Citation Nr: 18145698 Decision Date: 10/29/18 Archive Date: 10/29/18 DOCKET NO. 17-46 381 DATE: October 29, 2018 ORDER Service connection for right wrist carpal tunnel syndrome (CTS) is granted. REMANDED Service connection for left wrist CTS and degenerative arthritis is remanded. Entitlement to a rating in excess of 10 percent for a right wrist disability, which now includes symptoms associated with CTS, is remanded. FINDING OF FACT The Veteran’s right wrist CTS is secondary to his service-connected wrist sprain and wrist arthritis. CONCLUSION OF LAW The criteria for service connection for right wrist CTS are met. 38 U.S.C. §§ 1110, 1131, 5107; 38 C.F.R. §§ 3.102, 3.303, 3.310. REASONS AND BASES FOR FINDING AND CONCLUSION The Veteran served on active duty from June 1961 to December 1990. These matters come before the Board of Veterans’ Appeals (Board) on appeal from the May 2014 and August 2016 rating decisions issued by a Department of Veterans Affairs (VA) Regional Office (RO). As it pertains to the claims for service connection for right and left wrist CTS, the Board notes that these issues were not certified to the Board. By way of procedural background, a May 2014 rating decision denied the claims for right and left wrist CTS and the Veteran filed a timely notice of disagreement in May 2015. Following a June 2016 statement of the case, the Veteran filed a substantive appeal in September 2016. The Veteran was notified that his substantive appeal was untimely; as such, the issues were not certified to the Board. Nonetheless, because the evidence supports a full grant of the benefit sought as it pertains to the claim for service connection for right wrist CTS, the Board is taking jurisdiction over that issue. Further, and in the interest of judicial efficiency, the Board is also taking jurisdiction of the claim for service connection for left wrist CTS (remanded herein). See Percy v. Shinseki, 23 Vet. App. 37, 45 (2009) (The filing of a substantive appeal is not a jurisdictional requirement and may be waived.). Notably, during the period between the June 2016 statement of the case and the September 2016 substantive appeal, the Veteran underwent a VA examination for his bilateral wrist disabilities and was provided a rating decision in August 2016. The Veteran also submitted medical evidence on his own behalf in August 2016 regarding his claims. Though his substantive appeal was received outside of the prescribed 60 day window, considering the fact that the Veteran underwent an examination, was provided a rating decision, and submitted evidence during this time, the Board finds the above summarized action to be the most fair to him. Service Connection Laws and Regulations Service connection may be granted for a disability resulting from disease or injury incurred in or aggravated by active military, naval, or air service. 38 U.S.C. § 1110; 38 C.F.R. § 3.303(a). Service connection may be granted for any disease diagnosed after discharge, when all the evidence, including that pertinent to service, establishes that the disease was incurred in service. 38 C.F.R. § 3.303(d). Establishing service connection generally requires (1) medical evidence of a current disability; (2) medical or, in certain circumstances, lay evidence of in-service incurrence or aggravation of a disease or injury; and (3) medical evidence of a nexus between the claimed in-service disease or injury and the present disability. Shedden v. Principi, 381 F.3d 1163, 1167 (Fed. Cir. 2004). Service connection may also be granted for a disability that is proximately due to or the result of a service-connected disability. See 38 C.F.R. § 3.310(a). The Veteran is already service connection for a right wrist strain with degenerative arthritis. See August 2016 rating decision. In a June 2017 VA addendum opinion, the examiner stated that “the most likely cause of his [the Veteran’s] right carpal tunnel syndrome that was surgically repaired is his history of trauma to the right wrist which led to the subsequent development of wrist pain and arthritis.” The examiner cited to medical literature and further noted that both chronic wrist sprains and wrist arthritis were well known within the medical community to cause CTS. The Board finds that this medical opinion weighs in favor of a finding that the Veteran’s CTS is secondary to his serviced-connected right wrist disability. There are no contradictory medical opinions of record. As such, service connection for right wrist CTS is granted. REASONS FOR REMAND Left Wrist The Veteran maintains that his left wrist CTS is related to service. Specifically, in his August 2017 substantive appeal, the Veteran reported that he served as a jet engine mechanic during service, which required repetitive use of tools resulting in damage to both wrists. The Board finds that a new VA medical opinion is required as the July 2016 VA examiner did not address the Veteran’s repetitive use of tools in service. Instead, the examiner noted that the Veteran’s service treatment records were silent for any left wrist complaints. In other words, the VA examiner provided a negative nexus opinion based solely on the lack of documentation of a left wrist disorder in service treatment records. See Dalton v. Nicholson, 21 Vet. App. 23 (2007) (examination was inadequate where the examiner did not comment on the Veteran’s report of in-service injury and instead relied on the absence of evidence in the service treatment records to provide a negative opinion). This is especially problematic since the Veteran reported bilateral wrist pain in service during the examination. For these reasons, the Board finds that a new examination is required. Rating for Right Wrist Disability The Veteran’s right wrist disability was previously rated under Diagnostic Code 5212, which allows for only a maximum 10 percent rating. As the Veteran’s claim for right wrist CTS has been granted herein (applicable Diagnostic Codes which allow for higher evaluations in excess of 10 percent), the Board finds that a remand is warranted in order to obtain a new VA examination addressing all symptoms, including those associated with CTS. The matter is REMANDED for the following actions: 1. Obtain any outstanding VA treatment records and associate them with the claims file. 2. Then, schedule the Veteran for a VA examination to address his bilateral wrist disorders, to include CTS and degenerative arthritis. All necessary tests should be conducted. The examiner is asked to address the following: (a.) State whether it is at least as likely as not (50 percent or greater probability) that the Veteran’s left wrist disorder (to include CTS) is related to service. The examiner must discuss the Veteran’s repetitive use of tools while serving as a jet engine mechanic in service. (b.) Perform all necessary neurological and range of motion testing to determine the current severity of the Veteran’s CTS disability (both wrists). Evan M. Deichert Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD R. Casadei, Counsel