Citation Nr: 22041545 Decision Date: 07/20/22 Archive Date: 07/20/22 DOCKET NO. 18-31 555 DATE: July 20, 2022 REMANDED Entitlement to service connection for left middle and ring finger conditions is remanded. REASONS FOR REMAND The Veteran served on active duty from February 1971 to June 1974. This matter comes to the Board of Veterans' Appeals (Board) from a September 2017 rating decision from a Department of Veterans Affairs (VA) Regional Office (RO) which denied service connection for left middle and ring finger conditions. The Veteran filed a timely Notice of Disagreement in February 2018, and a Statement of the Case was issued in April 2018. In June 2018, the Veteran submitted VA Form 9 and requested a hearing before a Veterans Law Judge (VLJ). In July 2018, the RO issued a Supplemental Statement of the Case. The Veteran testified before the undersigned VLJ at a February 2022 hearing. A copy of the transcript has been associated with the claims file. The Board notes that in his VA Form 9, the Veteran expressed disagreement with the issue addressed in the April 2018 statement of the case. However, he also wrote, "increased from 10% to 30% due to pain and loss of full use of left hand due to injury." The Board does not have jurisdiction over the claim of entitlement to an increased rating for the Veteran's left hand sprain. As such, this decision will only discuss whether the Veteran is entitled to service connection for left middle and ring finger conditions. Left middle and ring finger conditions The Veteran contends that his finger conditions are related to an in-service helicopter accident and alternatively, related to his service-connected left wrist injury. Service treatment records show a March 1973 consultation report indicating that "pain was (illegible) in AROM (active range of motion) for the fingers of the left hand." Post-service, VA treatment records show that the Veteran has had continued left wrist pain with decreased sensation of his left 3rd and 4th fingers. See March 2017 VA examination. The Veteran underwent a VA examination in September 2017 and was diagnosed with a left hand strain. The examiner opined that the Veteran's left middle and ring finger are less likely than not proximately due to or the result of his left wrist sprain. The examiner explained that in an October 2012 note, the Veteran had previously reported pain and swelling to his left hand 4th finger for 3 days, which was consistent with his current complaints of left hand 4th/ring finger pain. However, at that time, he had an assessment of paronychia, which is an infection of the skin folds around the fingernails, which was the cause of the Veteran's left hand symptoms. The examiner noted that the only other record in the file is the 1973 service treatment record for a left wrist ganglionectomy, with no mention of left hand symptoms of pain or weakness. The examiner concluded that a thorough review of the record does not indicate any objective evidence of a nexus between the Veteran's left middle and ring finger and his previously rated left wrist sprain. However, the examiner did not discuss aggravation of the Veteran's finger conditions by his service-connected left wrist disability. An opinion regarding secondary service connection is inadequate if it does not address both causation and aggravation of the nonservice-connected condition. Whenever VA undertakes to either provide an examination or to obtain an opinion, it must ensure that the examination or opinion is adequate. Barr v. Nicholson, 21 Vet. App. 303, 312 (2007). As the medical opinion is inadequate, a remand is necessary to obtain a new opinion. Additionally, an April 2022 private examination report from Tidewater Electromyography which indicates the Veteran has a moderate left median nerve impairment at the wrist level and moderate left ulnar nerve impairment at the medical across the elbow level. The report also noted an abnormal left median nerve digit III and an abnormal left median and ulnar digit IV. These findings shall also be assessed upon remand. The matters are REMANDED for the following action: Schedule the Veteran for a VA examination to determine the nature and etiology of his left middle and left ring finger conditions. Any indicated evaluations, studies, or tests deemed necessary by the examiner should be accomplished. The entire claims file, to include a complete copy of this remand, should be made available to the examiner, and the examination report should include a discussion of the Veteran's documented medical history and assertions. The examiner must answer the following questions (a.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's finger conditions were caused by, onset in, or otherwise related to active service, to include a helicopter accident? Why or why not? (b.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's finger conditions were proximately due to his service-connected left wrist injury? Why or why not? (c.) Is it at least as likely as not (a 50 percent probability or greater) that the Veteran's finger conditions were aggravated (worsened) by his service-connected left wrist injury? Why or why not? In answering these questions, the examiner must consider the Veteran's lay statements, to include his reports of an in-service helicopter accident, and the findings of the April 2022 private examination report from Tidewater Electromyography. SHAUN S. SPERANZA Veterans Law Judge Board of Veterans' Appeals Attorney for the Board J. R. Bobb, 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.