Citation Nr: 21032796 Decision Date: 05/28/21 Archive Date: 05/28/21 DOCKET NO. 16-25 077 DATE: May 28, 2021 REMANDED Entitlement to service connection for trigger thumb, left hand is remanded. Entitlement to a total disability rating based on individual unemployability (TDIU) due to service-connected disabilities is remanded. REASONS FOR REMAND The Veteran served on active duty from September 1974 to May 1977. This matter comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions in April 2016 and September 2016. The above issues were remanded by the Board in April 2019 for further development. Unfortunately, the issues must be remanded yet again. See Stegall v. West, 11 Vet. App. 268, 271 (1998); see also D'Aries v. Peake, 22 Vet. App. 97, 105 (2008). Although the Board sincerely regrets the additional delay, it is necessary to ensure that there is a complete record upon which to decide these issues, so the Veteran is afforded every possible consideration. In April 2019, the Board also remanded the Veteran's claims for service connection for residuals of right leg fracture and an acquired psychiatric disorder. An April 2020 rating decision granted service connection for residuals of right leg fracture and for major depressive disorder, recurrent. As this represents a full grant of the benefits sought regarding these issues, they are no longer before the Board. See Grantham v. Brown, 114 F.3d 1156, 1158-59 (Fed. Cir. 1997). 1. Entitlement to service connection for trigger thumb, left hand is remanded. Pursuant to the Board's April 2019 remand directives, the Veteran was afforded an August 2019 Hand and Finger Conditions Disability Benefits Questionnaire and corresponding medical opinion. For the reasons discussed below, the Board finds that the medical opinion is inadequate. See Barr v. Nicholson, 21 Vet. App. 303, 312 (2007) (When VA undertakes to provide a VA examination or obtain a VA opinion, it must ensure that the examination or opinion is adequate). In finding that the Veteran's disability is less likely than not related to his active service, the medical opinion recites evidence from the Veteran's service treatment records and post-service treatment records. Of note, the medical opinion cites to the Veteran's in-service July 1977 Report of Medical History that shows he reported joint pain and post-service treatment records from many years after service indicating complaints relating to his left thumb trigger finger and related treatment. The Veteran reports that he injured his left thumb and left third digit during obstacle course training per the medical opinion. The medical opinion also provides general information concerning tendons and lists the major risk factors for trigger finger. The medical opinion indicates that while the Veteran might have been at risk for trigger finger during service due to his history from the time he served, there is no evidentiary support from the available medical records that his injury was caused by his service or was incurred during his active service. The medical opinion concludes that the Veteran's first complaints of left thumb issues occurred in 2014, 37 years after his service. The medical opinion is inadequate because it is based, in part, upon an absence of contemporaneous documentation of an in-service hand or finger injury as it appears the Veteran's lay statements concerning the subject were discounted solely because there was no objective evidence indicating he was seen and treated for such an injury during his active service. See Buchanan v. Nicholson, 451 F.3d 1331, 1336-37 (holding that the absence of contemporaneous medical records does not, in and of itself, render lay testimony not credible); Cf. Dalton v. Nicholson, 21 Vet. App. 23, 39-40 (2007) (holding that a VA opinion was inadequate where the examiner did not comment on the Veteran's report of in-service injury and relied on lack of evidence in service medical records to provide a negative opinion). Therefore, the Board finds that a new medical opinion is necessary to fully address the etiology of the Veteran's trigger thumb, left hand. 2. Entitlement to a TDIU rating due to service-connected disabilities is remanded. Given that final adjudication of the Veteran's claim for service connection on remand could result in eligibility for a TDIU rating, or result in additional evidence speaking to the Veteran's employability, the issue of entitlement to a TDIU rating is inextricably intertwined with the claim for service connection being remanded herein, and the issues should be considered together. See 38 C.F.R. § 4.16(a); 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). Accordingly, the issue of a TDIU rating must be remanded as well. The matters are REMANDED for the following action: 1. Obtain a medical opinion from an appropriate clinician regarding the etiology of the Veteran's trigger thumb, left hand. The clinician must review the Veteran's claims file. The clinician must opine: (a.) Whether it is it at least as likely as not (50 percent probability or greater) that the Veteran's trigger thumb, left hand is related to an in-service injury, event, or disease, including a hand or finger injury sustained during obstacle course movements. In providing this opinion, the clinician should specifically address any reported symptoms during the applicable time period, including the Veteran's July 1977 Report of Medical History that shows he reported swollen or painful joints. In providing the requested opinions, consider the Veteran's description of his in-service symptoms and treatment as well as his post-service symptoms. If there is any medical reason to accept or reject the proposition that the Veteran's reported symptoms in service and thereafter represented the onset of his current disability, this should be noted. Stated another way, do the Veteran's reports about his symptoms align with how the currently diagnosed disability is known to develop or are the Veteran's reports generally inconsistent with medical knowledge or implausible? (Continued on the next page) If the clinician determines that the Veteran's reported swollen or painful joints in July 1977 were not manifestations of his trigger thumb, left hand, or that his trigger thumb, left hand is not related to any aspect of active service, including a hand or finger injury sustained during obstacle course movements, the examiner should discuss what other factor(s) caused the above symptoms or caused his trigger thumb, left hand. A complete rationale must be provided for all opinions and conclusions reached. P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board Sean Mussey, 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.