Citation Nr: 18140601 Decision Date: 10/03/18 Archive Date: 10/03/18 DOCKET NO. 11-27 908 DATE: October 3, 2018 REMANDED Entitlement to compensation under the provisions of 38 U.S.C. § 1151 for additional right wrist arthritis with long ulna and ulna impaction status post Darrach procedure and resurfacing in June 2010, is remanded.   REASONS FOR REMAND The Veteran was on active duty from April 1971 to March 1974. The Board remanded this appeal in March 2017 for additional development. 1. Compensation benefits under the provisions of 38 U.S.C. § 1151 for additional right wrist arthritis with long ulna and ulna impaction status post Darrach procedure and resurfacing in June 2010, is remanded. This issue is remanded for a new VA opinion and to obtain missing VA medical records. The Board previously remanded this matter in March 2017. The Board explained that a prior VA examiner, in March 2014, provided opinions that “were merely conclusory as no rationale was provided regarding the conclusions reached.” Upon remand, a second opinion was obtained in November 2017. The examiner, a Chief, Occupational Medicine/Comp and Pension, gave an opinion with supporting rationale as it pertained to the question of informed consent. Regarding the remaining questions, however, this VA examiner, as with the prior examiner, only provided conclusory opinions without supporting rationales. Of further concern, a different VA examiner reviewed the Veteran’s case in August 2017. That examiner, who was a Nurse Practitioner, concluded that he could not provide the requested opinion as it was beyond his scope of practice to address surgical matters. The examiner stated that the “request would be best addressed by an orthopedist or someone who has a background in orthopedic surgery.” It is not clear that the November 2017 VA examiner had these credentials. The examiner provided no foundation for his competence to address the questions. Thus, where the August 2017 VA examiner’s opinion established the need for a specific specialist and where it is not clear if the November 2017 VA examiner was such a specialist, the Board finds that the cannot, at present, rely on the November examiner’s opinion. See, e.g., Wise v. Shinseki, 26 Vet. App. 517, 527 (2014). Finally, the November 2017 VA examiner, in summarizing the Veteran’s claims file, commented that a physician’s note from a March 2010 Hand Surgery Visit was not available for review. Although the examiner did not identify this information as necessary or material in reaching an opinion, it should be obtained upon remand. See Jones v. Shinseki, 23 Vet. App. 382, 390 (2010). The matter is REMANDED for the following action: 1. Obtain the Veteran’s outstanding VA treatment records, including those prior to the June 2010 surgery, such as a physician’s note from a March 2010 Hand Surgery Visit. 2. Obtain a medical opinion from an orthopedist or other qualified clinician with a background in orthopedic surgery, to address the claim. The clinician should specifically address the following: (a.) Does the Veteran have “additional disability” caused by the June 2010 right wrist surgery? If so, the additional disabilities should be clearly identified. If there is no “additional disability,” then the clinician does not need to provide answers to (b) and (c) but must explain why the Veteran’s ongoing symptoms are not additional disability caused by the VA surgery. (b.) If the Veteran has an additional disability caused, is it at least as likely as not that the proximate cause of such disability or disabilities is carelessness, negligence, lack of proper skill, error in judgment or similar instance of fault on the part of VA? In determining whether the proximate cause of a disability was the result of carelessness, negligence, lack of proper skill, error in judgment, or similar instance of fault on the part of VA in furnishing hospital care, medical or surgical treatment, or examination, discuss if VA failed to exercise the degree of care that is expected of a reasonable health care provider. (c.) If the Veteran has an additional disability caused by the surgery, is it at least as likely as not that this additional disability was reasonably foreseeable as an ordinary risk of the treatment that would be disclosed in connection with the informed consent (primary health care provider explains the reasonably foreseeable risks associated VA treatment or services furnished the Veteran)? (Continued on the next page)   In answering all questions, it is imperative that the examiner explain the medical reasons underpinning every conclusion. That is, the examiner should (1) identify what facts and information, whether found in the record or outside the record, support each conclusion, and (2) explain how that evidence justifies the conclusion. C. BOSELY Acting Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD V. Woehlke, Associate Counsel