Citation Nr: 18140570 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 12-32 381 DATE: October 3, 2018 REMANDED Service connection for a right wrist disability is remanded. Service connection for a left wrist disability is remanded. REASONS FOR REMAND The Veteran served on active duty from July 1978 to May 1983. This matter comes before the Board of Veterans’ Appeals (Board) on appeal from a February 2012 rating decision by the Department of Veterans Affairs (VA) Regional Office (RO) in Augusta, Maine. The Board remanded this case to the Agency of Original Jurisdiction (AOJ) in January 2015 for additional development. The case has since been returned to the Board for appellate review. The Board notes that, in April 2016, the Appellant submitted an Appointment of Veterans Service Organization as Claimant’s Representative (VA Form 21-22) that appointed Military Order of the Purple Heart as his representative. In May 2016, after certification of this appeal to the Board in September 2013, the Military Order of the Purple Heart withdrew its power of attorney for the Veteran for his VA claim, indicating that a copy of this letter had been forwarded to the Veteran. However, once an appeal has been certified to the Board, a representative may not withdraw without showing good cause through a written motion. See 38 C.F.R. § 20.608. No indication of the reasons for withdrawal of power of attorney for the Veteran was provided in this case. The Veteran has not revoked the Military Order of the Purple Heart’s power of attorney. As the Military Order of the Purple Heart has not made an appropriate motion to withdraw representation, as prescribed by 38 C.F.R. § 20.608, the Military Order of the Purple Heart submitted an informal hearing presentation in August 2018, and the Veteran has not appointed a new representative, the Military Order of the Purple Heart remains the appointed representative for the purposes of deciding this appeal. Failure to report to VA Examinations Under 38 C.F.R. § 3.655, when a claimant fails to report for an examination scheduled in conjunction with an original compensation claim, the claim shall be rated based on the evidence of record. VA regulations define an original claim as an initial application on a form prescribed by the Secretary. 38 C.F.R. § 3.160 (b). When a Veteran misses a scheduled VA examination, the Board must consider (1) whether the examination was necessary to establish entitlement to the benefit sought, and (2) whether the Veteran lacked good cause to miss the scheduled examination. See 38 C.F.R. § 3.655 (a); Turk v. Peake, 21 Vet. App. 565, 569 (2008). Examples of good cause include, but are not limited to, the illness or hospitalization of the claimant and death of an immediate family member. Id. In this case, an examination was necessary to establish entitlement to the benefits sought because the examinations were necessary to address the crucial question of nexus, or the etiology of the claimed disabilities. As explained by the January 2015 remand, the evidence of record was not sufficient to reach a decision on these issues. Regarding whether good cause was shown for the Veteran’s failure to report to his VA examination in August 2015, VA records do not reveal that the Veteran received notice of the scheduled examination. In August 2018, the Veteran’s representative asserted that the Veteran never was notified of the August 2015 wrist examination. There are multiple subsequent addresses of record. As the record does not establish that the Veteran was notified of the August 2015 examination, the Board finds that the Veteran failed to report for VA examinations with good cause. Service connection for a left wrist disability and a right wrist disability is remanded. The Board notes that the case was remanded in January 2015 in order to obtain additional clinical evidence. However, it does not appear from the record that the Veteran was notified of the scheduled examination. Treatment records from East Providence Medical Center and the Rhode Island Adult Correctional Institute contain competent evidence that the Veteran has been diagnosed with left and right wrist disabilities. See March 2010 East Providence Medical Center (diagnosing the Veteran with a left wrist sprain and left wrist mild degenerative joint disease); June 2005 Rhode Island Adult Correctional Institute (diagnosing the Veteran with right wrist carpal tunnel). Further, service treatment records (STRs) indicate that the Veteran complained of and was treated for symptoms related to the left and right wrists in service. See February 1983 Physical Profile (assessing wrist arthritis); February 1983 STRs (complaining of swollen and painful wrists). The record, however, lacks sufficient information to make a decision on the claim, as the Veteran has not yet been provided a VA examination and the Board lacks the medical expertise to determine the nature and etiology of any left or right wrist disability. McLendon v. Nicholson, 20 Vet. App. 79, 83 (2006). Therefore, the Board cannot make a fully-informed decision on the issue of left and right wrist disabilities because no VA examiner has opined whether the Veteran’s current right and left wrist disabilities are etiologically related his in-service complaints of swollen and painful wrists. The matters are REMANDED for the following action: 1. Schedule the Veteran for an examination by an appropriate clinician to determine the nature and etiology of any left or right wrist disability, including any degenerative joint disease or carpal tunnel syndrome. The examiner must opine whether it is at least as likely as not related to an in-service injury, event, or disease, including treatment for swollen and painful wrists (see February 1983 STRs). All opinions MUST consider the Veteran’s lay testimony regarding the onset and duration of his symptoms. See Transcript of Record pp. 3-12. Please provide the basis for any diagnosis and a complete medical rationale for any opinion. If medical literature is used, please provide a citation. If the examiner finds that an opinion cannot be rendered without resorting to speculation, the examiner MUST state whether the need to speculate is due to a deficiency in the state of general medical knowledge (no one could respond given medical science and the known facts), a deficiency in the record (additional facts are required), or by the examiner (does not have the knowledge or training). S. L. Kennedy Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD J. Costello, Associate Counsel