Citation Nr: 21030913 Decision Date: 05/20/21 Archive Date: 05/20/21 DOCKET NO. 16-31 272 DATE: May 20, 2021 REMANDED The claim of entitlement to service connection for a left hand disability is remanded. The claim of entitlement to service connection for a right hand disability is remanded. REASONS FOR REMAND The Veteran had active service from February 2006 to May 2010. This matter is before the Board of Veterans' Appeals (Board) from an October 2013 rating decision by the Agency of Original Jurisdiction (AOJ). A Board hearing was held in June 2019. A transcript is of record. The instant issues were remanded in October 2019 and December 2020. In the October 2019 remand, the Board directed that an examination be conducted to determine the etiology of the Veteran's claimed bilateral hand disability, to include diagnosed bilateral tendonitis. The Board specified that the examiner should provide an opinion as to whether any diagnosis was at least as likely as not related to an in-service injury, event, or disease. The Board indicated that the examiner should consider the Veteran's credible reports of pain during service related to continuous repetitive hand exertion, as well as his report of symptoms continuing since service. The Board indicated that if a clinical diagnosis was made, the examiner was to opine on whether the etiology or pathophysiology of the Veteran's hand condition is not conclusive as to this particular Veteran. On examination in December 2019, the diagnosis was bilateral hand strain. The examiner stated that none of the injuries sustained during service were likely to lead to chronic hand pain. He noted that there were no records or reports of chronic hand pain during service related to repetitive activity. He indicated that bilateral hand strain was most likely related to overuse, but that such was not definitive as there was no hard evidence to show this. In December 2020, the Board determined that the December 2019 examination did not adequately address the Veteran's credible reports of pain during service related to repetitive activity or exertion. The Board additionally noted that the examiner did not provide an adequate discussion of whether the etiology or pathophysiology of hand strain was conclusive as to the Veteran. It directed that an additional examination be obtained. On VA examination in February 2021, the diagnosis was periarticular osteoporosis. The examiner concluded that this was not incurred in or caused by the claimed in-service injury, event, or illness. In the section of the report provided for rationale, she recited various medical reports and cited to the Journal of Bone and Mineral Research regarding periarticular bone loss (osteoporosis). She additionally noted that periarticular osteoporosis was not noted on previous radiographs, and concluded that the diagnosis was not incurred in or caused by service. This examination report does not adequately address the Veteran's credible reports of pain during service related to repetitive activity and exertion. Moreover, the examiner did not provide an adequate discussion of whether etiology or pathophysiology of hand strain or osteoporosis was conclusive as to this Veteran. See Stewart v. Wilkie, 30 Vet. App. 383 (2018). In April 2021, the examiner again reviewed the record and recited the Veteran's statements regarding his activities during service and his symptoms. She provided the same conclusion as in her February 2021 report, but did not explain the rationale underlying her conclusion. Notably, this review and addendum was obtained subsequent to the issuance of a supplemental statement of the case in February 2021. In any event, the Board concludes that neither the February 2021 examination report nor the April 2021 addendum adequately address the questions posed by the Board. A remand by the Board confers on an appellant, as a matter of law, the right to compliance with the terms of the remand order and imposes upon VA a concomitant duty to ensure compliance with those terms. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Thus, remand is again required for an examination that complies with the Board's previous remand directives. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination, by an examiner who has not previously examined him, to determine the nature and etiology of his claimed bilateral hand disability. The evidentiary record, including a copy of this remand, must be made available to and reviewed by the examiner. After conducting an examination of the Veteran and performing any clinically-indicated diagnostic testing, the examiner should identify all diagnoses relating to the Veteran's hands. With regard to any diagnoses made, including hand strain and osteoporosis, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or greater probability) that any such diagnosis had its clinical onset during active service or is related to any in-service disease, event, or injury. The examiner must also provide an opinion regarding whether the etiology or pathophysiology of any clinical diagnosis is not conclusive as to this particular Veteran. If any of the Veteran's symptomatology cannot be attributed to a known clinical diagnosis, the examiner should indicate whether such symptomatology represents an objective indication of chronic disability. If any of the Veteran's symptomatology is found to represent an objective indication of chronic disability, the examiner should also describe the extent to which the disability has manifested. The examiner is to consider and discuss the Veteran's credible complaints of hand pain during service, as well as his report of continuous symptoms since then. The complete rationale for all opinions should be set forth and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. If an opinion cannot be provided without resorting to mere speculation, the examiner must provide a complete explanation for why an opinion cannot be rendered. In so doing, the examiner must explain whether the inability to provide a more definitive opinion is the result of a need for additional information, or that he or she has exhausted the limits of current medical knowledge in providing an answer to that particular question. (Continued on the next page) 2. Then, readjudicate the Veteran's claim, with application of all appropriate laws, regulations, and case law, and consideration of any additional information obtained as a result of this remand. If the decision remains adverse to the Veteran, he and his representative should be furnished a supplemental statement of the case (SSOC) and afforded an appropriate period within which to respond thereto. DONNIE R. HACHEY Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Barone, 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.