BVA9503795 DOCKET NO. 93-08 130 ) DATE ) ) On appeal from the decision of the Department of Veterans Affairs Regional Office in Huntington, West Virginia THE ISSUES 1. Service connection for arthritis of the right wrist. 2. Entitlement to an increased (compensable) evaluation for service-connected residuals of a fracture of the right fifth metacarpal. REPRESENTATION Appellant represented by: Disabled American Veterans ATTORNEY FOR THE BOARD K. Keyes, Associate Counsel INTRODUCTION The veteran served on active duty from December 1968 to May 1971. This matter comes before the Board of Veterans' Appeals (Board) from a December 1991 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Huntington, West Virginia, which denied service connection for arthritis of the right wrist and denied an increased (compensable) rating for residuals of the veteran's service-connected fracture of the right fifth metacarpal. REMAND The veteran contends that the RO committed error in denying his claims for service connection for arthritis of the right wrist and for an increased (compensable) disability rating for residuals of his service-connected fracture of the fifth metacarpal. He contends, in essence, that the arthritis of his right wrist, and the pain and weakness of grip in the right hand are secondary to injuries sustained to his hand in service. In this case, the Board notes that there is evidence of injuries to the right hand and arm before service and injuries to the right hand during service. At the time of his enlistment to active duty in November 1968, a four-inch scar on the palm of the veteran's right hand was noted by the examiner, and the veteran reported a history of a broken right arm which was shown by an August 1969 x-ray as a remote fracture of the ulnar styloid process. In August 1969, the veteran suffered an injury to his right hand when a tow chain was whipped across it. An x-ray revealed a fracture of the distal fifth metacarpal shaft with dorsal angulation. The veteran was treated with a short arm cast. In November 1970, the veteran reported that he had struck his right hand. The examiner noted abrasions on the back of the veteran's right hand and that the veteran had difficulty making a fist. An x-ray revealed no fracture, and the veteran's hand was treated with an ace wrap. There were no complaints pertinent to the right hand or arm on his separation examination, and the upper extremities were reported by the examiner as normal. In September 1980, the veteran complained of a loss of feeling in his hand, a weakening of his grip, arthritis, and pain along the ulnar aspect of his right hand. Upon VA examination, a slight deformity of the right fifth metacarpal was noted, but no limitation of motion of the right fingers or the right wrist was found. The diagnosis based on examination and x-ray findings was healed fracture of the right fifth metacarpal. In June 1991, the veteran submitted a private x-ray report of the right wrist which showed degenerative changes involving the articular surface of the distal radius and an old fracture of the ulnar styloid process. The private physician's impression was osteoarthritic changes involving the wrist joint. An October 1991 VA x-ray of the right hand revealed deformity of the fifth metacarpal with some swelling of the soft tissue about proximal interphalangeal joints and a small bony particle, about 1 by 3 millimeters in size, in soft tissue just proximal to the proximal interphalangeal joint of the little finger on the radial side which was most likely the residual of an old injury. No other findings could be seen in the hand. Joints were normal. VA examination in October 1991 revealed some limitation of motion of dorsiflexion and palmar flexion of the right wrist as compared to the left; supination and pronation unremarkable; tenderness to palpation along the 5th metacarpal; pain of metacarpal phalangeal joint of the third, fourth, and fifth digits; marked decreased grip on the right as compared to the left secondary to pain upon gripping and making a fist; ability to flex and extend all fingers and to touch them to the thumb; inability to touch the tip of the thumb to hypothenar eminence; and a positive Tinel's sign. The physician's diagnosis was status post fracture of the fifth metacarpal; possible early degenerative joint disease of the 3rd, 4th, and 5th digits; and possible carpal tunnel involvement. To ensure that VA has met its duty to assist the claimant in developing facts pertinent to the claim and is in full compliance with due process requirements, the case is REMANDED to the RO for the following developments: 1. The RO should schedule the veteran for VA special orthopedic and neurological examinations limited to the right upper extremity. The claims folder and a copy of this remand must be made available to and reviewed by the examiners prior to the examinations. The reports of examination should include a detailed account of all manifestations of right arm, wrist, hand, and finger pathology found to be present. All necessary tests should be conducted, and the examiners should review the results of any testing prior to completion of their reports. The examiners must provide diagnoses of all current right arm, wrist, hand, and finger pathology. In rendering diagnoses for current disorders of the right arm, wrist, hand, or fingers, the examiners must consider the medical evidence in the claims file pertinent to the injuries to the veteran's right arm and hand before service and during service, as well as the evidence of symptoms described and diagnoses rendered after service, that is pertinent to the right arm, hand, wrist and fingers. The examiners must consider the previous findings of other physicians who have examined the veteran and state whether their own findings are consistent with the previous medical findings and, if not, explain the distinctions between their findings and prior findings. Based on the findings upon examination and the review of the medical evidence in the claims file, the examiners must express an opinion as to the following matter: a.) What is the likelihood that the veteran's current right arm, wrist, hand, or finger disorder is the proximate result of the injuries sustained to his right hand in service as opposed to the injuries sustained to his right palm and right ulnar styloid process before service or to some other cause. The examiners must provide a comprehensive report including a complete rationale for all opinions and conclusions reached. 2. The RO must review the examination reports and determine whether they are adequate for rating purposes and in full compliance with this remand. If a report is not adequate for rating purposes, it must be returned to the examiner for correction. If the decision remains unfavorable following completion of these actions, the veteran and his representative should be provided with a supplemental statement of the case and afforded a reasonable period of time in which to respond. Thereafter, in accordance with the current appellate procedures, the case should be returned to the Board for completion of appellate review. No action is required of the veteran until further notice is issued. JOAQUIN AGUAYO-PERELES Member, Board of Veterans' Appeals The Board of Veterans' Appeals Administrative Procedures Improvement Act, Pub. L. No. 103-271, § 6, 108 Stat. 740, ___ (1994), permits a proceeding instituted before the Board to be assigned to an individual member of the Board for a determination. This proceeding has been assigned to an individual member of the Board. Under 38 U.S.C.A. § 7252 (West 1991), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Veterans Appeals. This remand is in the nature of a preliminary order and does not constitute a decision of the Board on the merits of your appeal. 38 C.F.R. § 20.1100(b) (1994).