Citation Nr: 21042488 Decision Date: 07/13/21 Archive Date: 07/13/21 DOCKET NO. 16-41 128 DATE: July 13, 2021 REMANDED Entitlement to service connection for a left-hand injury is remanded. Entitlement to service connection for a low back injury is remanded. REASONS FOR REMAND The Veteran had active service from October 1985 to September 1989. The issue of entitlement to service connection for a left-hand injury comes to the Board on appeal from a December 2014 Regional Office (RO) decision, and the low back disability claim was denied in a February 2017 RO decision. The Veteran testified at a hearing before the undersigned in January 2020; a transcript of that hearing is of record. The matters were previously denied in an April 2020 Board decision. The Veteran appealed the denials to the United States Court of Appeals for Veterans Claims (Court), and a March 2021 Joint Motion for Partial Remand (Joint Motion) vacated the denials and returned them to the Board for corrective action. 1. Entitlement to service connection for a left-hand injury is remanded. The Joint Motion indicated that the April 2020 denial provided an inadequate statement of reasons and bases for relying on a July 2015 VA negative nexus opinion that relied in part on a finding that the Veteran's hand pain did not present until 2 to 3 years prior to the examination, which would make it unlikely to be caused by an in-service event 25 years prior. The Court noted that the Veteran's January 2020 hearing testimony, as well as a December 2019 statement, indicated that the Veteran believed his pain had continued since service. The Court further noted that the Board's decision did not address such lay evidence and whether it rendered the July 2015 VA opinion inadequate. The Board finds that in light of that evidence, as well as other evidence received after the July 2015 opinion, another VA nexus opinion is necessary. The July 2015 VA examination report states that "over the past couple of years, the Veteran reports excruciating hand pain when he flexes and extends his wrist in certain positions." The examiner's opinion utilized rationale that concluded that his pain began 2 to 3 years prior. Other medical evidence of record shows the Veteran reported left hand pain in November 2013, consistent with the examiner's conclusion. However, the Board notes that the examiner's report merely states that severe hand pain began a few years prior. It does not rule out the possibility of less severe pain that existed earlier. The examination report itself is not sufficient to conclude that pain did not begin prior to the time period inferred by the examiner, especially in light of multiple subsequent reports by the Veteran that his pain continued since a documented crushing injury in service. Further, after the July 2015 examination, a September 2017 letter from a private medical provider stated that the Veteran's presenting complaints of hand pain are consistent with his complaints in military service. That examiner did not provide adequate rationale sufficient rationale to support the conclusion. The letter did contain an August 2015 medical treatment letters diagnosing a left wrist strain and pain due to crushing injury as well as decreased grip strength of the left hand due to a crushing injury. However, given the aforementioned issues surrounding continuity of symptomatology raised by the Veteran's lay statements, combined with the private medical opinion, an additional medical opinion is necessary to reconcile whether the Veteran's current left-hand symptoms are related to his in-service injury. 2. Entitlement to service connection for a low back injury is remanded. The Joint Motion found that a November 2017 VA examination was inadequate because it failed to address the Veteran's lay statements as to the continuity of his back pain since service. The examiner concluded that the Veteran's low back disability was not related to service because there were no reported back issues in his service treatment records. The examiner did not address lay contentions from the Veteran stating that he has had back pain since service. The Court directed the Board to obtain a new opinion that considers and addresses the Veteran's lay statements. The matters are REMANDED for the following action: 1. Forward the record and a copy of this Remand to the examiner who completed the July 2015 hand and finder examination and opinion, or, if that examiner is unavailable, to another suitably qualified examiner for completion of an addendum opinion. The claims file must be made available to and reviewed by the examiner. The examiner must note whether the claims file was reviewed. If the examiner determines that additional clinical examination or testing of the Veteran is necessary to render the opinion requested below, such examination should be scheduled. The examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current left-hand disability was incurred in or caused by service. The examiner must address the Veteran's lay statements as to the onset and continuity of his symptoms, particularly his contentions that his hand pain has continued since service. The examiner must also address the evidence of record discussed herein, particularly the September 2017 opinion and August 2015 medical record, that attributes his current left-hand symptoms to his in-service hand injury. A complete rationale must accompany any conclusion reached. 2. Forward the record and a copy of this Remand to the examiner who completed the November 2017 VA back examination and opinion, or, if that examiner is unavailable, to another suitably qualified examiner for completion of an addendum opinion. The claims file must be made available to and reviewed by the examiner. The examiner must note whether the claims file was reviewed. If the examiner determines that additional clinical examination or testing of the Veteran is necessary to render the opinion requested below, such examination should be scheduled. The examiner must opine as to whether it is at least as likely as not (50 percent or greater probability) that the Veteran's current low back disability was incurred in or caused by service. The examiner must address the Veteran's lay statements as to the onset and continuity of his symptoms, particularly his contentions that his back pain has continued since service. (Continued on the next page) A complete rationale must accompany any conclusion reached. 3. After completing the above, and conducting any additional development deemed necessary, readjudicate the issues on appeal. If the benefit sought on appeal remains denied, the Veteran and his representative should be furnished with a supplemental statement of the case and afforded an opportunity to respond. Thereafter, return the case to the Board for appellate review. Thomas H. O'Shay Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. Baker, 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.