Citation Nr: 1322450 Decision Date: 07/15/13 Archive Date: 07/24/13 DOCKET NO. 09-37 728 ) DATE ) ) On appeal from the Department of Veterans Affairs Regional Office in Muskogee, Oklahoma THE ISSUES 1. Entitlement to service connection for a left wrist disorder, to include carpal tunnel syndrome. 2. Entitlement to a disability evaluation in excess of 30 percent for right medial nerve neuralgia. 3. Entitlement to an initial compensable disability evaluation for bilateral hearing loss. REPRESENTATION Appellant represented by: Disabled American Veterans WITNESS AT HEARING ON APPEAL The Veteran ATTORNEY FOR THE BOARD S. Coyle, Counsel INTRODUCTION The Veteran served on active duty from June 1963 to August 1965. This matter is before the Board of Veterans' Appeals (Board) on appeal of a December 2008 rating decision of a Department of Veterans Affairs (VA) Regional Office (RO). The appeal initially included a claim for service connection for right ear hearing loss, which was granted by a January 2012 rating decision and combined with the pending appeal for a compensable disability evaluation for left ear hearing loss, and a claim for service connection for posttraumatic stress disorder, which was granted by an August 2012 rating decision. Thus, these issues are no longer before the Board. The claim for an increased rating for bilateral hearing loss has been recharacterized as shown on the title page. The claim for an increased rating for right medial nerve neuralgia has also been recharacterized, to comport with the evidence of record. A hearing on this matter was held before the undersigned Veterans Law Judge on May 8, 2013. A copy of the hearing transcript is of record. 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 Over two years have elapsed since the Veteran was last afforded a VA audiological examination. During his May 2013 hearing, the Veteran asserted that the symptomatology associated with his service-connected hearing loss has worsened since he was last examined. When a veteran claims that his condition is worse than when originally rated, and the available evidence is too old for an adequate evaluation of the veteran's current condition, VA's duty to assist includes providing a new examination. See Weggenmann v. Brown, 5 Vet. App. 281, 284 (1993). The Veteran must be afforded a VA examination for the purpose of ascertaining the current severity of his service-connected bilateral hearing loss. The Veteran also asserts that he has a left wrist disability, as a consequence of compensating for his service-connected right wrist disability. During a May 2008 VA examination, it was noted that the Veteran had adapted to using his left hand to compensate for his right wrist disability. An electrodiagnostic study conducted in September 2009 found that the Veteran has carpal tunnel syndrome in his left wrist. The Veteran must be afforded a VA examination for the purpose of ascertaining the etiology of any left wrist disability. According to recent VA clinical notes, the symptomatology associated with the Veteran's right medial nerve neuralgia may have worsened since the most recent examination of his right wrist in March 2011. Since December 2012, the Veteran has reported increased pain, numbness and tingling in the fingers of his right hand, as well as triggering of the third and fourth digits. The Veteran must be afforded a VA examination for the purpose of ascertaining the current level of severity of his right medial nerve neuralgia. A December 2012 VA clinical note states that the Veteran was treated for trigger finger at that facility in June 2011; however, there are no records of VA treatment for right medial nerve neuralgia from December 2011 to December 2012. Additionally, the Veteran filed a claim for VA vocational rehabilitation benefits in January 2011. All outstanding VA treatment records must be obtained and considered. Accordingly, the case is REMANDED for the following action: 1. Obtain all outstanding VA records since December 2011, as well as any vocational rehabilitation folder that may exist. 2. Schedule the Veteran for an audiology examination to determine the current severity and effect of his hearing loss on occupational functioning and daily activities. The entire claim file (i.e., the paper claim file and any medical records contained in Virtual VA, CAPRI, and AMIE) must be reviewed by the examiner. If the examiner does not have access to Virtual VA, any relevant treatment records contained in the Virtual VA file that are not available on CAPRI or AMIE must be printed and associated with the paper claim file so they can be available to the examiner for review. All required testing is to be accomplished. In addition to the objective test results, the examiner must fully describe the functional effects caused by the Veteran's hearing loss disability, including the extent to which his hearing loss decreases his functioning in terms of performing his daily activities (e.g. such as the ability to communicate effectively with other people), as well as the impact of the hearing loss on his occupational functioning. 3. Schedule the Veteran for a VA examination to assess the current severity of his service-connected right medial nerve neuralgia. The entire claim file (i.e., the paper claims file and any medical records contained in Virtual VA, CAPRI, and AMIE) must be reviewed by the examiner. If the examiner does not have access to Virtual VA, any relevant treatment records contained in the Virtual VA file that are not available on CAPRI or AMIE must be printed and associated with the paper claim file so they can be available to the examiner for review. All required testing is to be accomplished. The examiner is to identify all symptoms attributable to the Veteran's service-connected right medial nerve neuralgia and discuss the extent, if any, of paralysis of the nerves involved. A comprehensive report, including complete rationales for all conclusions reached, must be provided. 4. Schedule the Veteran for an examination of his left wrist by an appropriate medical professional. The entire claim file (i.e., the paper claim file and any medical records contained in Virtual VA, CAPRI, and AMIE) must be reviewed by the examiner. If the examiner does not have access to Virtual VA, any relevant treatment records contained in the Virtual VA file that are not available on CAPRI or AMIE must be printed and associated with the paper claim file so they can be available to the examiner for review. All required testing is to be accomplished. The examiner is to provide an opinion as to whether it is at least as likely as not (a 50 percent or greater probability) that any disability affecting the Veteran's left wrist, hand or fingers is related to service, or, alternatively, caused or aggravated by the service-connected right wrist disability. "Aggravation" means a permanent increase in the claimed disability; that is, an irreversible worsening of the condition beyond the natural clinical course and character of the condition due to the service-connected disability as contrasted to a temporary worsening of symptoms. The examination report must include a complete rationale for all opinions expressed. If the examiner feels that the requested opinion cannot be rendered without resorting to speculation, the examiner must state whether the need to speculate is caused by a deficiency in the state of general medical knowledge (i.e. no one could respond given medical science and the known facts) or by a deficiency in the record or the examiner (i.e. additional facts are required, or the examiner does not have the needed knowledge or training). 5. Then, readjudicate the appeal. If any of the benefits sought remains denied, issue a supplemental statement of the case and return the case to the Board. 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 case must be afforded expeditious treatment. The law requires that all claims that are remanded by the Board or by the United States Court of Appeals for Veterans Claims (Court) 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). _______________________________________________ RONALD W. SCHOLZ Veterans Law Judge, Board of Veterans' Appeals Under 38 U.S.C.A. § 7252 (West 2002), only a decision of the Board is appealable to the Court. 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).