Citation Nr: 22014241 Decision Date: 03/11/22 Archive Date: 03/11/22 DOCKET NO. 15-18 542A DATE: March 11, 2022 REMANDED Entitlement to an initial disability rating in excess of 10 percent disabling for fracture of the right thumb distal phalanx (residuals of right thumb fracture) is remanded. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disability (TDIU) is remanded. REASONS FOR REMAND The Veteran served on active duty from October 1988 to March 1994 in the United States Army. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a September 2013 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO). The Board remanded the case to the Agency of Original Jurisdiction (AOJ) in August 2019, July 2020, and April 2021. 1. Entitlement to an initial disability rating in excess of 10 percent disabling for fracture of the right thumb distal phalanx (residuals of right thumb fracture) is remanded. The Veteran claims that he is entitled to an increased initial disability rating for his service-connected right thumb fracture at his distal phalanx because: he has a knot in the palm of his right hand that periodically locks up on him when doing simple tasks, including writing, opening jars, and using screwdrivers; there are days that he has limited or no use of his right hand; and he often awakes at night to a numb right hand; and knots on his right hand "would appear and leave over the years." See VA Form 9, Appeal to Board of Veterans' Appeals, received June 8, 2015. Thus, it appears that the Veteran is claiming entitlement to an increased evaluation of his right thumb disability due, in part, to its effects on, or related conditions affecting, other parts of his right hand. The Veteran, however, explicitly claimed only a right thumb disability, service connection was only granted for a right thumb disability, and none of the VA examinations diagnosed any disabilities or conditions outside of the service-connected right thumb fracture at the distal phalanx; nevertheless, the Board finds that this appeal for an increased disability rating for that right thumb disability also encompasses a claim for an increased rating based on effects of the right thumb disability on other parts of the hand, and one for service connection for any other right hand disabilities that are related to service or secondary to the right thumb disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009) (the Board must consider any disability that "may reasonably be encompassed by" a description of the claim, symptoms reported, and other evidence). While none of the VA examination reports/disability benefits questionnaires (DBQs) in the claims file indicate that there are any other right hand disabilities, they also do not explicitly indicate that there are no other such disabilities. In fact, to the contrary, during the July 2021 VA examination, the Veteran reported localized tenderness in his right thumbpad, and the examiner noted that the Veteran's capillary refill was abnormal in all fingers, thumbs, and upper extremities, and that the Veteran's nailbeds were purple. The examiner also noted that the Veteran reported numbness in both hands, all fingers, and his feet. The Veteran reported that he had an appointment with his VA primary care physician the following day and would follow up with the physician regarding his abnormal capillary refill. The VA treatment records in the claims file do not contain any record of the July 2021 primary care visit, but they do contain an August 2021 VA treatment note stating that the Veteran had a contracture on the palm of his right hand, in the "4th MC area." During the most recent VA examination in December 2021, the examiner indicated that the Veteran reported that his right hand/thumb will flare up if the thumb is overused. Considering the foregoing, the Board finds that this appeal must be remanded so that all outstanding VA treatment records can be obtained and so that the Veteran can be afforded another VA examination for the purpose of determining whether he has any other right hand disabilities, including a contracture on the palm of his right hand, and if so, whether it is at least as likely as not related to service or caused or aggravated by his service or service-connected right thumb disability. 2. Entitlement to a total disability evaluation based on individual unemployability due to service-connected disability (TDIU) is remanded. The Board finds that entitlement to TDIU is inextricably intertwined with the Veteran's claim of entitlement to an increased rating for his right thumb disability. See Tyrues v. Shinseki, 23 Vet. App. 166, 177 (2009) (en banc) (explaining that claims are inextricably intertwined where the adjudication of one claim could have a significant impact on the adjudication of another claim). As such, consideration of entitlement to TDIU must be deferred pending the outcome of the Veteran's claim of entitlement to an increased rating for his right thumb disability. Harris v. Derwinski, 1 Vet. App. 180, 183 (1991) (where a claim is inextricably intertwined with another claim, the claims must be adjudicated together in order to enter a final decision on the matter). The matters are REMANDED for the following action: 1. Obtain any updated or otherwise outstanding VA treatment records for the period from May 2013 to present. 2. Schedule the Veteran for a VA examination for his claimed right thumb and hand disability. The examiner must review the claims file, including but not limited to (a) the Veteran's VA treatment records, which evidence a contracture in the right palm; and (b) the Veteran's statements discussing symptoms including "knots" on his right palm and potentially other areas of the right hand. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinion(s) below. The examiner is asked to provide a response to the following: (a.) Is any disability of the right hand or fingers (other than the already service-connected right thumb fracture at the distal phalanx) at least as likely as not related to service, including any in-service right hand injuries? (b.) Is any disability of the right hand or fingers (other than the already service-connected right thumb fracture at the distal phalanx) at least as likely as not proximately due to the service-connected right thumb fracture at the distal phalanx? (c.) Is any disability of the right hand or fingers (other than the already service-connected right thumb fracture at the distal phalanx) at least as likely as not aggravated, i.e., worsened beyond its natural progression, by the service-connected right thumb fracture at the distal phalanx? (d.) If aggravation is found, provide the baseline manifestations and any increased manifestations due to the service-connected right thumb fracture at the distal phalanx. A complete rationale, with citation to appropriate medical principles, is requested. L. Baskerville Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board C. Banks, 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.