical spine disorder is etiologically related to military service? (b) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s service-connected right and left shoulder disorders caused or aggravated (a medically discernible increase in functional impairment e.g. increase in the severity, frequency or duration of symptoms or additional functional impairment beyond the expected baseline impairment) any diagnosed cervical spine disorder? In answering (a) and (b), the examiner should address the May 2019 private medical records reflecting cervical degenerative disc disease among other issues, and the Veteran’s in-service accident in which he banged his head on a .50 caliber machine gun, resulting in symptoms of neck pain and headaches. See, e.g., February 2016, September 2017 Lay Statements. (c) Is it at least as likely as not (50 percent or greater possibility) that any diagnosed headache disorder or headache pain is etiologically related to military service? (d) Is it at least as likely as not (i.e., probability of 50 percent or greater) that the Veteran’s service-connected right and left shoulder disorders caused or aggravated (a medically discernible increase in functional impairment e.g. increase in the severity, frequency or duration of symptoms or additional functional impairment beyond the expected baseline impairment) any diagnosed headache disorder or headache pain? In answering (c) and (d), the examiner should address the Veteran’s September 2020 Board testimony that his headaches are triggered by pain in his neck, and the Veteran’s in-service accident in which he banged his head on a .50 caliber machine gun, resulting in symptoms of neck pain and headaches, and that he receives alpha stem treatment for headaches. See, e.g., February 2016, September 2017 Lay Statements. A comprehensive rationale must be furnished for all opinions expressed. 4. Schedule the Veteran for an examination by an appropriate examiner for an opinion to determine the current severity of the Veteran’s right and left wrist and thumb disorders. The examiner must answer the following questions: (a) Does the Veteran experience flare-ups in his right and/or left wrists? If the answer is yes, the examiner should accomplish the following: • have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use; • determine if the flares cause the functional equivalent of ankylosis in either wrist; and • estimate the type (favorable or unfavorable) and/or degree of the equivalent of ankylosis. (b) Does the Veteran experience limitation of motion of any digits on either hand, including the right and left thumbs? If the answer is yes, describe the limitation of motion in accordance with DCs 5228, 5229, and 5230. (c) Does the Veteran experience flare-ups in any digits, including the right and left thumbs? If the answer is yes, the examiner should accomplish the following: • have the Veteran describe and/or demonstrate the extent of motion loss during flares or repetitive use; and • determine if the flares cause the functional equivalent of ankylosis in any digits. A complete medical rationale for all opinions expressed must be provided. T. MAINELLI Veterans Law Judge Board of Veterans’ Appeals Attorney for the Board C. Howell, 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.