Citation Nr: 1036089 Decision Date: 09/24/10 Archive Date: 09/30/10 DOCKET NO. 06-31 726A ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Petersburg, Florida THE ISSUES 1. Entitlement to a rating in excess of 10 percent for arthritis of the right knee. 2. Entitlement to service connection for right carpal tunnel syndrome. 3. Entitlement to service connection for left carpal tunnel syndrome. REPRESENTATION Appellant represented by: The American Legion ATTORNEY FOR THE BOARD B. Thomas Knope INTRODUCTION The Veteran served on active duty from January 1984 to March 1989 and from March 2003 to April 2004. This matter is on appeal from decisions in April 2006 and February 2007 by the Department of Veterans Affairs (VA) Regional Office (RO) in St. Petersburg, Florida. 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 Veterans Claims Assistance Act of 2000 (VCAA) describes VA's duty to notify and assist claimants in substantiating a claim for VA benefits. 38 U.S.C.A. §§ 5100, 5102, 5103(a), 5103A, 5107, 5126 (West 2002 & Supp. 2010); 38 C.F.R. §§ 3.102, 3.159, 3.326(a) (2009). In this case, the Board determines that further development is necessary before the merits of the claims may be addressed. First, with respect to his claim for an increased rating for his right knee disability, the Veteran indicated in his June 2007 VA Form-9 that this disability may have worsened since his most recent VA examination in November 2006. Specifically, he effectively stated that he was missing work at a higher frequency in 2007 than he had in 2006 due to his knee symptoms. Moreover, in his April 2007 Notice of Disagreement, he stated that he was scheduled to undergo additional surgery on his right knee "toward the end of summer." Unfortunately, the claims file does not include any treatment records since 2007, and there is no indication whether or not he actually underwent the planned surgery. However, given the Veteran's statements, it is reasonably likely that he underwent a surgical procedure since the most recent VA examination which would represent a material change in the condition of his knee. Therefore, given the Veteran's contentions that his knee is worse than it was at the time of his most recent VA examination (as indicated by the increased rate of days missed from work), in addition to the material changes likely to result from any surgical procedure to his knee, the Board determines that a new VA examination is necessary in order to ascertain the current extent of his right knee disability. See Snuffer v. Gober, 10 Vet. App. 400, 402-403 (1997); Caffrey v. Brown, 6 Vet. App. 377, 381 (1994); cf. VAOPGCPREC 11-95 (April 7, 1995). Next, with regard to the Veteran's claim for entitlement to service connection for bilateral carpal tunnel syndrome, the VA examiner who examined him in March 2007 opined that this disorder was "most likely" due to repetitive activities as part of his duties in the postal service, which the Veteran had been doing for over 10 years. However, this opinion requires additional clarification. Specifically, although the Veteran had been working as a postal employee for a long period of time (since prior to 1997, according to the VA examination), he stated that he did not experience wrist symptomatology until 2003, which was a year spent mostly on active duty. Moreover, when receiving treatment for this disorder in February 2005, the Veteran stated that he had been experiencing numbness in his wrists for only the last 3 to 4 months (or since approximately November 2004, and only months after he left active duty). In contrast, none of the treatment records from prior to when his active duty period began in March 2003 indicate any wrist symptomatology. Additionally, just prior to his separation, in January 2004, the Veteran reported having numbness and tingling in the hands and/or feet. The current opinion of record is not adequate. It does not appear to take into consideration the Veteran's lay statements as it pertained to the onset of his symptoms, which he claims began in 2003. Additionally, it does not appear to take into consideration the Veteran's complete history, including his history of working in service as a wheel vehicle mechanic, as well as the history noted on the January 2004 service record which shows that he reported having numbness and tingling of the hands/feet. Moreover, the examiner never addressed the question necessary for adjudication-whether it is at least as likely as not that bilateral CTS was due to/incurred in service. Accordingly, the case is REMANDED for the following action: 1. Obtain the Veteran's treatment records from the VA Medical Center in Miami, Florida, since February 2007. If the Veteran has undergone any private treatment to his knees since February 2007, the RO should also attempt to acquire these records after obtaining the Veteran's permission to do so. The Veteran should be asked whether he has undergone right knee surgery and if so, he should be asked to identify the physician/medical facility which performed such surgery. A record of any negative development should be included in the claims file. 2. Schedule the Veteran for another VA orthopedic examination to determine the current nature and severity of his right knee disability. The Veteran's claims folder must be made available to and reviewed by the examining physicians. All indicated tests and studies should be accomplished and the findings then reported in detail. Following the examination, the examiner should address the following: a) Describe all symptoms caused by the service-connected right knee disability, as well as the severity of each symptom. In this regard, range of motion studies should be conducted and the examiner should also address whether the right knee exhibits weakened movement, excess fatigability, or incoordination attributable to the service connected right knee disability and, if feasible, these determinations should be expressed in terms of the degree of additional range of motion loss due to any weakened movement, excess fatigability, or incoordination. Finally, the examiner should express an opinion on whether pain could significantly limit functional ability during flare-ups or when the right knee is used repeatedly over a period of time. This determination should also, if feasible, be portrayed in terms of the degree of additional range of motion loss due to pain on use or during flare-ups. b) The examiner should state whether there is any instability/subluxation of the knee and if so, the severity of such should be described as slight, moderate, or severe. c) The examiner should also state whether there is any cartilage, semilunar, dislocated, with frequent episodes of locking, pain, and effusion into the joint. The examiner must provide a comprehensive report by including a complete rationale for all opinions and conclusions reached and citing the objective medical findings leading to the conclusions. 3. The examiner who conducted the VA examination on the Veteran's carpal tunnel syndrome in March 2007 should be asked to provide an addendum to her report in order to provide an opinion as to whether it is at least as likely as not (at least a 50 percent probability) that the Veteran's bilateral carpal tunnel syndrome was incurred in service. In other words, the examiner should state whether the Veteran has CTS which is due to the Veteran's service from January 1984 to March 1989 and/or to his March 2003 to April 2004 service. In addressing the question above, the examiner should discuss the Veteran's January 2004 service record in which he gives a history of numbness and tingling of the hands and feet, his history of being a wheel vehicle mechanic in service, and his postservice history of having symptoms of CTS which first manifested in 2003. The examiner must provide a thorough reasons and bases for all opinions rendered and this rationale must include a discussion of the above. The claims file should be returned to the examiner for her review. However, a new VA examination is not required unless deemed necessary by the examiner or if the current examiner is no longer available. If the examiner is unable to render any of the requested opinions without resorting to speculation, a thorough reasons and bases should be set forth as to why such an opinion cannot be provided. 4. After completion of the foregoing, readjudicate the claims on appeal, to include entitlement to an increased rating for a right knee disability and entitlement to service connection for bilateral carpal tunnel syndrome. If any benefit sought remains denied, the Veteran and his representative must be furnished a supplemental statement of the case and be given an opportunity to submit written or other argument in response before the claims file is returned to the Board for further appellate consideration. The appellant has the right to submit additional evidence and argument on the matter or 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). _________________________________________________ K. OSBORNE 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).