Citation Nr: 21041515 Decision Date: 07/09/21 Archive Date: 07/09/21 DOCKET NO. 19-04 476 DATE: July 9, 2021 ORDER Entitlement to service connection for a right middle finger disorder, to include residuals of a right middle finger fracture is granted. REMANDED Entitlement to service connection for tinnitus is remanded. FINDING OF FACT The Veteran's right middle finger disorder had its onset in service. CONCLUSION OF LAW The criteria for service connection for a right middle finger disorder have been met. 38 U.S.C. §§ 1131, 5107; 38 C.F.R. §§ 3.102, 3.303. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran serviced on active duty in the United States Army from August 1948 to December 1949. These matters come before the Board of Veterans' Appeals (Board) on appeal from an April 2017 rating decision issued by the Department of Veterans Affairs (VA) Regional Office (RO). The Veteran testified before the undersigned Veterans Law Judge in a June 2021 hearing. The Board notes that there are not any contemporaneous service records available for review as the Veteran's service treatment and personnel records were destroyed in a fire-related incident. See February 2018, Correspondence. In such situations, VA has a heightened obligation to explain its findings and conclusions and carefully consider the benefit of the doubt rule. See Cuevas v. Principi, 3 Vet. App. 542, 548 (1992); O'Hare v. Derwinski, 1 Vet. App. 365, 367 (1991). Entitlement to service connection for a right middle finger disorder. Service connection will be granted for a disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. Establishing service connection generally requires medical or, in certain circumstances, lay evidence of (1) a current disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a nexus between the claimed in-service disease or injury and the present disability. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009); Hickson v. West, 12 Vet. App. 247, 253 (1999); Caluza v. Brown, 7 Vet. App. 498, 506 (1995), aff'd per curiam, 78 F. 3d 604 (Fed. Cir. 1996) (table decision). The Veteran reported fracturing his right middle finger during service, being treated at Walter Reed General Hospital, and recurrent right finger problems since that time. The Veteran also indicated that during service he used bulldozers and jack hammers in connection with his military occupation specialty. See June 2021, Board hearing; February 2019, VA Form 9; May 2017, NOD; April 2017, VA examination At the June 2021 Board hearing, the Veteran reported injuring his right middle finger in service and of having problems with his right middle finger since that time. He added that he has not had problems with any of his other nine fingers. The record contains a diagnosis of right-hand degenerative arthritis, to include middle finger fracture residuals. See August 2018, VA examination. In May 2017, Dr. R.B., the Veteran's private treating physician since at least 2010, noted the Veteran's report that a jack hammer dropped on his right middle finger (during service) and he had to have surgery. The Veteran further stated that his right middle finger is now twisting and more painful. Dr. R.B. recommended that the Veteran follow up at the VA as his finger pain is "definitely" service related. See May 2017, Private treatment record. The Board finds the August 2020 positive nexus opinion to be competent, credible and slightly probative as it is based on an in-person examination, consideration of the Veteran's lay statements and history, but did not provide a complete rationale. See Nieves-Rodriguez v. Peake, 22 Vet. App. 295 (2008) (noting most of the probative value of a medical opinion comes from its reasoning). In light of the medical and lay evidence of record, the Board concludes the evidence shows the Veteran's right middle finger disorder had its onset in service and has been recurrent since that time. 38 U.S.C. § 1131; 38 C.F.R. § 3.303. The Board notes the competent and credible lay evidence, including the Veteran's testimony, that he fractured his right middle finger during service and has experienced recurrent pain since discharge. See Charles v. Principi, 16 Vet. App. 370, 374 (2002); see also Layno v. Brown, 6 Vet. App. 465, 470 (1994); Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). The Board acknowledges the August 2018 VA examiner's negative nexus opinion; however, because the evidence shows that the Veteran's right middle finger disorder had its onset in service, service connection for a right middle finger disorder is warranted. See Flynn v. Brown, 6 Vet. App. 500, 503 (1994). REASONS FOR REMAND 1. Entitlement to service connection for tinnitus is remanded. The Veteran reported ringing of the ears began five or six years ago and is related in-service acoustic trauma. Specifically, the Veteran contends his military occupation specialty exposed him to hazardous noise from demolitions, heavy equipment, and artillery rounds, and he was not provided hearing protection. The Veteran stated he did not have any hazardous noise exposure after discharge from service. See June 2021, Board hearing; January 2017, VA Form 21-4138. The Veteran's military occupation specialty (MOS) was a plumber. Based on the Veteran's lay statements, MOS, and the fire-related destruction of the Veteran's service treatment records, VA has conceded acoustic trauma during service. The Board finds the April 2017 and August 2018 VA examinations for tinnitus to be inadequate. The VA examiners found the Veteran did not have a tinnitus diagnosis because there were no findings, signs, or symptoms to support a diagnosis. However, a September 2017 VA treatment record notes the Veteran's reports of occasional non-bothersome tinnitus in both ears. Inasmuch as the VA examiners did not provide an opinion as to the etiology of tinnitus and found the Veteran did not have a tinnitus diagnosis, the examinations are inadequate. See Reonal v. Brown, 5 Vet. App. 458, 460-61 (1993) (medical opinions based on an incomplete or inaccurate factual premise are not probative). Accordingly, the Veteran should be afforded another examination to determine the nature and etiology of any current tinnitus, to include as secondary to his service-connected bilateral hearing loss. The matter is REMANDED for the following action: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Schedule a VA examiner to review the Veteran's claims folder to determine the nature and etiology of tinnitus. The examiner should opine as to whether it is at least as likely as not that tinnitus is related to service, to specifically include to his documented in-service acoustic trauma. The examiner must also opine as to whether it is at least as likely as not that the Veteran's tinnitus was caused or aggravated by his service-connected bilateral hearing loss, which the Board notes is rated as 50 percent disabling. In providing the requested opinions, the reviewing medical expert should concede the Veteran was exposed to in-service acoustic trauma, address the Veteran's competent reports of the onset of tinnitus five or six years ago, and the 2017 VA treatment record indicating occasional tinnitus in both ears. See June 2021, Board hearing; September 2017, VA treatment record. In light of the foregoing, the examiner must accept as true that the Veteran suffers from tinnitus. STEVEN D. REISS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. Straughn, 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.