Citation Nr: 1304628 Decision Date: 02/08/13 Archive Date: 02/19/13 DOCKET NO. 10-38 774 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in St. Louis, Missouri THE ISSUES 1. Entitlement to service connection for carpal tunnel syndrome of the right arm. 2. Entitlement to service connection for carpal tunnel syndrome of the left arm. 3. Entitlement to service connection for a scar on the right elbow. REPRESENTATION Appellant represented by: Missouri Veterans Commission ATTORNEY FOR THE BOARD Cheryl E. Handy, Associate Counsel INTRODUCTION The Veteran, who is the appellant, served on active duty from June 1980 to May 1983 and from November 1991 to August 2002. This matter is before the Board of Veterans' Appeals (Board) on appeal of a July 2009 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in St. Louis, Missouri. 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 A VA examination or opinion is necessary if the evidence of record: (A) contains competent evidence that the Veteran has a current disability, or persistent or recurrent symptoms of disability; and (B) establishes that the Veteran suffered an event, injury or disease in service; (C) indicates that the claimed disability or symptoms may be associated with the established event, injury, or disease in service or with another service-connected disability, but (D) does not contain sufficient medical evidence for the Secretary to make a decision on the claim. 38 C.F.R. § 3.159(c)(4); See 38 U.S.C.A. § 5103A(d) (West 2002); McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). The Veteran's service treatment records show that he was seen on several occasions for pain involving his right and left arms, hands, and wrists. Specifically, he was treated in May 1986 for a right shoulder injury, in March 1996 for an injury to the left wrist, in January and February 1998 for epicondylitis vs. radial tunnel syndrome in the right arm, and in November 1997 and November 2000 for strained left trapezius muscle. Prior to service, the Veteran had a piece of wire surgically extracted from his right elbow at the age of four and later had sustained a fracture of his right hand. In addition, the Veteran is currently service-connected for the following: degenerative joint disease of the right shoulder with slight impingement; cervical spine disability; degenerative joint disease of the left shoulder, post surgery, with scars; and, right lateral epicondylitis with minimal degenerative joint disease. All of these service-connected disabilities may well be related to the symptoms and disabilities claimed by the Veteran and must be considered on examination. Indeed, there is evidence that the Veteran has undergone surgery on the right ulnar nerve, which may be related to the right elbow scar, which should also be addressed in the examination report. The Veteran has undergone surgery for carpal tunnel syndrome on the right arm, and his claim for a right elbow scar appears to be due to this surgery. He has reported that he has experienced symptoms in the right upper extremity ever since service; and that his physician had told him that the carpal tunnel syndrome was a kind of injury, often related to writing and typing. He points out that he performed such jobs for many years during service. The Veteran has not, as yet, been afforded a VA examination with respect to any of these claims. An examination is needed to clarify whether the post service carpal tunnel syndrome is related to service or the other service connected disabilities of the upper extremities. Based on the evidence of symptoms and incidents in service, the evidence of current disabilities, including surgical treatment of right arm carpal tunnel syndrome since service, and the possibility of a connection between service and current disabilities, including as due to aggravation by presently service-connected disabilities, the low threshold standard of McLendon is met and a VA examination is warranted on remand. Accordingly, the case is REMANDED for the following action: 1. Afford the Veteran a VA examination to determine whether it is at least as likely as not (probability 50 percent or greater) that his current right or left carpal tunnel syndrome, to include the resulting post-service right carpal tunnel release, was incurred in or aggravated by his military service, to include any of the incidents, injuries, or symptoms reported therein. The examiner should address the Veteran's contention that treatment he received in service for lateral epicondylitis was actually due to an improperly diagnosed carpal tunnel syndrome. The examiner should also address whether the Veteran's duties during service made him more susceptible to carpal tunnel syndrome. The examiner should address whether it is at least as likely as not (probability 50 percent or greater) that any single service-connected disability or any combination of these disabilities caused or aggravated the Veteran's right and/or left carpal tunnel syndrome. The currently service connected disabilities are: degenerative joint disease of the right shoulder with slight impingement; cervical spine disability; degenerative joint disease of the left shoulder, post surgery, with scars; and, right lateral epicondylitis with minimal degenerative joint disease. The examiner The examiner should provide reasons for these opinions. The examiner should review the claims file, including any relevant records stored in an electronic format. 2. The Veteran a VA examination to determine whether it is at least as likely as not (probability 50 percent or greater) that he has a current scar on his right elbow which is the result of an injury or disability which was incurred in or aggravated by his military service, to include right lateral epicondylitis. The examiner should indicate, to the extent possible, the dimensions and locations of any and all scars on the right elbow. The examiner should also indicate if multiple scars are present and the etiology of each scar identified. The examiner should provide the rationale for all opinions. The examiner should review the claims file, including any relevant records stored in an electronic format. 3. If any benefit sought on appeal remains denied, issue a supplemental statement of the case and return the case to the Board, if otherwise in order. The Veteran 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. 2012). _________________________________________________ Mark D. Hindin 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) (2012).