Citation Nr: 21028460 Decision Date: 05/11/21 Archive Date: 05/11/21 DOCKET NO. 14-25 713 DATE: May 11, 2021 REMANDED Entitlement to service connection for a right hand finger disorder is remanded. Entitlement to service connection for a left hand finger disorder is remanded. Entitlement to service connection for a right ankle disorder is remanded. Entitlement to service connection for a left ankle disorder is remanded. Entitlement to service connection for a lumbar spine disorder is remanded. REASONS FOR REMAND The Veteran had active air service from July 1988 to January 2011. This case comes before the Board of Veterans' Appeals (Board) on appeal from a January 2012 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Portland, Oregon. A May 2018 Board decision denied, in pertinent part, the claims on appeal. The Veteran appealed the Board's May 2018 decision to the United States Court of Appeals for Veterans Claims (Court). In December 2019, the Court granted the parties' Joint Motion for Partial Remand (JMPR), which vacated the Board's May 2018 decision with regard to the claims on appeal and remanded that portion of the appeal. This case was again before the Board in June 2021, at which time the issues currently on appeal was remanded for additional development. The case has now been returned to the Board for further appellate action. In a March 2021 rating decision, the Veteran was granted entitlement to service connection for right knee patellofemoral pain syndrome, representing a full grant of the matter previously on appeal. Accordingly, that matter is no longer before the Board. See Grantham v. Brown, 114 F.3d 1156 (Fed. Cir. 1977). Service Connection The Board finds that additional development is required before the claims on appeal may be decided. Fingers- Right and Left Hands In February 2021, the Veteran was afforded a VA examination to determine the nature and etiology of her right and left hand finger disorders. The examiner opined that the Veteran's diagnosed right and left hand finger disorders were less likely than not related to service. In reaching these conclusions, the examiner commented that the Veteran's right and left hand finger disorders were less likely than not related to right and left right and left index fingers during service. The examiner subsequently commented that the Veteran's right and left finger disorders were at least as likely as not related to an in-service injury. The examiner proceeded to explain that there were no treatment or diagnoses related to the right and left hands during service. The Board finds that it is unable to decide the claim based on the findings contained within the February 2021 VA medical opinion report. In this regard, the examiner reported that the Veteran's right and left hand finger disorders were related to active service and then subsequently indicated that each disability was not related to service. Moreover, in her rationale, the examiner relied on the absence of documented in-service treatment as the sole basis for the negative etiological opinions. The Board is unable to reconcile these discrepancies and finds the opinions inadequate for adjudication purposes. Therefore, the Board finds that new VA medical opinions are warranted to address the nature and etiology of her claimed right and left hand finger disorders. Stegall v. West, 11 Vet. App. 268 (1998) (holding that a remand by the Board confers the right to compliance with remand orders). Right and Left Ankles In February 2021, the Veteran was afforded a VA examination to determine the nature and etiology of her right and left ankle disorders. The examiner opined that the Veteran's diagnosed right and left ankle disorders were less likely than not related to her active service. In reaching this conclusion, the examiner reported that the Veteran's medical records reflected that the first documented complaint related to the right and left ankle was not made until June 2016, and that no documented symptoms were present prior to that time. The examiner also reported that a November 2010 examination was silent for a diagnosis of a right and/or left ankle condition. The Board finds that it is unable to decide the claims based on the findings contained within the February 2021 VA medical opinion report. In this regard, the examiner relied heavily on the absence of complaints in the Veteran's service treatment records, and the absence of post-service treatment for several years as the rationale for the negative nexus opinion. Moreover, the examiner did not address the Veteran's reports that she sprained her ankles several times during active service and did not seek treatment. Dalton v. Nicholson, 21 Vet. App. 23, 39 (2007). Therefore, the Board finds that new VA medical opinion are warranted to address the nature and etiology of the Veteran's right and left ankle disorders. Stegall, 11 Vet. App. 268. Lumbar Spine At a February 2021 VA examination, the examiner diagnosed lumbar spine degenerative disc disease and degenerative arthritis. The examiner opined that the Veteran's lumbar spine disorder was less likely than not related to her active service. The Board finds that it is unable to decide the claim based on the findings contained within the February 2021 VA medical opinion report. In this regard, the examiner reported that the Veteran's in-service complaints of back pain were related to pregnancy and that pain had resolved after pregnancy. However, the examiner did not address the Veteran's April 2012 statements, indicating that she experienced frequent lower back pain throughout her final years of active service. Dalton, 21 Vet. App. 23, 39. Moreover, the examiner relied heavily on the absence of documented post-service treatment for lower back condition for several years following the Veteran's separation from service in forming the negative nexus opinion. Therefore, the Board finds that a new VA medical opinion is warranted to address the nature and etiology of the Veteran's lumbar spine disorder. Stegall, 11 Vet. App. 268. The matters are REMANDED for the following action: 1. The Veteran should be given the opportunity to identify any outstanding private or VA treatment records relevant to the claims on appeal. After obtaining any necessary authorization from the Veteran, all outstanding records should be obtained, to include updated VA treatment records from March 2021 to present. For private treatment records, make at least two (2) attempts to obtain records from any identified sources. If any such records are unavailable, inform the Veteran and her representative and afford her an opportunity to submit any copies in her possession. For federal records, all reasonable attempts should be made to obtain such records. If any records cannot be obtained after reasonable efforts have been made, issue a formal determination that such records do not exist or that further efforts to obtain such records would be futile, which should be documented in the claims file. The Veteran must be notified of the attempts made and why further attempts would be futile, and allowed the opportunity to provide such records, as provided in 38 U.S.C. § 5103A(b)(2) and 38 C.F.R. § 3.159(e). 2. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed right and left finger disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present left finger disorder, to include degenerative arthritis, had its onset during his active service, or is otherwise etiologically related to such service? (B) Is at least as likely as not (50 percent or better probability) that any currently present right finger disorder, to include right thumb strain, had its onset during his active service, or is otherwise etiologically related to such service? The examiner must consider the Veteran's statements regarding the onset and continuity of her symptoms. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 3. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed right and left ankle disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to the following: (A) Is at least as likely as not (50 percent or better probability) that any currently present right ankle disorder, to include a strain, had its onset during his active service, or is otherwise etiologically related to such service? (B) Is at least as likely as not (50 percent or better probability) that any currently present left ankle disorder, to include a strain, had its onset during his active service, or is otherwise etiologically related to such service? The examiner must consider the Veteran's statements regarding the onset and continuity of her symptoms, to include her reports that she sprained her ankles numerous times during active service and that she did not seek medical attention. A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. 4. Following the receipt of outstanding records, obtain an etiology opinion from an appropriate examiner to determine the nature and etiology of the Veteran's claimed lumbar spine disorder. The need for a physical examination is left to the discretion of the medical professional offering the medical opinion. The record must be made available to the examiner for review, and the examiner should indicate that the record was reviewed in connection with the examination. All indicated tests and studies should be accomplished and the findings then reported in detail. Based on the review of the record, the examiner must provide an opinion as to whether it is at least as likely as not (50 percent or better probability) that any currently present lumbar spine disorder, to include degenerative disc disease and degenerative arthritis, had its onset during his active service, or is otherwise etiologically related to such service. The examiner must consider the Veteran's lay statements regarding the onset and continuity of her symptoms, to include her reports that she experienced lower back pain throughout her final years of active service. (Continued on the next page) A complete rationale should be given for each opinion expressed. In this regard, a discussion of the facts and medical principles involved would be considerable assistance to the Board. KRISTY L. ZADORA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Christopher O'Donnell, 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.