Citation Nr: 18142253 Decision Date: 10/15/18 Archive Date: 10/15/18 DOCKET NO. 16-31 719 DATE: October 15, 2018 ORDER Entitlement to service connection for carpal tunnel syndrome (CTS) of the right hand is denied. REMANDED Entitlement to service connection for a respiratory or lung condition, to include chronic sinusitis, asthma, and allergic rhinitis, due to burn pit exposure in service, is remanded. FINDING OF FACT The preponderance of the evidence is against a finding that the CTS of the Veteran’s right hand began during a period of active service, or is otherwise related to an in-service injury, event, or disease. CONCLUSION OF LAW The criteria for service connection for CTS of the right hand have not been met. 38 U.S.C. §§ 1110, 1131, 5107(b); 38 C.F.R. §§ 3.102, 3.303(a). REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran had active service from June 1979 to July 1982 in the U.S. Army. He had subsequent service in the U.S. Army Reserve and Army National Guard (ARNG), including a period of active duty service from February 2003 to August 2004 in the Army Reserve, to include serving in Iraq from April 2003 to July 2004; and a period of active duty service from August 2007 to July 2008 in the ARNG, to include serving in Iraq from August 2007 through May 2008. The Veteran contends he has breathing problems due to in-service burn pit exposure. In a July 2014 rating decision, the RO initially characterized the issue as entitlement to service connection for “hard time breathing (now claimed as lung condition due to burn pit exposure in Iraq/Afghanistan)”. In a June 2016 rating decision, the RO recharacterized the issue as “chronic sinusitis, asthma, and allergic rhinitis (claimed as allergies and as sinus infect disease) (previously, hard time breathing (now claimed as lung condition due to burn pit exposure in Iraq/Afghanistan))”. Review of the record shows the Veteran has contended he has breathing/respiratory problems, a lung condition, sinus infection/disease, allergies, sinusitis, asthma, and allergic rhinitis, due to burn pit exposure. When a claimant makes a claim, he is seeking service connection for symptoms regardless of how those symptoms are diagnosed or labeled. Thus, the Board characterized the issue as set forth above. Clemons v. Shinseki, 23 Vet. App. 1 (2009). Entitlement to service connection for CTS of the right hand The Veteran contends that he has CTS of his right hand that is related to his active service and that he had a right carpal tunnel injury in service in Iraq in 2004 and 2007. Review of the record shows that service connection has been granted for CTS of the left hand, as service treatment records (STRs) show that he injured his left arm in service and that he thereafter underwent surgery for left CTS in November 2003. While the STRs show that he reported various symptoms including numbness and pain in the left hand/arm and that he underwent treatment for left CTS, there was no report or finding of right hand CTS or related right hand/arm symptoms during service. The question for the Board is whether the Veteran has a current disability that began during service or is at least as likely as not related to an in-service injury, event, or disease. In this regard, the Board concludes that, while the Veteran has a current diagnosis of CTS of his right hand, which he believes is related to his active service, the preponderance of the evidence weighs against finding that the CTS of his right hand began during active service or is otherwise related to active service. 38 U.S.C. §§ 1110, 1131, 5107(b); Holton v. Shinseki, 557 F.3d 1363, 1366 (Fed. Cir. 2009); 38 C.F.R. § 3.303(a), (d). VA treatment records show that the Veteran was not diagnosed with mild right CTS until July 2011, approximately three years after his separation from service. In June 2011, he reported having left hand, arm, and shoulder, weakness, pain, and decreased sensation that had been worsening since 2003, and that he now had symptoms in his right hand and arm. While the Veteran is competent to report having experienced symptoms of numbness and pain in his right hand since service, he is not competent to provide a diagnosis or to determine that these symptoms were manifestations of CTS of the right hand in service. The issue is medically complex, as it requires knowledge of and interpretation of diagnostic medical testing. Jandreau v. Nicholson, 492 F.3d 1372 (Fed. Cir. 2007). REASONS FOR REMAND Entitlement to service connection for a respiratory or lung condition, to include chronic sinusitis, asthma, and allergic rhinitis, due to exposure to burn pits, is remanded. The Veteran essentially contends that he has breathing problems due to burn pit exposure in service in Iraq. Service personnel records show that he served in Iraq from April 2003 to July 2004, and from August 2007 through May 2008. He also served in Afghanistan as a civilian contractor and was exposed to burn pits during that time. His contentions regarding environmental exposures during active service in Iraq, however, are competent and credible, and consistent with the circumstances of his active service. 38 U.S.C. § 1154(b); 38 C.F.R. § 3.304(d). Service treatment records (STRs) show that in April 2003 the Veteran complained of a productive cough and congestion and was treated for a viral syndrome. In March 2004, he complained of chest congestion and coughing for three weeks. He saw a provider 2 weeks earlier and received a Z-pak and inhaler; his symptoms cleared up after 3 days, but came back a week later. The assessment was allergic rhinitis, resolving bronchitis – RAD (reactive airway disease), and sinusitis. In July 2004, he complained of sore throat, breathing trouble, and a bad cough for 4 days. His lungs were slightly congested, with no wheezing. It was noted that he had been in country for 15 months and that this happened the same time last year when his lungs were slightly congested. The assessment included sinus infection. Further review of the record shows that the Veteran has reported experiencing, and has been treated for, various respiratory symptoms and conditions, during and since active service. He has also been treated for current disabilities, to include sinusitis, allergic rhinitis, bronchitis, asthma, and sinus infections. While there are medical opinions of record (a VA physician in 2014 and a VA examiner in 2016) regarding whether he has a current respiratory/lung condition related to the conceded burn pit exposure in service, for reasons set forth below, the Board finds these to be inadequate as they do not specifically address his contentions. Once VA undertakes to provide an examination in developing a service-connection claim, even if not statutorily obligated to do so, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303 (2007). In this regard, in 2014, a VA physician noted that, although the Veteran had extensive, prolonged, burn pit exposure, his symptoms were not consistent with constrictive bronchiolitis, but were mostly upper respiratory with rhinorrhea, post nasal drip, and sinus congestion. The physician did not opine as to whether these upper respiratory symptoms resulted in a condition related to burn pit exposure. Additionally, while the VA examiner in 2016 opined that the Veteran’s allergic rhinitis, sinusitis, and asthma were not related to his in-service exposures, the Board finds the rationale to be inadequate as it did not discuss sinusitis, and was primarily based on burn pit exposure not being a risk factor for rhinitis. Also, the VA examiner seemed to acknowledge the Veteran’s symptoms brought on by irritant-type exposures in service, but indicated these were non-specific and did not favor a diagnosis of asthma over other respiratory diseases, but did not address whether any other current respiratory diseases might be related to service. The matters are REMANDED for the following action: 1. With any assistance needed from the Veteran, obtain any recent pertinent VA or private treatment records, dated since February 2018. 2. Then, schedule the Veteran for a VA examination to determine the etiology of any current respiratory or lung condition(s). The entire claims file should be made available to the VA examiner. For each diagnosed respiratory or lung condition, to include sinusitis and allergic rhinitis, the examiner should opine as to whether the condition is at least as likely as not (i.e., 50 percent or greater probability) related to, or caused by, service, to include burn pit exposures in Iraq. The examiner must explain the rationale for all opinions given. If unable to provide any of the requested opinions without resorting to speculation, the examiner should so state and provide an explanation as to the reason(s) therefore. THERESA M. CATINO Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD D. Casula, Counsel