Citation Nr: 22018490 Decision Date: 03/29/22 Archive Date: 03/29/22 DOCKET NO. 18-41 166 DATE: March 29, 2022 REMANDED Entitlement to service connection for a right hand disorder is remanded. Entitlement to service connection for a left hand disorder is remanded. REASONS FOR REMAND The Veteran served on active duty from November 1998 to November 2003. This matter comes before the Board of Veterans' Appeals (Board) on appeal from a January 2018 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO). In November 2021, the Veteran testified at a video-conference hearing before the undersigned Veterans Law Judge (VLJ). A transcript of that hearing has been associated with the claims file. The Board acknowledges that additional evidence was added to the claims file since the June 2018 Statement of the Case (SOC), to include updated VA treatment records. At the November 2021 Board hearing, the Veteran waived consideration of new evidence by the agency of original jurisdiction (AOJ). 38 C.F.R. § 20.1304(c). Therefore, the Board may properly consider this evidence. 1. Entitlement to service connection for a right hand disorder is remanded. 2. Entitlement to service connection for a left hand disorder is remanded. The Veteran asserts that his bilateral hand disorder, to include rheumatoid arthritis, is due to the physical requirements of his in-service military occupational specialty (MOS) of assault amphibious vehicle repairer/technician. Alternatively, he asserts that his rheumatoid arthritis is caused by his in-service MOS exposure to fuels, oils, and solvents. The Veteran also testified that he received non-VA treatment for his rheumatoid arthritis by Dr. Poole. See November 2021 Hearing Transcript. VA medical records indicate that VA has requested, and received, the Veteran's non-VA treatment records for his rheumatoid arthritis. See November 2021 Telephone Note (indicating a discussion regarding his outside primary care records). A review of the record reveals that those non-VA treatment records have not been associated with the claims file. On remand, appropriate efforts to obtain those records should be made. Additionally, a December 2021 statement by the Veteran's VA physician opined that his hand pain was at least as likely as not related to the Veteran's in-service excessive repeated use of his hands. See December 2021 Primary Care Letter. The letter did not specify whether the Veteran's hand pain was due to a specific diagnosis or resulted in functional impairment. See Davidson v. Shinseki, 581 F.3d 1313 (Fed. Cir. 2009) (establishing service connection requires a current disability); Saunders v. Wilkie, 886 F.3d 1356 (Fed. Cir. 2018) (holding that a disability for VA compensation purposes exists where pain causes functional impairment). Therefore, the Board finds that a remand is required to obtain a VA examination and opinion clarifying the nature of the Veteran's claimed bilateral hand disabilities. Finally, as this matter is being remanded, the Veteran's updated VA treatment records should be obtained. The matters are REMANDED for the following action: 1. Make arrangements to obtain the Veteran's VA treatment records, from February 2022, forward. Specifically request the non-VA medical treatment records from Dr. Poole of the University of Massachusetts Rheumatology Department, requested by VA on November 19, 2021. If the medical records from the University of Massachusetts are not available, contact the Veteran and request that he identify any outstanding records of pertinent medical treatment. Follow the procedures for obtaining the records, as set forth by 38 C.F.R. § 3.159(c), and obtain VA Form 21-4142 releases if necessary. If any outstanding records are unavailable, the Veteran should be notified in accordance with 38 C.F.R. § 3.159(e). The Veteran should also be informed that he may submit these records himself. 2. Thereafter, schedule the Veteran for a VA examination to determine the nature and etiology of any bilateral hand disorder. All necessary testing should be accomplished. The examiner should diagnose any current bilateral hand disability, to include rheumatoid arthritis and carpal tunnel syndrome. If no such disability is identified, the examiner must indicate whether the Veteran's reported bilateral hand pain causes any functional impairment. For any bilateral hand disability diagnosed, or if it is determined the Veteran's bilateral hand pain causes functional impairment, please opine as to the whether it is at least as likely as not (a 50 percent or greater probability) that such disability/functional impairment had its onset during the Veteran's service, or is otherwise etiologically related to the Veteran's service, to include his MOS duties and/or exposure to oils, fuels, and solvents. The examiner should consider and address the Veteran's statements regarding the onset and continuity of his hand pain, as well as his statements as to self-medicating with Motrin during service. See November 2021 Hearing Transcript. The examiner shoulder also consider and address the statements of the Veteran's fellow servicemember and sister attesting to the Veteran's hand symptomatology. See April 2017 S.L. Statement; April 2017 B. P. Statement. (Continued on the next page) The examiner should also consider and address the December 2021 statement by Dr. J. Nanra attributing the Veteran's bilateral hand pain to the excessive repeated use of his hands during active duty service. See December 2021 Primary Care Letter. A complete rationale should be given for all opinions and conclusions expressed. In the event the examiner cannot provide an opinion without resorting to speculation, it is essential that the examiner provide a rationale for this conclusion (e.g., lack of sufficient information/evidence, the limits of medical knowledge, etc.). P.M. DILORENZO Veterans Law Judge Board of Veterans' Appeals Attorney for the Board S. M. Stedman, 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.