HAND IMPAIRMENT OF

CORY M. PICTON · 2026 · Case ID: A26039761

MIXED

Summary

The veteran, who served in the U.S. Army from June 1968 to June 1970 as a Dental Laboratory Specialist, appeals the denial of service connection for a left hand disability and a left ankle fracture. The Board granted service connection for the left hand disability, finding that the veteran has a current diagnosis of mild degenerative changes with deformity at the base of the fourth metacarpal, consistent with an in-service fracture documented in service treatment records. The Board found the evidence to be in equipoise regarding the etiology of the left hand condition, resolving doubt in the veteran's favor. However, the claim for service connection for a left ankle fracture was remanded. The veteran contends he fractured his left ankle during service and has experienced chronic pain and alignment issues since. Service treatment records document a right ankle fracture in February 1970, but are silent regarding a left ankle fracture. Post-service records mention left ankle fractures on two separate occasions, but without dates. The Board found the July 2025 VA examiner's opinion inadequate, as it did not reconcile the veteran's reports of left ankle pain, the February 2016 treatment record, or the STRs documenting a right ankle fracture. The examiner also failed to address findings of osteopenia and osteoporosis, which could be relevant to fracture susceptibility. A remand is necessary for a new VA examination to clarify the nature and etiology of the ankle condition, reconcile competing evidence, and address the duty to assist error.

Rationale

Current diagnosis of mild degenerative changes and deformity; In-service fracture documented in STRs; Evidence in equipoise, doubt resolved in veteran's favor

Service Branch

ARMY

Special Benefit

NO SPECIAL BENEFIT

Docket No.

251007-595913

Full Decision Text

Citation Nr: A26039761
Decision Date: 04/28/26 Archive Date: 04/28/26

DOCKET NO. 251007-595913
DATE: April 28, 2026

ORDER

Entitlement to service connection for a left hand disability is granted.

REMANDED

Entitlement to service connection for an ankle fracture is remanded.

FINDING OF FACT

The Veteran's left hand disability began during service; or was shown as chronic in service and not attributable to intercurrent causes.

CONCLUSION OF LAW

The criteria for entitlement to service connection of a left hand disability were met. 38 U.S.C. §§ 1110, 1112, 1113, 1131, 5107; 38 C.F.R. §§ 3.303, 3.307, 3.309.

REASONS AND BASES FOR FINDING AND CONCLUSION

The Veteran had active service in the United States Army from June 1968 to June 1970 with military occupation specialty (MOS) of Dental Laboratory Specialist.

These matters come before the Board of Veterans' Appeals (Board) on appeal from an August 2025 supplemental claim decision issued by the Agency of Original Jurisdiction (AOJ), a Department of Veterans Affairs (VA) Regional Office (RO).

In the October 7, 2025, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the Veteran elected the Hearing docket. A Board hearing was held on January 16, 2026, before the undersigned Veterans Law Judge. Hence, the Board may only consider the evidence of record at the time of the August 2025 AOJ rating decision on appeal, as well as any evidence submitted by the Veteran (or representative) at the hearing or within 90 days following the hearing. 38 C.F.R. § 20.302(a). If evidence was submitted either (1) during the period after the AOJ issued the decision on appeal and prior to the Board hearing, or (2) more than 90 days following the hearing, the Board did not consider it in its decision. 38 C.F.R. §§ 20.300, 20.302(a), 20.801. However, because the Board is remanding the service-connection claim for a left ankle fracture, any evidence the Board could not consider will be considered by the AOJ in its adjudication of the claim. 38 C.F.R. § 3.103(c)(2)(ii).

Procedural History

On December 22, 2017, the Veteran filed an original claim seeking entitlement to service connection for a left ankle fracture with weakness and pain and left hand fracture of the 4th and 5th metacarpals with residual pain, weakness, and deformity of the knuckle. See VA Form 21-526EZ, dated Dec. 22, 2017. On March 12, 2018, the AOJ issued a decision, which denied the claim based on the evidence of record at that time. The Veteran did not file a substantive appeal and new and material evidence was not received within one year of its issuance. That decision is final. 38 U.S.C. § 7105; 38 C.F.R. § 20.1103.

Several years later, on July 15, 2025, the Veteran submitted a VA Form 20-0995, Decision Review Request: Supplemental Claim, and requested readjudication of issues most recently addressed in the prior final decision issued March 12, 2018. On August 18, 2025, the AOJ issued the supplemental claim decision on appeal, which found that new and relevant evidence had been received, but denied the claim based on the evidence of record at the time.

This appeal has been prioritized on the docket due to advanced age. See 38 U.S.C. § 7107(b); 38 C.F.R. § 20.800(c).

Entitlement to service connection for a left hand disability is granted.

The Veteran contends that he incurred a fracture of the left hand during service with residual pain, weakness, and deformity of the knuckle as a result. See VA Form 21-526EZ, Dec. 22, 2017.

Service connection may be granted for disability resulting from disease or injury incurred in or aggravated by active service. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. § 3.303. The three-element test for service connection requires evidence of: (1) a current disability; (2) in-service incurrence or aggravation of a disease or injury; and (3) a causal relationship between the current disability and
disability is granted.

The Veteran contends that he incurred a fracture of the left hand during service with residual pain, weakness, and deformity of the knuckle as a result. See VA Form 21-526EZ, Dec. 22, 2017.

Certain chronic diseases will be presumed related to service if they were shown as chronic in service; or, if they manifested to a compensable degree within a presumptive period following separation from service; or, if they were noted in service, with continuity of symptomatology since service that is attributable to the chronic disease. 38 U.S.C. §§ 1101, 1112, 1113, 1137; 38 C.F.R. §§ 3.303, 3.307, 3.309. Walker v. Shinseki, 708 F.3d 1331, 1338 (Fed. Cir. 2013).

The first element of service connection is met. The Veteran has a current diagnosis of mild degenerative changes of the left hand with mild deformity at the base of the fourth metacarpal. See VA Hand Surgery Consult Note, dated Aug. 16, 2023. Degenerative changes (i.e., arthritis) is an enumerated condition under 38 C.F.R. § 3.309(a); Walker, 708 F.3d 1331. The second element of service connection is also met. STRs dated January 13, 1970, show where the Veteran was diagnosed with a fracture at the base of the third and fourth metacarpal.

The issue is whether the Veteran has a current disability that was incurred in or caused by service.

The Board concludes that the Veteran has a current disability that began during service; or was shown as chronic in service and not attributable to intercurrent causes.

In August 2023, the Veteran was seen with complaints of chronic left hand and wrist pain. He stated that while in service, he had an injury to his left hand. "He was diagnosed with a left fourth metacarpal fracture and was placed in a cast. Unfortunately, the left fourth metacarpal shorten[ed] and it [has been causing] chronic pain and dysfunction in his left hand since that incident." CAPRI Record, dated Aug. 16, 2023.

As discussed, STRs showed where the Veteran was diagnosed with a fracture at the base of the third and fourth metacarpal, while VA treatment records noted that the fourth metacarpal has some mild deformity at the base, which may be consistent with an old/healed fracture. So, basically, the Veteran's current left hand deformity was observed in the same place where he fractured it during service. The Board finds this evidence highly probative.

Upon review of the record, the Board finds the evidence to at least be in equipoise as to whether the Veteran's current left hand disability began during service. At the same time, no intercurrent causes have been shown in this case. In either event, the third element of service connection is met. After resolving any reasonable doubt in the Veteran's favor, the Board finds that entitlement to service connection for a left hand disability is warranted. 38 U.S.C. § 5107; 38 C.F.R. § 3.102.

REASONS FOR REMAND

If the Board cannot grant the issue(s) in full, it must remand the appeal to the AOJ to correct any pre?decisional duty?to?assist error under 38 U.S.C. §?5103A. The Board may also remand to correct any other statutory or regulatory error by the AOJ if correction has a reasonable possibility of aiding in substantiating the appellant's claim. See 38 C.F.R. § 20.802.

Different examiners, at different times, will not describe the same disability in the same language. Features of the disability which must have persisted unchanged may be overlooked or a change for the better or worse may not be accurately appreciated or described. It is the responsibility of the rating specialist to interpret reports of examination in the light of the whole recorded history, reconciling the various reports into a consistent picture so that the current rating may accurately reflect the elements of disability present. Each disability must be considered from the point of view of the veteran working or seeking work. If a diagnosis is not supported by the findings on the examination report or if the report does not contain sufficient detail, it is incumbent upon the rating board to return the report as inadequate for evaluation purposes. 38 C.F.R. § 4.2; Barr v. Nicholson, 21 Vet. App. 303, 311 (2007) (holding that once the Secretary undertakes the effort to provide an examination when developing a service-connection claim, even if not statutorily obligated to do so, he must provide an adequate one or, at a minimum, notify the claimant why one will not or cannot be provided).

Entitlement to service connection for an ankle fracture is remanded.

The Veteran contends that he incurred a left ankle fracture during service.

My current condition right now is that my left ankle is the first bone that I broke in the military, and within 90 days I, because of my weak ankle, I broke my wrist, so the ankle was broken first on the left hand side, then my wrist was broken, those are the only two items that were broken on my body while in the military...

Hearing Transcript at 2-3, dated Jan. 16, 2026.

The Veteran also asserts that his left ankle continued to cause him problems since service.

I am constantly in chronic pain because of the alignment of that ankle being broken, up to my knee, you know, the foot bone connected to the knee bone, the ankle bone, the ankle bone connected to the leg bone, the leg bone, and I have the problem along the left side 90% of the time. That's all.

Id. at 6.

The issue is whether the Veteran has a current ankle disability that was incurred in or otherwise caused by service. However, the evidence of record is insufficient to make a fully-informed decision on the issue.

The Board concludes that remand is necessary to correct a pre-decisional duty to assist error and to obtain an adequate VA medical examination and opinion.

A new VA medical examination and opinion is required because the July 2025 VA examiner's opinion is based on an incomplete and (in part) inaccurate premise, and does not fully address the relevant evidence of record.

The record reflects competing and unresolved evidence regarding the nature and etiology of the Veteran's claimed left ankle disability. Service treatment records (STRs) document a right ankle fracture in February 1970, with notation that an ankle fracture remained under treatment at separation. STRs are silent for a left ankle fracture. As noted, the Veteran has since reported that he fractured the left ankle during service and has experienced chronic pain due to the alignment since that time.

Post-service treatment records include a February 2016 note reflecting that the Veteran "has broken the left ankle on 2 separate occasions," but the record does not identify when those injuries occurred. As such, it remains unclear whether the reported left ankle fractures are related to service, reflect post-service injuries, or represent a misidentification of the documented in-service right ankle fracture. Stated differently, the record raises the possibility of a laterality discrepancy, but does not resolve whether any such discrepancy reflects error in the medical record or in the Veteran's recollection.

The July 2025 VA examiner concluded that the Veteran did not have a current diagnosis associated with a left ankle fracture and further stated that the right ankle was an "undamaged joint." This opinion is inadequate for adjudication purposes. The examiner did not reconcile the Veteran's lay reports of chronic ankle pain and functional limitation, did not address the February 2016 treatment record reflecting a history of left ankle fractures, and did not acknowledge or reconcile the STRs documenting a right ankle fracture during service. Moreover, no imaging studies were performed or reviewed, despite the Veteran's reports of prior fractures and ongoing symptoms.

The Board also notes that VA radiologic studies of the spine document findings of osteopenia and osteoporosis. VA Radiologic Reviews, conducted May 27 & June 7, 2016.
not have a current diagnosis associated with a left ankle fracture and further stated that the right ankle was an "undamaged joint." This opinion is inadequate for adjudication purposes. The examiner did not reconcile the Veteran's lay reports of chronic ankle pain and functional limitation, did not address the February 2016 treatment record reflecting a history of left ankle fractures, and did not acknowledge or reconcile the STRs documenting a right ankle fracture during service. Moreover, no imaging studies were performed or reviewed, despite the Veteran's reports of prior fractures and ongoing symptoms.

The Board also notes that VA radiologic studies of the spine document findings of osteopenia and osteoporosis. VA Radiologic Reviews, conducted May 27 & June 7, 2016. These findings raise a medically relevant question as to whether the Veteran may have had underlying bone demineralization that could affect susceptibility to fractures and interpretation of his reported ankle fracture history. The July 2025 VA examiner did not address these findings or discuss whether they have any bearing on the nature and etiology of the claimed ankle condition. This omission further renders their opinion inadequate.

In sum, the absence of adequately responsive medical evidence in the claims file amounts to a pre-decisional duty to assist error that must be corrected. 38 C.F.R. § 20.802. To this end, entitlement to service connection for an ankle fracture is remanded.

The matter is REMANDED for the following action:

1. Schedule the Veteran for a VA examination to assess the nature and etiology of his ankle fracture(s). The examiner must review the claims file and identify all current disabilities of the ankles. To this end, any additional diagnostic testing should be obtained (e.g., imaging without contrast) if deemed necessary by the examiner. If a diagnosis cannot be provided but the Veteran's condition manifests in symptoms that cause functional impairment, then the examiner should consider them a "disability" for the purpose of providing the requested opinions below.

The examiner is asked to provide a response to the following:

(a.) Does the Veteran have a current ankle disability that is at least as likely as not related to service, including an undisplaced and closed fracture of the right medial malleolus with no artery or nerve involvement during service? See STR at 6, 8, 35.

(b.) Does he have a current ankle disability that is at least as likely as not related to service, including complaints of feet hurting at the bottom of arches while walking during service. See STR at 71.

(c.) Does he have a current ankle disability that is at least as likely as not related to service, including his medical history that he "slipped in one of the trainings, bottom of foot burst, walked sideways, putting pressure on the left ankle" vs. "[f]ractured the left ankle while skiing." See VA Examination at 3, dated Jul. 29, 2025.

(d.) Is it at least as likely as not that current a right and/or left ankle fracture (1) began during active service, (2) manifested within one year after discharge from service, or (3) was noted during service with continuity of the same symptomatology since service?

In providing the requested opinions, the examiner must consider the Veteran's description of the in-service injury and symptoms as well as post-service symptoms. If there is any medical reason to accept or reject the proposition that his reported injury and symptoms in service and thereafter represented the onset of the current disability, this should be noted. Stated differently, do the Veteran's reports about the symptoms align with how the currently diagnosed disability is known to develop or are they generally inconsistent with medical knowledge or implausible?

In providing the requested opinions, the examiner must address and reconcile the following:

Whether the record reflects a laterality error or discrepancy, and, if so, explain whether the Veteran's current reports are consistent with misidentification of the documented in-service right ankle fracture, a separate left ankle injury, or another etiology.

STRs documenting a right ankle fracture in February 1970 and notation at separation.

The absence of documentation of a left ankle fracture in STRs.

The Veteran's lay statements asserting that the in-service fracture involved the left ankle and the he has experienced chronic symptoms since service.

The February 2016 treatment record reflecting a history of left ankle fractures, without identified timing.

The examiner must address VA radiologic findings noting osteopenia and osteoporosis and discuss whether such conditions have any bearing on the Veteran's history of ankle fractures, including whether they suggest increased susceptibility to fracture during or after service. Compare STRs at 6, 8, 35, 71 with VA Radiologic Reviews, conducted May 27, and June 7, 2016.

2. A complete rationale is required for all conclusions, and if any opinion cannot be provided without resort to speculation, the examiner must explain why and identify what

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