Citation Nr: 21032782 Decision Date: 05/27/21 Archive Date: 05/27/21 DOCKET NO. 18-15 207 DATE: May 28, 2021 REMANDED Entitlement to service connection for a right hip disability is remanded. Entitlement to service connection for a left hip disability is remanded. Entitlement to service connection for a right knee disability is remanded. Entitlement to service connection for a left ankle disability is remanded. Entitlement to a compensable rating for a service-connected mallet left little finger disability, to include pain in the hand, forearm, and elbow, is remanded. REASONS FOR REMAND The Veteran served on active duty in the United States Army from October 2004 to August 2013, to include service in Iraq and Afghanistan. This matter comes before the Board of Veterans' Appeals (Board) from an April 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). In October 2020, the Veteran testified before the undersigned Veterans Law Judge at a virtual Board hearing. 1. Entitlement to service connection for a right hip disability is remanded. 2. Entitlement to service connection for a left hip disability is remanded. 3. Entitlement to service connection for a right knee disability is remanded. 4. Entitlement to service connection for a left ankle disability is remanded. 5. Entitlement to a compensable rating for a service-connected mallet left little finger disability, to include pain in the hand, forearm, and elbow, is remanded. The Veteran asserts that his bilateral hip, right knee, and left ankle disabilities are related to his active service, or alternatively caused or worsened by his service-connected left knee disability. See October 2020 Board hearing transcript (Tr.) at 10-14; March 2018 VA Form 9; June 2014 Notice of Disagreement (NOD). The Veteran additionally asserts that his service-connected mallet left little finger disability warrants a compensable rating and that it also causes radiating pain throughout his hand, forearm, and elbow. See Tr. 2-9; March 2018 VA Form 9; June 2014 NOD. Given the length of time since the last examinations of the Veteran's claimed disabilities, the Veteran's October 2020 hearing testimony, and several inadequacies of the prior examinations, remand is warranted to obtain an updated examination of the Veteran's service-connected finger disability, a peripheral nerves examination and nexus opinion, and addendum opinions regarding his service connection claims. Updated VA and private treatment records should also be secured. The matters are REMANDED for the following action: 1. Obtain any outstanding VA treatment records. 2. With any necessary assistance from the Veteran, obtain all outstanding relevant private treatment records. 3. Schedule the Veteran for an examination with an appropriate clinician, other than the February 2018, October 2016, and April 2014 hand and finger examiners, to determine the current severity of his service-connected mallet left little finger disability. The entire claims should be made available to and reviewed by the examiner. All findings should be reported in detail. 4. Then schedule the Veteran for a VA peripheral nerves examination addressing the Veteran's pain in the left hand, arm, and elbow that he relates to his service-connected mallet left little finger disability. See October 2020 Board hearing transcript (Tr.) at 2-3. The entire claims file should be made available to and reviewed by the examiner. After reviewing the claims file and examining the Veteran, the examiner is asked to identify any neurological disabilities affecting left hand, arm, or elbow disabilities. For each such disability identified, the examiner is asked to opine whether it is at least as likely as not (50 percent or greater probability) that such disability: (a.) is proximately due to the Veteran's service-connected mallet left little finger disability; or (b.) has been aggravated (worsened) by the Veteran's service-connected mallet left little finger disability. In addressing the above questions in 4(a)-(b), the examiner must address each question separately and must consider and discuss the following: (c.) The entirety of the October 2020 Board hearing transcript as it relates to the Veteran's left finger disability, and specifically the Veteran's testimony regarding pain radiating from his finger to his hand, arm, and elbow (Tr. 2), his testimony about the "whole left side of [his] upper body" manifesting pain (Tr. 2), and the functional impairment caused by his left finger disability, including dropping items without notice and loss of strength (Tr. 2-5). (d.) The February 2018 C&P hand and finger examination that indicated an EMG finding of left median motor nerve showing decreased conduction velocity (palm-wrist, 45 m/s). The examiner is specifically asked to discuss whether this EMG finding indicates a disability that (1) is proximately due to the Veteran's service-connected mallet left little finger disability; or (2) has been aggravated (worsened) by the Veteran's service-connected mallet left little finger disability. The examiner is further advised that any functional impairment that affects earning capacity, such as that described by the Veteran on pages 4-5 of the hearing transcript, constitutes a disability for VA purposes. 5. Obtain addendum opinions from the same examiner, if available, who conducted the October 2016 examinations of the Veteran's hips, left ankle, and right knee, or a different examiner if unavailable. The entire claims file should be made available to and reviewed by the examiner, including the October 2020 Board hearing transcript. The examiner must concede that the Veteran has current bilateral hip, left ankle, and right knee disabilities for VA purposes based on demonstrated functional impairment that impacts earning capacity. After conceding that the Veteran has current bilateral hip, left ankle, and right knee disabilities, the examiner is asked to opine whether it is at least as likely as not (50 percent or greater probability) that such disabilities: (a.) had their onset in service or are otherwise related to service, to include as the result of a conceded cumulative impact injury described below; (b.) are proximately due to the Veteran's service-connected left knee disability or the limp due to his service-connected left knee disability; or (c.) have been aggravated (worsened) by the Veteran's service-connected left knee disability or the limp due to his service-connected left knee disability. In addressing the above questions in 5(a)-(c), the examiner must consider and discuss the following: (d.) The cumulative impact of the Veteran's military occupational specialty in service as a mechanic working on Apache helicopters. See Tr. 10. The examiner must specifically consider and discuss the Veteran's testimony at pages 10-12 of the hearing transcript where the Veteran describes the impact of his duties including contorting and squeezing his body into tight spaces and carrying heavy ammunition, including 110-pound missiles, and getting repeatedly hit in the right knee by 110-pound ammo cans. (e.) Medical evidence, which the examiner must accept as true, that he walked with a limp in service due to his service-connected left knee disability and left knee surgery, specifically September 2005 and November 2006 service treatment records noting limp on the left leg and the left knee giving out when bearing weight. (f.) The Veteran's credible testimony, which the examiner must accept as true, that he limped in service for years before the left knee surgery (Tr. 12), he has experienced consistent pain in the hips and ankles since the left knee surgery (Tr. 12), he has had pain in all joints since leaving service (Tr. 14), his description of the contralateral side, opposite joint manifesting pain (Tr. 14), his reports of constant left ankle pain and being unable to walk (Tr. 17), his gait problems starting in service around 2007 (Tr. 18), and that his bilateral hips, left ankle, and right knee pain prevent him from playing sports (Tr. 18). The examiner is advised that basing a negative nexus opinion on any lack of documentation, including lack of documentation of an abnormal gait or of "chronic off-loading from the left knee" to another joint (see, e.g., October 2016 hips and knee examinations) will render the opinion inadequate and will necessitate another remand to obtain another addendum opinion. A complete rationale should be given for all opinions and conclusions expressed. If unable to opine without resorting to speculation, please provide a basis for reaching this conclusion. S. BUSH Veterans Law Judge Board of Veterans' Appeals Attorney for the Board D. deBruyn, Associate 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.