Citation Nr: 18145854 Decision Date: 10/30/18 Archive Date: 10/30/18 DOCKET NO. 16-19 340A DATE: October 30, 2018 REMANDED Entitlement to service connection for a left upper extremity disability, to include carpal tunnel syndrome, is remanded for additional development. REASONS FOR REMAND The Veteran had active service with the U.S. Air Force from July 1978 to July 1982, and from June 1983 to July 1983. During this time, he was awarded the Air Force Good Conduct Medal. This matter comes to the Board of Veterans’ Appeals (Board) on appeal from a July 2015 rating decision issued by the Department of Veterans Affairs (VA) regional office (RO) in Oakland, California. Entitlement to service connection for a left upper extremity disability is remanded. While the Veteran has claimed entitlement to service connection for left wrist carpal tunnel syndrome, the Board notes that the record reflects various diagnostic impressions, including cervicalgia, radiculopathy, peripheral neuropathy, and carpal tunnel syndrome. See, e.g., May 2010 Rocklin Family Practice and Sports Medicine Office Visit Note (noting that the Veteran was restricted by the Air Force from performing push-ups and that he had a previous diagnosis of cervicalgia); March 2011 Informal Line of Duty Determination (diagnosing the Veteran with left hand ulnar radiculopathy and noting that he was injured while performing physical training testing); March 2011 Roseville Neurosciences Neurological Consultation (positing that the Veteran’s left upper extremity symptoms raise the question of peripheral neuropathy, as opposed to radiculopathy); April 2013 Rocklin Family Practice and Sports Medicine Progress Note (diagnosing the Veteran with left hand carpal tunnel syndrome as opposed to cervical radiculopathy). Because the scope of the Veteran’s disability claim includes any disability that may reasonably be encompassed by his description of the claim and reported symptoms and all other information of record, the Board finds that it is more appropriate to characterize his claim broadly, as a claim of entitlement to service connection for a left upper extremity disability. See Clemons v. Shinseki, 23 Vet. App. 1 (2009). In conjunction with the Veteran’s claim, he underwent a VA wrist examination in May 2016. See May 2016 VA Wrist Conditions Disability Benefits Questionnaire. The examiner opined that the Veteran’s left hand carpal tunnel syndrome was less likely than not related to his active service. Id. The examiner’s rationale for this determination was that he “could not find any STR or any ‘Statement of Medical Examination and Duty Status’ form related to either numbness to [the Veteran’s] left arm/hand, left shoulder or left wrist CTS prior to his visit with [his doctor] on 5/5/10 in the eFolder of VBMS.” Id. The medical opinion provided for the Veteran’s current left upper extremity disability is inadequate for the purposes of determining service connection. The VA examiner’s negative opinion was based solely upon the lack of contemporaneous service treatment records (STRs) in the evidentiary record. Nor did the opinion address the scope of the symptoms reported by the Veteran, including his statements regarding completing an obstacle course. See March 2011 Roseville Neurosciences Neurological Consultation (indicating that the Veteran had informed his doctor that prior to the onset of his left upper extremity condition that he had completed an obstacle course that involved climbing and hanging from ropes). Once VA undertakes the effort to provide a medical examination or opinion, it must provide an adequate one. Barr v. Nicholson, 21 Vet. App. 303, 311-12 (2007). An adequate medical opinion with regard to etiology should consist of a thorough review of the claims file and discussion of the relevant evidence (including the disability in question), a consideration of the lay contentions of the Veteran, and clear conclusions with a supporting rationale. Barr, 21 Vet. App. at 311; Stefl v. Nicholson, 21 Vet. App. 120, 123 (2007); Nieves-Rodriguez v. Peake, 22 Vet. App. 295, 301 (2008). The matter is REMANDED for the following action: 1. Send a letter to the Veteran requesting him to identify any relevant outstanding private treatment records and any other relevant evidence pertaining to his claims. He should be invited to submit this evidence himself or to request VA to obtain it on his behalf. Authorized release forms (VA Form 21-4142) should be provided for this purpose. 2. If the Veteran properly fills out and returns any authorized release forms for private records identified by him, reasonable efforts should be made to obtain such records and associate them with the VBMS virtual file. At least two such efforts should be made unless it is clear that a second effort would be futile. If attempts to obtain any records identified by the Veteran are not successful, he must be notified of this fact and all efforts to obtain them must be documented and associated with the claims file. 3. Obtain any additional outstanding VA treatment records for the Veteran and associate them with the claims file. All attempts to secure any identified records and any response received must be documented in the case file. 4. After any available records are associated with the claims file, schedule the Veteran for additional VA examinations in the appropriate specialty to determine the nature and etiology of the Veteran’s current left upper extremity disability. The examinations should include any diagnostic testing or evaluation deemed necessary. The electronic claims file must be made available for the examiner to review. The Veteran must be interviewed. It should be noted that the Veteran is competent to attest to matters of which he has first-hand knowledge, including observable symptomatology. The examiner must provide a clear explanation for the opinion, to include any comment on any credibility issues raised by the record from a medical perspective. Based upon a review of the entirety of the claims file, the history presented by the Veteran, and the examination results as to the Veteran’s left upper extremity disability, the examiner is requested to respond to the following inquiries: (a.) First, the examiner must provide diagnoses for all current and previously diagnoses for the Veteran’s left upper extremity found following a review of the entirety of the Veteran’s claims file. (b.) For each disorder identified, the examiner should state whether it is at least as likely as not (i.e. a 50 percent chance or greater) that the disorder manifested in service or is otherwise etiologically-related to the Veteran’s military service. If the VA examiner finds a left upper extremity disability is not etiologically-related to the Veteran’s military service, the examiner is asked to provide a clear rationale explaining their conclusion. Specifically, there must be a rationale which adequately connects data and conclusions (e.g. concluding that a diagnosis of cervicalgia is related to ongoing health concerns is not adequate unless there is a rationale which explains this assumption). The examiner must provide a complete rationale for all opinions expressed. As part of the rationale, the examiner should identify and explain the relevance or significance, as appropriate, of any history, clinical findings, medical knowledge or literature, etc., relied upon in reaching the conclusion(s). A discussion of the facts and medical principles involved would be of considerable assistance to the Board. If the examiner cannot provide the requested opinion without resorting to speculation, it must be so stated, and the examiner must provide the reasons why an opinion would require speculation. The examiner must indicate whether there was any further need for information or testing necessary to make a determination. The examiner must indicate whether an opinion could not be rendered due to limitations of knowledge in the medical community at large and not those of the specific examiner. 5. After completing the above development, the AOJ should review the claims file and ensure that all of the foregoing development actions have been conducted and completed in full. Stegall v. West, 11 Vet. App. 268, 271 (1998). 6. Thereafter, the AOJ should consider all of the evidence of record and readjudicate the claims for increased ratings. If the benefit sought is not granted, the AOJ must then issue a Supplemental Statement of the Case (“SSOC”) and allow the Veteran and his representative an opportunity to respond. 7. The appellant has the right to submit additional evidence and argument on the matter or matters the Board has remanded. Kutscherousky v. West, 12 Vet. App. 369 (1999). DAVID L. WIGHT Veterans Law Judge Board of Veterans’ Appeals ATTORNEY FOR THE BOARD S. Raj, Associate Counsel