Citation Nr: 21031989 Decision Date: 05/25/21 Archive Date: 05/25/21 DOCKET NO. 05-03 060 DATE: May 25, 2021 REMANDED Entitlement to an initial compensable evaluation for residuals of a laceration of the distal phalanx of the left middle finger is remanded. Entitlement to an initial compensable evaluation for residuals of a laceration of the distal phalanx of the left ring finger is remanded. Entitlement to a rating greater than 10 percent for painful scars of the left middle and ring fingers is remanded. REASONS FOR REMAND The Veteran served on active duty from June 1968 to February 1970. The Board notes that this appeal has a rather lengthy procedural history. In this regard, an April 2007 Board decision denied the Veteran's claims for higher initial ratings for his left middle and left ring fingers. An April 2008 order of the United States Court of Appeals for Veterans Claims (Court) granted a joint motion by the parties to vacate the decision and remand these matters to the Board. In December 2008, October 2016, August 2017, December 2019, and October 2020, the Board remanded the matter for additional evidentiary development. It has since been returned to the Board for further consideration. 1. Entitlement to an initial compensable evaluation for residuals of a laceration of the distal phalanx of the left middle finger is remanded. 2. Entitlement to an initial compensable evaluation for residuals of a laceration of the distal phalanx of the left ring finger is remanded. A review of the record reveals that a remand is necessary to ensure substantial compliance with the Board's previous remand directives. See Stegall v. West, 11 Vet. App. 268, 271 (1998). Initially, the Board notes that one of its prior directives was completed. In this regard, the Board directed the Agency of Original Jurisdiction (AOJ) to obtain any outstanding treatment records, along with x-rays of the hands which showed osteoarthritis. It appears that the AOJ completed this task, as results from a January 2020 x-ray are included in recently uploaded treatment records and also referred to in the December 2020 VA hand and finger examination, wherein the impressions reveal there is mild osteoarthritis in the Veteran's left hand. The Board also directed the AOJ that if arthritis is found, the examiner must indicate whether it is at least as likely as not due to or aggravated by the service-connected left middle and ring finger lacerations. In a January 2021 addendum, the examiner provided the following remarks: After review of available VBMS, STRs, and CPRS records, it is the opinion of this examiner that Veteran's arthritis condition is less likely as not related to or aggravated by the left middle and ring finger lacerations. Since lacerations are soft tissue injury which do not cause arthritis, which is a condition [due to] the aging process. In an April 2021 Informal Hearing Presentation (IHP), the Veteran and his representative contend that the January 2021 opinion is improper because it does not adequately consider the theory of secondary service connection, provides insufficient rationale, and fails to fully consider the traumatic injury he sustained in-service. Considering the above, the Board tends to agree and finds the January 2021 opinion to be at least partially inadequate for rating purposes at this time, mainly due to the reasons set forth in the April 2021 IHP. As such, additional clarification in the form of an addendum opinion would help resolve the matter. 3. Entitlement to a rating greater than 10 percent for painful scars of the left middle and ring fingers is remanded. The Board acknowledges that the Veteran underwent a VA hand and finger examination in December 2020. However, a discussion of the results of this examination at this juncture would be premature given the additional development required in the previous section. Because a decision on the remanded issues addressed above could significantly impact a decision on the issue of entitlement to a rating greater than 10 percent for painful scars of the left middle and ring finger, the issues are inextricably intertwined. A remand of the claim for entitlement to an increased rating for painful finger scars is thereby required. See Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (two issues are "inextricably intertwined" when they are so closely tied together that a final decision on one issue cannot be rendered until a decision on the other issue has been rendered). The matters are REMANDED for the following action: 1. Obtain an addendum opinion from the January 2021 examiner (or a similarly suited examiner) to determine the nature and etiology of the Veteran's arthritis of the left hand to include as secondary to service-connected painful scars of the left middle and ring fingers. The electronic claims files and all pertinent records must be made available to the examiner and the examiner must indicate in the examination report that these records have been reviewed. Consideration must be given to the nature and extent of the original hand injury in service. It should be noted that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. (a) The VA examiner must opine whether it is at least as likely as not (50 percent or higher degree of probability) that any left hand/finger arthritis manifested in-service or is otherwise causally or etiologically related to the Veteran's military service. (b) If not directly related to service, the examiner should offer an opinion as to whether it is at least as likely as not (50 percent or higher degree of probability) that any identified left hand/finger arthritis is caused by his service-connected residual scars of the fingers on his left hand. (c) That examiner should then opine whether the left hand/finger arthritis is aggravated (i.e., permanently worsened beyond the normal progression of that disease) by his service-connected residual scars of the fingers on his left hand. In offering any opinion, the examiner must consider the full record, to include the lay statements in support of the Veteran's claim. The examiner should also reconcile any prior report, if necessary. The rationale for any opinions offered should be provided. If the VA examiner determines that further examination is necessary in order to render the requested medical opinion, then the Veteran should be scheduled for such an examination. 2. After the development requested has been completed, the AOJ should review any report to ensure that it is in complete compliance with the directives of this remand. If the report is deficient in any manner, the AOJ must implement corrective procedures at once. MICHAEL D. LYON Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Miller, 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.