Citation Nr: 1007269 Decision Date: 02/26/10 Archive Date: 03/05/10 DOCKET NO. 03-10 311 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Nashville, Tennessee THE ISSUES 1. Entitlement to service connection for a right wrist disability. 2. Entitlement to service connection for a left wrist disability. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD M. Riley, Associate Counsel INTRODUCTION The Veteran served on active duty from August 1977 to May 1985. This case comes before the Board of Veterans' Appeals (Board) on appeal from rating decisions issued by the Department of Veterans Affairs (VA) Regional Office (RO) in Nashville, Tennessee. In September 2005, the Board denied the Veteran's claims for entitlement to service connection for right and left wrist disabilities. The Veteran appealed this denial to the Court of Appeals for Veterans Claims (Court). In July 2006, the Court granted a Joint Motion for Remand filed by the parties requesting that the September 2005 decision be vacated and remanded. The appeal was returned to the Board where it was remanded for additional development in January 2007 and then denied in a December 2007 decision. The Veteran again appealed the denial of his claim to the Court, and in a September 2009 memorandum decision, the Court vacated and remanded the Board's December 2007 decision. The case has once again returned to the Board for further review. The appeal is REMANDED to the RO via the Appeals Management Center (AMC), in Washington, DC. VA will notify the appellant if further action is required. REMAND The Court's September 2009 memorandum decision found that the Board erred in its December 2007 decision by relying on a May 2007 medical opinion from a VA examiner. The May 2007 VA examiner diagnosed degenerative changes of both wrists and noted that degenerative arthritis could be related to acute trauma related to falls. The VA examiner concluded, however, that the current bilateral wrist arthritis was not related to active duty service as the Veteran did not recall falling on his wrists during service and service records did not document such a fall. Based in part on the opinion of the May 2007 VA examiner, the Board concluded in its December 2007 decision that the evidence did not establish the presence of a nexus between the Veteran's claimed disabilities and his military service. Although the May 2007 VA examiner stated, "As per the records and [V]eteran, he never sustaines (sic) any injury to his rt wrist while in service," a service treatment record dated January 20, 1981, refers to right shoulder pain "following direct blow last night when slipped and fell on stairs in barracks." A contusion of the right scapula was noted. A report of x-rays of the right shoulder on the same date indicates that there was no abnormality noted on x-ray and gave a pertinent history of "Fell on right shoulder last night. Now has abrasion and pain [with] external [rotation and] elevation of arm. R/O fx." The Court observed that the Board had not noted the discrepancy between the 2007 examiner's statement that the record did not contain evidence of a fall onto outstretched hands and the service treatment record documenting a 1981 slip and fall accident and injuries that the Veteran had suffered to the right side of his body, and concluded that the Board should have sought clarification from the medical examiner or explained why it was not needed. Upon remand, the claims folder should be returned to the May 2007 VA examiner to allow for clarification of the previously provided medical opinion with consideration of the Veteran's January 1981 fall. Accordingly, the case is REMANDED for the following action: 1. Return the claims folder to the VA examiner who performed the Veteran's May 2007 examination. If the previous examiner is not available, the claims folder and a copy of this remand should be provided to a physician with the necessary expertise to render a medical opinion in this case. The claims folder or copies of relevant evidence from the claims folder, and a copy of this remand must be made available to and be reviewed by the examiner. The examiner should review the claims folder and provide an addendum report that states whether, with consideration of the January 20, 1981, service treatment record, it is at least as likely as not (a 50 percent or better probability) that any currently present wrist disability is etiologically related to active duty service. The examiner should provide the full basis for any expressed opinion. If the May 2007 VA examiner is not available, the reviewing physician should proffer an opinion as to whether it is at least as likely as not (a 50 percent or better probability) that the Veteran's wrist disabilities are etiologically related to any incident of service including his January 1981 slip and fall accident and May 1979 motor vehicle accident. The rationale for any opinions should also be provided. 2. If the benefits sought on appeal are not fully granted, issue a supplemental statement of the case before returning the case to the Board, if otherwise in order. The appellant has the right to submit additional evidence and argument on the matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). This claim must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board of Veterans' Appeals or by the United States Court of Appeals for Veterans Claims for additional development or other appropriate action must be handled in an expeditious manner. See 38 U.S.C.A. §§ 5109B, 7112 (West Supp. 2009). _________________________________________________ Mary Gallagher Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board of Veterans' Appeals is appealable to the United States Court of Appeals for Veterans Claims. 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) (2009).