Citation Nr: 22018272 Decision Date: 03/28/22 Archive Date: 03/28/22 DOCKET NO. 17-29 520 DATE: March 28, 2022 ORDER Entitlement to service connection for a right hand disorder, other than service-connected residuals of boxer's fracture of the right hand, is denied. REMANDED Entitlement to service connection for residuals of a right forearm gunshot wound is remanded. Entitlement to service connection for lumbar degenerative disc disease is remanded. Entitlement to service connection for lumbar radiculopathy is remanded. FINDING OF FACT The evidence of record persuasively weighs against finding that the Veteran has a right hand disorder order, other than his currently service-connected residuals of boxer's fracture of the right hand's fifth metacarpal, which began during active service, or is otherwise related to an in-service injury or disease. CONCLUSION OF LAW The criteria for a right hand disorder, other than service-connected residuals of boxer's fracture of the right hand, have not been met. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1972 to June 1975 and from May 1976 to January 1980. This case is before the Board of Veterans' Appeals (Board) on appeal from an October 2014 rating decision by a Department of Veterans Affairs (VA) Regional Office (RO). The Veteran withdrew his Board hearing request in November 2019. See November 2019 Attorney Correspondence. The Board remanded the matters for additional development in February 2020 and October 2021. Now the matters are returned to the Board. The Veteran is seeking service connection for a right hand disorder. The Board notes that the Veteran is currently service-connected for residuals of boxer's fracture of the right hand's fifth metacarpal. See May 2, 2017 Rating Decision. Thus, the issue before the Board is whether the Veteran is warranted a separate service connection for a right hand disorder other than the boxer's fracture. A veteran is entitled to VA disability compensation if there is disability resulting from personal injury suffered or disease contracted in line of duty in active service, or for aggravation of a preexisting injury suffered or disease contracted in line of duty in active service. 38 U.S.C. §§ 1110, 1131 (2012). To establish an entitlement to service connection for a disability, a veteran must show: (1) a present disability; (2) an in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the present disability and the disease or injury incurred or aggravated during service, the so-called "nexus" requirement. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). In Gilbert v. Derwinski, 1 Vet. App. 49, 53 (1990), the United States Court of Appeals for Veterans Claims stated that "a veteran need only demonstrate that there is an 'approximate balance of positive and negative evidence' in order to prevail." When there is an approximate balance of positive and negative evidence regarding any issue material to the determination of a matter, VA shall give the benefit of the doubt to the claimant. 38 U.S.C. § 5107(b) (2012). To determine the current diagnosis and etiology of his right hand disorder, the Veteran underwent a VA examination for hand and finger conditions in November 2021. The November 2021 VA examiner noted the Veteran's diagnosis of residuals of boxer's fracture of the right hand's fifth metacarpal. The Veteran's history of a right hand injury during a fight in active duty was also noted. However, the examiner provided that all residuals found on examination were residuals of the boxer's fracture without any additional diagnosis. The Board notes that a different examiner from a November 2017 VA examination for hand and finger conditions reported the same findings. The November 2017 VA examiner provided that the X-rays dated November 28, 2017 showed widespread degenerative joint disease, but it was unrelated to the Veteran's old fifth metacarpal fracture. The examiner further stated that the boxer's fracture has healed without sequelae, and the Veteran's should not be service-connected for degenerative joint disease. Moreover, a March 2020 VA examiner provided that the Veteran's right hand injury as a result of a fight is separate from his pre-service injury from shotgun pellets (buck shot) to his right arm. See also July 17, 2019 Neurology Attending Note (right hand numbness at least in part due to neuropathies related to injury history). Based on the above, the evidence of record persuasively weighs against finding that the Veteran has a right hand disorder order, other than his currently service-connected residuals of boxer's fracture of the right hand's fifth metacarpal, which began during active service, or is otherwise related to an in-service injury or disease. Thus, the benefit-of-the-doubt doctrine does not apply here. Consequently, the Veteran's entitlement to service connection for a right hand disorder, other than service-connected residuals of boxer's fracture of the right hand, is not warranted. 38 U.S.C. §§ 1110, 1131, 5107 (2012); 38 C.F.R. §§ 3.102, 3.303 (2020). REASONS FOR REMAND Further, the Veteran is seeking service connection for residuals of a right forearm gunshot wound, lumbar degenerative disc disease, and lumbar radiculopathy. However, the Board finds that another remand is necessary prior to final adjudication. In regard to the Veteran's service connection claim for residuals of a right forearm gunshot wound, the Board notes that a new VA examination with medical opinion was obtained in November 2021. The November 2021 examiner opined that the claimed condition, which clearly and unmistakably existed prior to service, was clearly and unmistakably not aggravated beyond its natural progression by an in-service injury, event, or illness. However, the rationale provided for this opinion was only that "no aggravation beyond natural progression was found on examination or record." The Board finds this rationale to be inadequate as it does not include any discussion or explanation of the Veteran's reported right forearm symptoms since separation. Thus, an addendum opinion is required in order to make a fully informed decision on the matter. As to his service connection claim for lumbar degenerative disc disease, the Veteran contends that his gunshot wound has been aggravated by service and "causes severe lower back pain next to spinal column that pinches a nerve at times." See August 2014 Statement in Support of Claim. Thus, because a decision on the remanded issue of the Veteran's service connection claim for a right forearm gunshot wound could significantly impact decisions on the issues of lumbar degenerative disc disease and lumbar radiculopathy, the issues are inextricably intertwined. Consequently, a remand of the claims for lumbar degenerative disc disease and lumbar radiculopathy is also required. Accordingly, the matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) must obtain an addendum opinion from the November 2021 VA examiner regarding the Veteran's service connection claim for residuals of a right forearm gunshot wound. If the November 2021 VA examiner is not available, the requested opinion with rationale should be rendered by another appropriate medical professional. If the new examiner determines that an updated examination is necessary, the AOJ should schedule one for the Veteran. The examiner should review the Veteran's claims file and a copy of this REMAND order before rendering the requested addendum opinion. The examiner must opine whether it is clear and unmistakable (undebatable) that residuals of a right forearm gunshot was not aggravated by service. The examiner must provide a complete written rationale for any opinion rendered. The examiner is advised that the Veteran is competent to report his symptoms and history and such reports must be acknowledged and considered in formulating any opinion. If the examiner rejects the Veteran's reports, the examiner must provide an explanation for such rejection. 2. After completing the above actions and any other necessary development, the issues on appeal, including the inextricably intertwined issues of service connection claims for lumbar degenerative disc disease and lumbar radiculopathy, must be readjudicated. If the claims remain denied, a Supplemental Statement of the Case must be provided to the Veteran and his attorney. After the Veteran and his attorney have had an adequate opportunity to respond, the appeal must be returned to the Board for appellate review. MICHAEL LANE Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. E. Kim, 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.