Citation Nr: 18140727 Decision Date: 10/05/18 Archive Date: 10/05/18 DOCKET NO. 16-27 488 DATE: October 5, 2018 REMANDED Entitlement to service connection for carpal tunnel syndrome is remanded. Entitlement to service connection for cubital tunnel syndrome is remanded. REASONS FOR REMAND The Veteran served on active duty service from July 1984 to August 2007. His awards and decorations include the Combat Action Ribbon This matter comes before the Board of Veterans’ Appeals (Board) on appeal from an April 2015 rating decision of the Department of Veterans Affairs (VA) Regional Office (RO) in Muskogee, Oklahoma. The Veteran was afforded a VA examination in April 2015 at which time the examiner opined that the Veteran’s carpal tunnel syndrome and cubital tunnel syndrome are less likely than not permanently aggravated or a result of any event or condition that occurred in service, to include any environmental hazards in Southwest Asia. He also stated that the disorders did not manifest within one year of service and were not caused or worsened by a service-connected disability. The examiner stated that both carpal tunnel syndrome and cubital tunnel syndrome are diagnosed conditions with known etiologies. Therefore, they are less than likely related to or caused by an undiagnosed illness due to service in Southwest Asia or environmental hazards therein. The examiner further explained that both cubital tunnel syndrome and carpal tunnel syndrome are etiologically related to entrapment of nerves due to fibrous tissue formation from either repetitive use or ergonomically incorrect posturing of the wrists and hands during repetitive use activity, and they are both correctable by surgical removal of the entrapment of the nerve involved. Nevertheless, the VA examiner did not address the Veteran’s contention that his military duties as a field artillery cannon crewman caused his carpal tunnel syndrome and cubital tunnel syndrome. See June 2016 VA Form 9. Therefore, the Board finds that an additional VA medical opinion is needed to determine the etiology of the claimed disorders. The matters are REMANDED for the following action: 1. The Agency of Original Jurisdiction (AOJ) should request the Veteran provide the names and addresses of any and all healthcare providers who have provided treatment for his carpal tunnel syndrome and cubital tunnel syndrome that are not already of record. After acquiring this information and obtaining any necessary authorization, the AOJ should obtain and associate these records with the claims file. The AOJ should also secure any outstanding VA treatment records. 2. After completing the preceding development, the Veteran should be afforded a VA examination to determine the nature and etiology of any carpal tunnel syndrome and cubital tunnel syndrome that may be present. Any and all studies, tests, and evaluations deemed necessary by the examiner should be performed. The examiner is requested to review all pertinent records associated with the claims file, including the Veteran’s service treatment records, post-service medical records, and assertions. The examiner should note that the Veteran is competent to attest to factual matters of which he had first-hand knowledge, including observable symptomatology. If there is a medical basis to support or doubt the history provided by the Veteran, the examiner should provide a fully reasoned explanation. The examiner should opine as to whether it is at least as likely as not that the Veteran has carpal tunnel syndrome and/or cubital tunnel syndrome that is causally or etiologically related to his military service, including his duties and any symptomatology therein. The Veteran has claimed that he developed the disorders in service as a result of repetitive stress from his duties as a field artillery cannon crewman. (The term “at least as likely as not” does not mean within the realm of medical possibility, but rather that the medical evidence both for and against a certain conclusion is so evenly divided that it is as medically sound to find in favor of such a conclusion as it is to find against it.) A clear rationale for all opinions would be helpful and a discussion of the facts and medical principles involved would be of considerable assistance to the Board. Because it is important “that each disability be viewed in relation to its history[,]” 38 C.F.R. § 4.1, copies of all pertinent records in the appellant’s claims file, or in the alternative, the claims file, must be made available to the examiner for review. 3. The AOJ should review the examination report to ensure that it is in compliance with this remand. If the report is deficient in any manner, the AOJ should implement corrective procedures. 4. After completing the above actions and any other development as may be indicated as a consequence of the actions taken in the preceding paragraphs, the case should be reviewed by the AOJ on the basis of additional evidence. J.W. ZISSIMOS Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D.S. Chilcote, Associate Counsel