Citation Nr: A25041257 Decision Date: 05/06/25 Archive Date: 05/06/25 DOCKET NO. 230329-335239 DATE: May 6, 2025 REMANDED Entitlement to service connection for right hand Dupuytren's contracture is remanded. Entitlement to service connection for left hand Dupuytren's contracture is remanded. REASONS FOR REMAND The Veteran served on active duty in the U.S. Air Force from July 1952 to January 1956. The rating decision on appeal was issued in March 2023 and constitutes an initial decision; therefore, the modernized review system, also known as the Appeals Modernization Act (AMA), applies. In the March 2023 VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Direct Review docket. In a decision of May 2023, the Board denied entitlement to service connection for right-hand and left hand Dupuytren's contracture. That determination was subsequently appealed to the United States Court of Appeals for Veterans Claims (Court) which, in an October 2024 Memorandum Decision, vacated the Board's May 2023 decision, and, in so doing, remanded the Veteran's case to the Board for action consistent with that Memorandum Decision. Specifically, the Court found that the Board provided inadequate reasons and bases for discounting the Veteran's lay statements with respect to the onset of his disorder and for finding that there was no pre-decisional duty to assist error in failing to order a new VA examination. Consequently, the Court remanded the matter back to the Board for re-evaluation of whether an examination is warranted in light of a re-evaluation of the Veteran's credibility. As a point of clarification, in this case, the Board may only consider the evidence of record at the time of the March 2023 agency of original jurisdiction (AOJ) decision on appeal. 38 C.F.R. § 20.301. Any evidence submitted after the AOJ decision on appeal cannot be considered by the Board. 38 C.F.R. §§ 20.300, 20.301, 20.801. However, because the Board is remanding the claims, any evidence the Board could not consider will be considered by the AOJ in the adjudication of those claims. 38 C.F.R. § 3.103(c)(2)(ii). The Board observes that the issue of entitlement to a service connection for bilateral hand Dupuytren's contracture was subsequently adjudicated in a July 2024 rating decision, which denied the Veteran's claims. This rating decision was not appealed, and it is not currently before the Board. To the extent that there was development associated with the July 2024 rating decision, the Board notes that it was not considered in this decision consistent with 38 C.F.R. § 20.301 as discussed above. Also, the Board notes that as of this writing, if the Veteran disagrees with the July 2024 rating decision, the Veteran still has time to appeal and may follow the instructions on the appeal rights given with the July 2024 decision in a July 26, 2024, notice letter. 1. Entitlement to service connection for right-hand Dupuytren's contracture is remanded. 2. Entitlement to service connection for left hand Dupuytren's contracture is remanded. The Veteran contends that his bilateral hand Dupuytren's contracture is due penicillin injection he received on active duty. Alternatively, the Veteran contends that his bilateral hand disorder is due to a motor vehicle accident sustained in-service. Service treatment records from July 1955 reveal that the Veteran was involved in a motor vehicle accident. In Novembre 1955, an Air Force investigation contained a Medical Report that noted normal upper extremities and a statement of no physical defects. A January 1956 separation examination reported that the Veteran's upper extremities were normal. Private treatment records from 1977 reveal that the Veteran reported that he first had difficulty with his hands in 1958, but did not experience any significant functional loss until 1964. In a July 1978 statement submitted by the Veteran, a fellow service member reported that the Veteran complained of itching and burning in his hands and that the Veteran also had a small bump or nodule on his hands. In an October 2018 VA examination, diagnoses of Dupuytren's contracture on both sides and further diagnosed bilateral hands, Dupuytren's contracture release surgery. The Veteran reported that his symptoms began in 1955. He further reported that the condition began from a shot for venereal disease in the summer of 1955. The Veteran described that the shot caused the palms of both hands to "break out" in extremely red, painful and itching, with pain up to first joint. The examiner did not render an etiological opinion with the examination. VA must provide an examination where the information and evidence of record does not contain sufficient competent medical evidence to decide the claim, but contains: (1) competent evidence of diagnosed disability or symptoms of disability, (2) establishes an event, injury or disease in-service, and (3) indicates that the claimed disability may be associated with the in-service event, injury, or disease. 38 C.F.R. § 3.159 (c)(4) (2019); McLendon v. Nicholson, 20 Vet. App. 79, 83-86 (2006) (noting that the evidence need only "indicates" that there "may" be a nexus between the current disability or symptoms and active service, including equivocal or non-specific medical evidence or credible lay evidence of continuity of symptomatology). Here, the Veteran has a current diagnosis of bilateral hand Dupuytren's contracture. Further, the Veteran has reported that his symptoms of a bilateral hand disability began during service, to include symptoms of itching and burning. Additional evidence confirms that the Veteran was involved in a motor vehicle accident during active service. As such, the evidence of record indicates that the Veteran's claimed bilateral hand Dupuytren's contracture may be associated with the events that occurred in-service. The Board finds that the October 2018 VA examination in inadequate to determine service connection because it lacks an etiological opinion. Given this deficiency, another VA examination is required with respect to the Veteran's service connection claim. See Barr v. Nicholson, 21 Vet. App. 303, 311 (2007); see also Bowling v. Principi, 15 Vet. App. 1, 12 (2001) (emphasizing the Board's duty to return an inadequate examination report "if further evidence or clarification of the evidence... is essential for a proper appellate decision"). Therefore, the Board finds that pre-decisional duty to assist error was committed because the October 2018 VA examination is inadequate. When the Board identifies a pre-decisional duty to assist error, under 38 U.S.C. § 5103A; 38 C.F.R. §§ 3.159(c), 20.802(a), the Board must remand the appeal back to the AOJ with instructions to correct the error. The matters are REMANDED for the following action: Schedule the Veteran with the appropriate VA examiner to determine the nature and etiology of the Veteran's bilateral hand Dupuytren's contracture. The entire electronic claims file must be reviewed, and such review must be documented in the report. The report should include discussion of the Veteran's documented medical history and assertions. All indicated tests should be accomplished and all clinical findings should be reported in detail and any earlier reports should be reconciled, if necessary. The examiner should opine as to whether the Veteran's bilateral hand Dupuytren's contracture is related to service. In rendering this opinion, the examiner must consider the Veteran's statements regarding the onset of his condition. Specifically, the examiner must address: i. Whether the Veteran's bilateral hand Dupuytren's contracture was caused by or is related to the motor vehicle accident sustained in-service. ii. Whether the Veteran's bilateral hand Dupuytren's contracture was caused by or is the result of antibiotic treatment, reported as penicillin, during service. iii. Whether the Veteran's reported symptoms of bilateral itchy hands and small nodule appearance were early symptoms or indications of bilateral hand Dupuytren's contracture. In offering any opinion, the examiner must consider the full record, to include the Veteran's lay statements of continuity of symptoms since service and may not disregard those statements merely because there was no treatment. The rationale for all opinions expressed must be provided and the examiner must clearly articulate the reasons for his or her conclusions. If an opinion cannot be provided without resort to speculation, it must be noted in the opinion report, and a rationale should be provided for that conclusion. Emily Tamlyn Veterans Law Judge Board of Veterans' Appeals Attorney for the Board K. Scanlan, 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.